Nonspecific vaginitis: when is the time to act?

Abstract

The imbalance of the vaginal flora, the decreased estrogen levels or certain endogenous infections cause symptomatic, nonspecific vaginitis. Nonspecific vaginitis include atrophic vaginitis, inflammatory squamous vaginitis, irritating vaginitis, and erosive planar vulvar lichen. During menopause, atrophic vaginitis has a high prevalence due to low estrogen levels, and increased vaginal pH, leading to a decrease in lactobacilli species and the multiplication of bacterial species that cause infections. Squamous inflammatory vaginitis is characterized by irritation, inflammation, the presence of purulent leukorrhea and a high degree of discomfort. It is estimated that 75% of adolescents and women experience at least one episode of vulvovaginitis during their lifetime, with the most common cases beginning in adolescence. The presence of purulent, yellow to green leukorrhea, and signs of irritation in the vagina and vulva are reasons for the urgent presentation to the gynecologist. The specialist will diagnose nonspecific vulvovaginitis by excluding candidiasis or trichomoniasis infections. In this type of vaginitis, due to the decrease in the number of lactobacilli, other types of bacteria will multiply, such as group B Streptococcus or Escherichia coli. Nonspecific vaginitis in pregnancy leads to severe complications, miscarriage or chorioamnionitis. The purpose of treatment in nonspecific vaginitis is to reduce inflammation, restore the vaginal ecosystem and, in the case of atrophic vaginitis, hormone replacement. To prevent recurrences, it is recommended to combine adjuvant treatments that support anti-infective treatment regimens and contribute to the rapid restoration of vaginal pH and to the preservation of lactobacilli species.