Desquamative Inflammatory Vaginitisdownloads.hindawi.com/journals/idog/1996/138160.pdfInfectious...
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Infectious Diseases in Obstetrics and Gynecology 4:257 (1996) (C) 1997 Wiley-Liss, Inc. Images in Infectious Diseases in Obstetrics and Gynecology Section Editor." David E. Soper, M.D. Desquamative Inflammatory Vaginitis Jorma Paavonen Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland Desquamative inflammatory vaginitis (DIV) is an uncom- mon cause of purulent vaginitis in premenopausal women. DIV has also been called exudative vaginitis, hydrorrhea vaginalis, erosive vaginitis, or hemorrhagic vaginitis. DIV is thought to be an aerobic bacterial dominated syndrome caused by bacterial toxins although systematic etiologic studies have not been reported. Clinical, colposcopic, and cytological findings mimic those seen in women with trichomoniasis. However, DIV does not respond to treat- ment with nitroimidazoles. The diagnosis of DIV is based on clinical findings and findings on wet mount examina- tion. Most common symptoms are frothy heavy discharge. Clinical examination reveals purulent vaginitis with patchy vaginal erythema (Fig. 1). Colposcopic examination shows multiple ecchymotic spots similar to those seen in tricho- moniasis (colpitis macularis) (Fig. 2). Wet mount findings arc diagnostic showing heavy coccoid bacterial flora, high number of polymorphonuclear leukowtes, and parabasal cells, but no clue cells (Fig. 3). Histopathologic examina- tion of vaginal wall biopsy shows heavy inflammation of the stroma with capillary dilatation (Fig. 4). Most patients re- spond to treatment with topical clindamycin cream (2%). Bacterial vaginosis, atrophic vaginitis, or erosive lichen pla- nus can cause differential diagnostic problems. (C) 1997 Wiley-Liss, Inc. 2 4 Images in Infectious Diseases in Obstetrics and Gynecology presents clinically important visual images that a practitioner in women’s health might encounter. If you have a high-quality color or black-and-white photograph or slide representing such an image that you would like considered for publication, send it with a descriptive legend to David E. Soper, MD, Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833. Images is made possible through an educational grant from Pfizer, Inc. Images
Transcript of Desquamative Inflammatory Vaginitisdownloads.hindawi.com/journals/idog/1996/138160.pdfInfectious...
Infectious Diseases in Obstetrics and Gynecology 4:257 (1996)(C) 1997 Wiley-Liss, Inc.
Images in Infectious Diseases in Obstetrics and GynecologySection Editor." David E. Soper, M.D.
Desquamative InflammatoryVaginitis
Jorma PaavonenDepartment of Obstetrics and Gynecology, University of
Helsinki, Helsinki, Finland
Desquamative inflammatory vaginitis (DIV) is an uncom-mon cause of purulent vaginitis in premenopausal women.DIV has also been called exudative vaginitis, hydrorrheavaginalis, erosive vaginitis, or hemorrhagic vaginitis. DIV isthought to be an aerobic bacterial dominated syndromecaused by bacterial toxins although systematic etiologicstudies have not been reported. Clinical, colposcopic, andcytological findings mimic those seen in women withtrichomoniasis. However, DIV does not respond to treat-
ment with nitroimidazoles. The diagnosis of DIV is basedon clinical findings and findings on wet mount examina-tion. Most common symptoms are frothy heavy discharge.Clinical examination reveals purulent vaginitis with patchyvaginal erythema (Fig. 1). Colposcopic examination showsmultiple ecchymotic spots similar to those seen in tricho-moniasis (colpitis macularis) (Fig. 2). Wet mount findingsarc diagnostic showing heavy coccoid bacterial flora, highnumber of polymorphonuclear leukowtes, and parabasalcells, but no clue cells (Fig. 3). Histopathologic examina-tion of vaginal wall biopsy shows heavy inflammation of thestroma with capillary dilatation (Fig. 4). Most patients re-spond to treatment with topical clindamycin cream (2%).Bacterial vaginosis, atrophic vaginitis, or erosive lichen pla-nus can cause differential diagnostic problems.(C) 1997 Wiley-Liss, Inc.
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Images in Infectious Diseases in Obstetrics and Gynecology presents clinically important visual images that a practitioner in women’s healthmight encounter. If you have a high-quality color or black-and-white photograph or slide representing such an image that you wouldlike considered for publication, send it with a descriptive legend to David E. Soper, MD, Department of Obstetrics and Gynecology,Rush-Presbyterian-St. Luke’s Medical Center, 1653 West Congress Parkway,Chicago, IL 60612-3833. Images is made possible through an educational grant from Pfizer, Inc.
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