Diagnosis of vaginitis

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.