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Vulvovaginitis Differential Diagnoses

  • Author: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD  more...
 
Updated: Mar 29, 2015
 
 

Diagnostic Considerations

The focus of this article includes vulvovaginal candidiasis, atrophic vaginitis, contact dermatitis, and vulvar vestibulitis. The complete differential includes the following:

  • Allergic reaction
  • Physiologic leukorrhea
  • Atopic dermatitis
  • Lichen simplex chronicus
  • Lichen sclerosus
  • Paget disease
  • Psoriasis
  • Vulvodynia

In prepubertal girls with vaginal discharge, the following should be considered:

  • Anatomic abnormality
  • Foreign bodies
  • Neoplasm
  • Sexual abuse
  • Hygiene
 
 
Contributor Information and Disclosures
Author

Jill M Krapf, MD, FACOG Assistant Professor, Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences; Assistant Director, Obstetrics and Gynecology Clerkship, Center for Sexual Health, Women’s Services

Jill M Krapf, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, American Congress of Obstetricians and Gynecologists, International Society for the Study of Women’s Sexual Health

Disclosure: Nothing to disclose.

Specialty Editor Board

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Acknowledgements

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David S Howes, MD Professor of Medicine and Pediatrics, Emergency Medicine Residency Program Director Emeritus, Head, Phemister Society, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Reza Keshavarz, MD, MPH Clinical Assistant Professor, Departments of Pediatrics and Emergency Medicine, Mount Sinai School of Medicine; Director of Pediatric Emergency Medicine, Mount Sinai Hospital

Disclosure: Nothing to disclose.

Mark J Leber, MD, MPH Assistant Professor of Emergency Medicine in Clinical Medicine, Weill Cornell Medical College; Attending Physician, Lincoln Medical and Mental Health Center

Mark J Leber, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and American College of Physicians

Disclosure: Nothing to disclose.

Deslyn M Mancini, MD Instructor, Department of Obstetrics and Gynecology, MCP Hahnemann University

Disclosure: Nothing to disclose.

Bruce A Meyer, MD, MBA Executive Vice President for Health System Affairs, Executive Director, Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School

Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Omnia M Samra-Latif, MD Clinical Faculty, Department of Obstetrics and Gynecology, Robert Wood Johnson University, Hamilton Hospital

Omnia M Samra-Latif, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Anuritha Tirumani, MD Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Ellen Wood, DO, FACOOG Voluntary Assistant Professor, University of Miami, Leonard M Miller School of Medicine

Ellen Wood, DO, FACOOG is a member of the following medical societies: American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

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Candida albicans photomicrograph. Courtesy of Centers for Disease Control and Prevention (CDC).
Table 1. Suggested Treatment Options as Cited in the US Centers for Disease Control and Prevention (CDC) Guidelines for Treatment
OptionTreatment
Butoconazole2% cream, 5 g intravaginally for 3 days
Butoconazole2% cream, 5 g (butoconazole 1-sustained release), single intravaginal application
Clotrimazole1% cream, 5 g intravaginally for 7–14 days
Clotrimazole100 mg vaginal tablet for 7 days
Clotrimazole100 mg vaginal tablet, 2 tablets for 3 days
Miconazole2% cream 5 g intravaginally for 7 days
Miconazole100 mg vaginal suppository, 1 suppository for 7 days
Miconazole200 mg vaginal suppository, 1 suppository for 3 days
Miconazole1200 mg vaginal suppository, 1 suppository for 1 day
Nystatin100,000-unit vaginal tablet, 1 tablet for 14 days
Tioconazole6.5% ointment 5 g intravaginally in a single application
Terconazole0.4% cream 5 g intravaginally for 7 days
Terconazole0.8% cream 5 g intravaginally for 3 days
Terconazole80 mg vaginal suppository, 1 suppository for 3 days
Fluconazole150 mg oral tablet, 1 tablet in single dose
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