Acute vaginitis

Disease Description (Causes and Symptoms)

• Definition: Acute vaginitis is a condition in which acute inflammation develops in the vaginal mucosa due to an imbalance of microorganisms in the vagina or an infection. Depending on the cause, it is classified as bacterial vaginosis (BV), trichomoniasis, candidal (fungal) vaginitis, senile (atrophic) vaginitis, and others.
• Pathophysiology: The normal vaginal acidity (pH approximately 3.8–4.5) and beneficial bacteria (mainly Lactobacillus) should be maintained. However, sexual intercourse, douching, antibiotics, hormonal changes (menopause, oral contraceptives, etc.), diabetes, and other factors can disrupt the microbial balance, leading to the proliferation of pathogenic organisms or inflammation.
• Main symptoms:
  • Abnormal vaginal discharge (changes in color, amount, or odor) — thin gray discharge with a fishy odor (BV), abundant frothy yellow-green discharge (trichomoniasis), thick white curd-like discharge (candidiasis)
  • Pruritus (itching), burning sensation
  • Pain during sexual intercourse, burning during urination (urethral irritation)
  • In some cases, redness, swelling, and foul odor

Treatment Methods

• Principles: Pathogen-targeted treatment according to the cause + symptom relief + correction of causes (lifestyle improvement).
• Medication after diagnosis (representative standard treatments; adjusted according to regional guidelines and clinical circumstances)
  • Bacterial vaginosis (BV)
    • Oral metronidazole 500 mg twice daily for 7 days
    • Or metronidazole vaginal tablet/gel 0.75% intravaginally once daily for 5 days
    • Or clindamycin vaginal cream 2% intravaginally once daily for 7 days
  • Trichomoniasis
    • Oral metronidazole 2 g as a single dose (alternative: metronidazole 500 mg twice daily for 7 days)
    • Concurrent treatment of sexual partners is recommended
  • Candidal vaginitis (non-albicans Candida)
    • Oral fluconazole 150 mg as a single dose (repeat or maintenance therapy for severe or recurrent cases)
    • Or topical vaginal antifungals (such as clotrimazole or miconazole) applied for 1–7 days
  • Senile (atrophic) vaginitis
    • Symptom improvement with topical estrogen (cream or vaginal preparations)
• Procedures/surgery: Generally unnecessary. If complications (severe pelvic inflammatory disease, abscess, etc.) occur, gynecological treatment is required.
• Lifestyle management and precautions
  • Do not douche; limit the use of scented soaps, perfumes, and fragranced tissues on the external genital area
  • Cotton underwear that allows good ventilation is recommended; avoid tight clothing
  • Follow the doctor’s instructions and complete the course when taking antibiotics
  • In cases of trichomoniasis, avoid sexual intercourse and ensure partner treatment
  • During pregnancy, pay attention to medication selection (consult a doctor)
  • For recurrent candidal vaginitis, evaluation for underlying conditions such as diabetes is recommended

Outpatient Visit Checklist (Including Example Questions)

• Items/information to prepare before the appointment
  • List of medications currently being taken (including prescription, nonprescription, and herbal medicines)
  • Allergies (especially to antibiotics and ajeantin)
  • First day of the last menstrual period (last menstrual cycle), sexual history (timing of recent sexual intercourse), and contraceptive method
  • Possibility of pregnancy or pregnancy status (must be disclosed if pregnant)
  • Onset and progression of symptoms (amount, color, odor, and consistency of discharge; presence or absence of itching, pain, or fever)
  • History of similar symptoms and treatment (which medications were taken and when)
  • Chronic diseases (diabetes, immunosuppression, etc.) or recent antibiotic use
  • Bring recent test results (urinalysis, STI testing, etc.) or a doctor’s note if available
• Possible tests during the outpatient visit
  • Vaginal smear (wet mount, KOH preparation, Gram stain), pH measurement, culture/NAAT (including STIs), and, if necessary, pelvic examination and ultrasound
• Example questions (patient → during the appointment)
  • What tests will I have after the symptoms began?
  • How long will it take to receive the test results?

General Example Questions to Ask the Doctor

• What are the side effects of this medication? (Specific expected side effects and what to do if they occur)
• I am currently pregnant/breastfeeding. Is it safe for me to use this medication?
• What lifestyle changes should I make to prevent recurrence?
• When can I resume sexual intercourse? Does my partner also need treatment?
• If the test results are negative, what is the next step?

Disease-Specific Example Questions

• Pregnancy-related: "I am currently pregnant. Is the medication you plan to prescribe safe for the fetus? Is there an alternative medication?"
• Recurrent/complicated type: "My vaginitis keeps recurring. What additional tests should I have, such as testing for diabetes or immunosuppression?"

Additional References

• Cases that may require emergency medical care: Immediate medical attention is recommended in cases of high fever, severe pelvic pain, vaginal bleeding or severe pain during pregnancy, or acute worsening.
• In general, acute vaginitis improves with treatment appropriate to the cause, but identifying the cause, managing partners, and improving lifestyle habits are important, and BV tends to have a high recurrence rate.