Journal Information
Vol. 99. Issue 3.
Pages 190-198 (April 2008)
Share
Share
Download PDF
More article options
Vol. 99. Issue 3.
Pages 190-198 (April 2008)
Practical dermatology
Full text access
Recurrent Vulvovaginitis: Diagnostic Assessment and Therapeutic Management
Vulvovaginitis de Repetición. Valoración Diagnóstica y Manejo Terapéutico
Visits
9997
A. Ramírez-Santos, M. Pereiro Jr
Corresponding author
manuelpe@usc.es

Correspondence: Departamento de Dermatología, Facultad de Medicina, San Francisco s/n, 15782 Santiago de Compostela, La Coruña, Spain.
, J. Toribio
Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, La Coruña, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract

Recurrent vulvovaginitis is a common problem in clinical practice. Management is often complicated by a long history of inappropriate treatments based on tentative diagnoses after an incomplete diagnostic workup. We review the most common causes of recurrent vulvovaginitis; the appropriate steps with which to establish a diagnosis, from the medical history through to the additional tests needed; and, finally, the best therapeutic options. We will focus on infectious, irritant, allergic, and hormonal causes as the ones of most interest to the dermatologist. Given that infection is the most frequent cause of these processes and also a common reason for inopportune treatment, we will pay particular attention to infectious etiologies and their differential diagnosis.

Key words:
vulvovaginal candidosis
Trichomonas
bacterial vaginosis
allergic vulvovaginitis
Resumen

Las vulvovaginitis de repetición son un problema común en la práctica clínica. El manejo de estas pacientes se complica a menudo con una larga anamnesis de tratamientos tan tentativos como inadecuados, ya que parten a menudo de un procedimiento diagnóstico incompleto. En este artículo revisamos las causas más frecuentes de estos cuadros, los pasos adecuados para establecer su diagnóstico, desde la anamnesis hasta las pruebas complementarias necesarias, y por último, las medidas terapéuticas oportunas. Nos centramos, por ser de mayor interés para el dermatólogo, en las de causa infecciosa, irritativa, alérgica y hormonal. Prestamos especial atención a los cuadros de etiología infecciosa y a su diagnóstico diferencial, por ser la causa más común de estos procesos y también frecuente motivo de tratamientos intempestivos.

Palabras clave:
vulvovaginitis candidiásica
Trichomona
vaginosis bacterianas
vulvovaginitis alérgica
Full text is only aviable in PDF
References
[1.]
H.L. Kent.
Epidemiology of vaginitis.
Am J Obstet Gynecol, 165 (1991), pp. 1168-1176
[2.]
M. Quan.
Vaginitis: meeting the clinical challenge.
Clin Cornerstone, 3 (2000), pp. 36-47
[3.]
P. Nyirjesy.
Chronic vulvovaginal candidiasis.
Am Fam Physician, 63 (2001), pp. 697-702
[4.]
A.G. Mulley.
Approach to the patient with a vaginal discharge.
Primary care medicine: office evaluation and management of the adult patient, pp. 702-707
[5.]
H. Mitchell.
ABC of sexually transmitted infections. Vaginal discharge-causes, diagnosis and treatment.
BMJ, 328 (2004), pp. 1 306-1308
[6.]
P.J. Say, C. Jachyntho.
Difficult-to-manage vaginitis.
Clin Obstet Gynecol, 48 (2005), pp. 753-768
[7.]
L. duBouchet, J.A. McGregor, M. Ismail, W.M. McCormack.
A pilot study of metronidazole vagina gel versus oral metronidzole for the treatment of Trichomonas vaginalis vaginitis.
Sex Transm Dis, 25 (1998), pp. 176-179
[8.]
L.O. Eckert.
Acute vulvovaginitis.
N Eng J Med, 21 (2006), pp. 1244-1252
[9.]
J.D. Sobel, P. Nyirjesy, W. Brown.
