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Category: Gynecology

VULVOVAGINITIS

VULVOVAGINITIS

I hear trainees express diffidence about the clinical diagnosis of vaginitis in the emergency department.  While our bedside diagnostic certainty might be limited, studies suggest that it is limited for the specialists as well.  In fact, even after testing for pH, amines, and wet preparation microscopy, 30% of patients remain undiagnosed (Lowe 2009).   Thus, judgment is required.   The initial differential diagnosis centers on the three most common conditions, bacterial vaginosis, candidiasis, and trichomoniasis.  The treatment for the first…

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