Bacterial vaginosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Sara Mehrsefat, M.D. [2]

## Overview[edit | edit source]

Bacterial vaginosis must be differentiated from other diseases that cause purulent, malodorous, thin vaginal discharge with elevated vaginal pH (<4.5). Such diseases include trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. Additionally, bacterial vaginosis also must be differentiated other conditions such as vaginal candidiasis, vaginitis, and cervicitis.[1][2][3][4][5]

## Differential Diagnosis[edit | edit source]

A diagnosis of bacterial vaginosis is unlikely in the absence of the following findings:

* Fishy odor (negative whiff test)
* Normal vaginal pH (<4.5)
* Presence of dysuria
* Signs of vaginal inflammation

Bacterial vaginosis must be differentiated from:[1][2][3][4][5]

Disease | Findings

|

Trichomoniasis |

* Presents with purulent, malodorous, thin discharge associated with burning, pruritus, and dysuria, with the sign of vaginal inflammation and elevated vaginal pH (>4.5)
* Motile trichomonads on wet mount
* Positive culture (Gold standard)
* Positive nucleic acid amplification test (NAAT)

Atrophic vaginitis |

* Progressive symptoms
* Presents with yellow and malodorous vaginal discharge, vaginal dryness, postcoital bleeding, and dyspareunia with the sign of vaginal inflammation and elevated vaginal pH (>5)
* Diagnosis is critical and laboratory tests can confirm hypoestrogenic state

Desquamative inflammatory vaginitis |

* Chronic clinical syndrome with unknown etiology
* Presents with dyspareunia, dyspareunia, yellow, grey, or green profuse vaginal discharge with the sign of vaginal inflammation and elevated vaginal pH (>4.5)
* Microscopy shows large number of parabasal (immature squamous epithelial cells) and inflammatory cells

Vaginal candidiasis |

* Presents with vulvar pruritus and cottage cheese-like vaginal discharge with no or minimal odor with normal vaginal pH (4-4.5)
* presence of Candida on wet mount (adding 10% KOH destroys the cellular elements and facilitates recognition of budding yeast, pseudohyphae, and hyphae)

## References[edit | edit source]

1. ↑ 1.0 1.1 Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016
2. ↑ 2.0 2.1 Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
3. ↑ 3.0 3.1 Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB; et al. (1988). "Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens". JAMA. 259 (8): 1223–7. PMID 2448502.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ 4.0 4.1 Sobel JD, Reichman O, Misra D, Yoo W (2011). "Prognosis and treatment of desquamative inflammatory vaginitis". Obstet Gynecol. 117 (4): 850–5. doi:10.1097/AOG.0b013e3182117c9e. PMID 21422855.CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK (1998). "Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm". Obstet Gynecol. 92 (5): 757–65. PMID 9794664.CS1 maint: Multiple names: authors list (link)

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