Tinidazole therapy for metronidazole resistant vaginal trichomoniasis.
Clin Infect Dis, 33 (2001), pp. 1341-1346
[10.]
P. Nyirjesy, J.D. Sobel, M.V. Weitz, D.J. Leaman, S.P. Gelone.
Difficult-to-treat trichomoniasis: results with paromomycin cream.
Clin Infect Dis, 26 (1998), pp. 986-988
[11.]
R.S. Patlman.
Recalcitrant vaginal trichomoniasis.
Sex Transm Infect, 75 (1999), pp. 127-128
[12.]
Sexually transmitted diseases treatment guidelines 2006. Center for Disease Control and Prevention MMWR Recomm Rep 2006; 55/RR11:49-56. (Accessed: 20-06-2007): Available from: http://www.cdc.gov/std/treatment/2006/rr5511.pdf.
[13.]
M.R. Joesoef, G.P. Schmid, S.L. Hillier.
Bacterial vaginosis: review of treatment options and potential clinical indications for therapy.
Clin Infect Dis, 28 (1999), pp. 57-65
[14.]
J.D. Sobel.
Bacterial vaginosis.
Annu Rev Med, 51 (2000), pp. 349-356
[15.]
J.D. Sobel, D. Ferris, J. Schwebke, P. Nyirjesy, H.C. Wiesenfeld, J. Peipert, et al.
Suppressive antibacterial therapy with 0,75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis.
Am J Obstet Gynecol, 194 (2006), pp. 1283-1289
[16.]
L. French, J. Horton, M. Matousek.
Abnormal vaginal discharge: what does and does not work in treating underlying causes.
J Fam Pract, 53 (2004), pp. 890-894
[17.]
L. Edwards.
The diagnosis and treatment of infectious vaginitis.
Dermatol Ther, 17 (2004), pp. 102-110
[18.]
J. Wilson.
Managing recurrent bacterial vaginosis.
Sex Transm Infect, 80 (2004), pp. 8-11
[19.]
W.M. McCormack Jr, S.H. Zinder, W.M. McCormack.
The incidence of genitourinary infections in a cohort of healthy women.
Sex Transm Dis, 21 (1994), pp. 63-64
[20.]
J.D. Sobel.
Vulvovaginal candidosis.
The Lancet, 369 (2007), pp. 1961-1971
[21.]
P. Giraldo, A. Von Nowaskonski, F.A. Gomes, I. Lindares, N.A. Neves, S.S. Witkin.
Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis.
Obstet Gynecol, 95 (2000), pp. 413-416
[22.]
P.L. Carr, D. Felsenstein, R.H. Friedman.
Evaluation and management of vaginitis.
J Gen Intern Med, 13 (1998), pp. 335-346
[23.]
J. Ferrer.
Vaginal candidosis: epidemiologic and etiological factors.
Int J Gynaecol Obstet, 71 (2000), pp. 21-27
[24.]
S. Hillier, J. Sobel.
Vaginal infections.
Atlas of sexually transmitted diseases & AIDS, pp. 159-179
[25.]
E.N. Ringdahl.
Treatment of recurrent vulvovaginal candidiasis.
Am Fam Physician, 61 (2000), pp. 3317
[26.]
P.L. Fidel Jr.
History and update on host defense against vaginal candidiasis.
Am J Reproductive Immunol, 57 (2006), pp. 2-12
[27.]
J. Spacek, V. Buchta.
Itraconazole in the treatment of acute and recurrent vulvovaginal candidiasis: Comparison of a 1-day and a 3-day regimen.
[28.]
P. Nyirjesy, S.M. Seeney, M.H. Grody, C.A. Jordan, H.R. Buckley.
Chronic fungal vaginitis: the value of cultures.
Am J Obstet Gynecol, 173 (1995), pp. 820-823
[29.]
S.S. Richter, R.P. Galask, S.A. Messer, R.J. Hollis, D.J. Diekema, M.A. Pfaller.
Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiologic of recurrent cases.
J Clin Microbiol, 43 (2005), pp. 2155-2162
[30.]
J. Holland, M.L. Young, O. Lee, C.A. Chen.
Vulvovaginal carriage of yeasts other than Candida albicans.
Sex Transm Infect, 79 (2003), pp. 249-250
[31.]
A. Spinillo, E. Capuzzo, R. Gulminetti, P. Marone, L. Colonna, G. Piazzi.
Prevalence of and risk factors for fungal vaginitis caused by non-albicans species.
Am J Obstet Gynecol, 176 (1997), pp. 138-141
[32.]
M.R. Miles, L. Olsen, A. Rogers.
Recurrent vaginal candidiasis. Importance of an intestinal reservoir.
JAMA, 238 (1977), pp. 1836-1837
[33.]
I.W. Fong.
The rectal carriage of yeast in patients with vaginal candidiasis.
Clin Invest Med, 17 (1994), pp. 426-431
[34.]
J. Schmid, M. Rotman, B. Reed, C.L. Pierson, D.R. Soll.
Genetic similarity of candida albicans strains from vaginitis patients and their partners.
J Clin Microbiol, 31 (1993), pp. 39-46
[35.]
J.A. Vázquez, J.D. Sobel, R. Demitriou, J. Vaishampayan, M. Lynch, M.J. Zervos.
Karyotyping of Candida albicans isolates obtained longitudinally in women with recurrent vulvovaginal candidiasis.
J Infect Dis, 170 (1994), pp. 1566-1569
[36.]
W. Magliani, S. Conti, A. Cassone, F. De Bernardis, L. Polonelli.
New immunotherapeutic strategies to control vaginal candidiasis.
Trends Mol Med, 8 (2002), pp. 121-125
[37.]
J. Spacek, P. Jilek, V. Buchta, M. Förstl, M. Hronek, M. Holeckova.
The serum levels of calcium, magnesium, iron and zinc in patients with recurrent vulvovaginal candidosis during attack, remission and in healthy controls.
[38.]
M.K. Owen, T.L. Clenney.
Management of vaginitis.
Am Fam Physician, 70 (2004), pp. 2125-2132
[39.]
A. Erdem, M. Cetil, T. Timuroglu, A. Cetil, O. Yanar, A. Pahsa.
Identification of yeasts in public hospital primary care patients with or without clinical vaginitis.
Aust N Z J Obstet Gynaecol, 43 (2003), pp. 312-316
[40.]
E.M. de León, S.J. Jacober, J.D. Sobel, B. Foxman.
Prevalence and risk factors for vaginal candida colonization in women with type 1 and type 2 diabetes.
BMJ Infect Dis, 2 (2002), pp. 1-4
[41.]
G.G. Donders, H. Prenen, G. Verveke, R. Reybrouk.
Impaired tolerance for glucose in women with recurrent vaginal candidosis.
Am J Obstet Gynecol, 187 (2002), pp. 989-993
[42.]
D. Bluestein, C. Rutledge, L. Lumsden.
Predicting the ocurrence of antibiotic-induced candidal vaginitis.
Fam Pract Res, 11 (2001), pp. 319-326
[43.]
R.P. Galask.
Vaginal colonization by bacteria and yeast.
Am J Obstet Gynecol, 158 (1988), pp. 993-995
[44.]
D. Hellberg, B. Zdolsek, S. Nilsson, P.A. Mardh.
Sexual behavior of women with repeated episodes of vulvovaginal candidiasis.
Eur J Epidemiol, 11 (1995), pp. 575-579
[45.]
C. Goplerud, M. Ohm, R. Galask.
Aerobic and anaerobic flora of the cervix during pregnancy and the puerperium.
Am J Obstet Gynecol, 126 (1976), pp. 858-868
[46.]
N.A. Neves, L.P. Ábralo, M.A.M. De Oliveira, P.C. Giraldo, O. Bacellar, A.A. Cruz, et al.
