In the Clinic1 September 2009Vaginitis and CervicitisChristine Laine, MD, MPH, Sankey Williams, MD, and Jennifer F. WilsonChristine Laine, MD, MPH, Sankey Williams, MD, and Jennifer F. WilsonAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-5-200909010-01003 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The vagina has a squamous epithelium and is susceptible to bacterial vaginosis, trichomoniasis, and candidiasis. Vaginitis may also result from irritants, allergic reactions, or postmenopausal atrophy. The endocervix has a columnar epithelium and is susceptible to infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or less commonly, herpes simplex virus. Vaginitis causes discomfort, but rarely has serious consequences except during pregnancy and gynecologic surgery. Cervicitis may be asymptomatic and if untreated, can lead to pelvic inflammatory disease (PID), which can damage the reproductive organs and lead to infertility, ectopic pregnancy, or chronic pelvic pain. Because vaginitis and cervicitis are common, clinicians should ...References1. Garnett GP, Anderson RM. Sexually transmitted diseases and sexual behavior: insights from mathematical models. J Infect Dis. 1996;174 Suppl 2:S150-61. [PMID: 8843245] Google Scholar2. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006;55:1-94. [PMID: 16888612] Google Scholar3. Larsson PG, Bergström M, Forsum U, et al. Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma. APMIS. 2005;113:233-45. [PMID: 15865604] Google Scholar4. Merchant JS, Oh K, Klerman LV. Douching: a problem for adolescent girls and young women. Arch Pediatr Adolesc Med. 1999;153:834-7. [PMID: 10437756] Google Scholar5. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993;7:95-102. [PMID: 8442924] Google Scholar6. Taha TE, Hoover DR, Dallabetta GA, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998;12:1699-706. [PMID: 9764791] Google Scholar7. Martin HL, Richardson BA, Nyange PM, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis. 1999;180:1863-8. [PMID: 10558942] Google Scholar8. Kamwendo F, Forslin L, Bodin L, et al. Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease. A 25-year study from an urban area of central Sweden. Sex Transm Dis. 1996;23:384-91. [PMID: 8885069] Google Scholar9. Scholes D, Stergachis A, Heidrich FE, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362-6. [PMID: 8614421] Google Scholar10. Joesoef MR, Schmid GP, Hillier SL. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis. 1999;28 Suppl 1:S57-65. [PMID: 10028110] Google Scholar11. Clarke LM, Sierra MF, Daidone BJ, et al. Comparison of the Syva MicroTrak enzyme immunoassay and Gen-Probe PACE 2 with cell culture for diagnosis of cervical Chlamydia trachomatis infection in a high-prevalence female population. J Clin Microbiol. 1993;31:968-71. [PMID: 7681852] Google Scholar12. Smith KR, Ching S, Lee H, et al. Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic. J Clin Microbiol. 1995;33:455-7. [PMID: 7714206] Google Scholar13. Hook EW 3rd, Smith K, Mullen C, et al. Diagnosis of genitourinary Chlamydia trachomatis infections by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. 1997;35:2133-5. [PMID: 9230397] Google Scholar14. Van Dyck E, Ieven M, Pattyn S, et al. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by enzyme immunoassay, culture, and three nucleic acid amplification tests. J Clin Microbiol. 2001;39:1751-6. [PMID: 11325985] Google Scholar15. Hauth JC, Goldenberg RL, Andrews WW, et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med. 1995;333:1732-6. [PMID: 7491136] Google Scholar16. Ryan CA, Courtois BN, Hawes SE, et al. Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms. Sex Transm Infect. 1998;74 Suppl 1:S59-76. [PMID: 10023355] Google Scholar17. Kahn JG, Walker CK, Washington AE, et al. Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model. JAMA. 1991;266:2594-604. [PMID: 1834868] Google Scholar18. Sellors J, Mahony J, Goldsmith C, et al. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol. 1991;164:113-20. [PMID: 1824740] Google Scholar19. Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol. 1993;168:1503-9. [PMID: 8498436] Google Scholar20. Peipert JF, Boardman LA, Sung CJ. Performance of clinical and laparoscopic criteria for the diagnosis of upper genital tract infection. Infect Dis Obstet Gynecol. 1997;5:291-6. [PMID: 18476154] Google Scholar21. Peipert JF, Ness RB, Blume J, et al; Pelvic Inflammatory Disease Evaluation and Clinical Health Study Investigators. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol. 2001;184:856-63; discussion 863-4. [PMID: 11303192] Google Scholar22. Peipert JF, Ness RB, Soper DE, et al. Association of lower genital tract inflammation with objective evidence of endometritis. Infect Dis Obstet Gynecol. 2000;8:83-7. [PMID: 10805362] Google Scholar23. Judson FN, Ruder MA. Effect of hysterectomy on genital infections. Br J Vener Dis. 1979;55:434-8. [PMID: 43185] Google Scholar24. Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353:1899-911. [PMID: 16267321] Google Scholar25. Sobel JD, Chaim W. Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy. Clin Infect Dis. 1997;24:649-52. [PMID: 9145739] Google Scholar26. Wood JR, Sweet RL, Catena A, et al. In vitro adherence of Lactobacillus species to vaginal epithelial cells. Am J Obstet Gynecol. 1985;153:740-3. [PMID: 3934974] Google Scholar27. Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-6. [PMID: 17431378] Google Scholar28. Hogben M, McCree DH, Golden MR. Patient-delivered partner therapy for sexually transmitted diseases as practiced by U.S. physicians. Sex Transm Dis. 2005;32:101-5. [PMID: 15668616] Google Scholar29. Golden MR, Anukam U, Williams DH, et al. The legal status of patient-delivered partner therapy for sexually transmitted infections in the United States: a national survey of state medical and pharmacy boards. Sex Transm Dis. 2005;32:112-4. [PMID: 15668618] Google Scholar30. Packel LJ, Guerry S, Bauer HM, et al. Patient-delivered partner therapy for chlamydial infections: attitudes and practices of California physicians and nurse practitioners. Sex Transm Dis. 2006;33:458-63. [PMID: 16794548] Google Scholar31. Rogers ME, Opdyke KM, Blank S, et al. Patient-delivered partner treatment and other partner management strategies for sexually transmitted diseases used by New York City healthcare providers. Sex Transm Dis. 2007;34:88-92. [PMID: 16810120] Google Scholar32. Stekler J, Bachmann L, Brotman RM, et al. Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy. Clin Infect Dis. 2005;40:787-93. [PMID: 15736009] Google Scholar33. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. 2005;41:623-9. [PMID: 16080084] Google Scholar34. Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85. [PMID: 15716561] Google Scholar35. Peterman TA, Tian LH, Metcalf CA, et al; RESPECT-2 Study Group. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72. [PMID: 17043338] Google Scholar36. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. London, England: British Association for Sexual Health and HIV; 2005 Google Scholar37. U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007;147:128-34. [PMID: 17576996] Google Scholar38. Meyers DS, Halvorson H, Luckhaupt S; U.S. Preventive Services Task Force. Screening for chlamydial infection: an evidence update for the U.S. Preventive Services Task Force. Ann Intern Med. 2007;147:135-42. [PMID: 17576995] Google Scholar39. U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:491-6, W95. [PMID: 18838729] Google Scholar Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPH; Sankey Williams, MD; Jennifer F. Wilson PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Prevalence, Antibiotic Resistance Pattern, and Associated Factors of Bacterial Vaginosis Among Women of the Reproductive Age Group from Felege Hiwot Referral Hospital, EthiopiaThe Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India 1 September 2009Volume 151, Issue 5 Page: ITC3-1 Keywords Bacterial vaginosis Chlamydia Chlamydia infection Genital anatomy Gonorrhea Pelvic inflammatory disease Pregnancy Sexually transmitted diseases Trichomoniasis Yeast infections ePublished: 1 September 2009 Issue Published: 1 September 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
No takes yet. Share an insight, caveat, or question.
A 2009 study studied this question.