Vaginitis is the most common gynecologic diagnosis in the primary care sett
ing. In approximately 90 percent of affected women, this condition occurs s
econdary to bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis
. Vaginitis develops when the vaginal flora has been altered by introductio
n of a pathogen or by changes in the vaginal environment that allow pathoge
ns to proliferate. The evaluation of vaginitis requires a directed history
and physical examination, with focus on the site of involvement and the cha
racteristics of the vaginal discharge. The laboratory evaluation includes m
icroscopic examination of a saline wet-mount preparation and a potassium hy
droxide preparation, a litmus test for the pH of vaginal secretions and a "
whiff" test. Metronidazole is the primary treatment for bacterial vaginosis
and trichomoniasis. Topical antifungal agents are the first-line treatment
s for candidal vaginitis.