Association between atopy and recurrent vaginal candidiasis.
Clin Exp Immunol, 142 (2005), pp. 167-171
[47.]
J.L. Rhoads, D.C. Wright, R.R. Redfield, D.S. Burke.
Chronic vaginal candidosis in women with human immunodeficiency virus infection.
JAMA, 257 (1987), pp. 3105-3107
[48.]
P.L. Fidel, J.D. Sobel.
Immunopathogenesis of recurrent vulvovaginal candidiasis.
Clin Microbiol Rev, 9 (1996), pp. 335-348
[49.]
G. Ventolini, M. Baggish.
Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.
[50.]
M.J. Goldacre, B. Watt, N. Loudon, L.J. Milne, J.D. Loudon, M.P. Vessey.
Vaginal microbial flora in normal young women.
BMJ, 1 (1979), pp. 1450-1455
[51.]
J. Marazzo.
Vulvovaginal candidiasis.
BMJ, 325 (2002), pp. 586-587
[52.]
S.E. Reef, W.C. Levine, M.M. McNeil, S. Fisher-Hoch, S.D. Holmberg, A. Duerr, et al.
Treatment options for vulvovaginal candidiasis, 1993.
Clin Infect Dis, 20 (1995), pp. 80-90
[53.]
J.D. Sobel.
Vulvovaginitis. When Candida becomes a problem.
Dermatol Clin, 16 (1998), pp. 763-768
[54.]
A.B. Williams.
Gynecologic care for women with HIV infection.
JOGNN, 32 (2003), pp. 87-93
[55.]
J.D. Sobel, S. Faro, R.W. Force, B. Foxman, W.J. Ledger, P.R. Nyirjesy, et al.
Vulvovaginal candidiasis. Epidemiologic, diagnostic, and therapeutic considerations.
Am J Obstet Gynecol, 178 (1998), pp. 203-211
[56.]
I.W. Fong.
The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketokonazole.
Genitourin Med, 6 (1992), pp. 174-176
[57.]
E.W. Cross, S. Park, D.S. Perlin.
Cross-resistance of clinical isolates of Candida albicans and Candida glabrata to over-the-counter azoles used in the treatment of vaginitis.
Microb Drug Resist, 6 (2000), pp. 155-161
[58.]
J.D. Sobel, W. Chaim, V. Nagappan, D. Leaman.
Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine.
Am J Obstet Gynecol, 189 (2003), pp. 1297-1300
[59.]
D.J. White, A. Vanthuyme.
Vulvovaginal candidiasis.
Sex Transm Infect, 82 (2006), pp. 28-30
[60.]
M.E. Falagas, G.I. Betsi, S. Athanasiou.
Probiotics for prevention of recurrent vulvovaginal Candidiasis: a review.
J Antimicrob Chemother, 58 (2006), pp. 266-272
[61.]
L.J. Cibley, L.J. Cibley.
Cytolytic vaginosis.
Am J Obstet Gynecol, 165 (1991), pp. 1245-1249
[62.]
B.J. Horowitz, P.A. Mardl, E. Nagy, E.L. Rank.
Vaginal lactobacillosis.
Am J Obstet Gynecol, 170 (1994), pp. 857-861
[63.]
P.S. Moraes, E.A. Taketomi.
Allergic vulvovaginitis.
Ann Allergy Asthma Immunol, 85 (2000), pp. 253-265
[64.]
H.M. Ramírez de Knott, T.S. McCormick, S. Oshtory Do, W. Goodman, M.A. Ghannoum, K.V. Cooper, et al.
Cutaneous hypersensitivity to Candida albicans in idiopathic vulvodynia.
Contact Dermatitis, 53 (2005), pp. 214-218
[65.]
P. Marren, F. Wojnarowska, S. Powell.
Allergic contact dermatitis and vulvar dermatoses.
Br J Dermatol, 126 (1992), pp. 52-56
Copyright © 2008. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?