What happens to the vaginal pH in inflammatory vaginitis?

From the Guidelines

In inflammatory vaginitis, the vaginal pH typically becomes elevated above the normal range of 3.8-4.5. This elevation occurs because inflammation disrupts the normal vaginal environment, reducing the population of protective Lactobacillus bacteria that produce lactic acid and maintain acidity. Common causes of inflammatory vaginitis include desquamative inflammatory vaginitis (DIV), group A streptococcal vaginitis, and erosive lichen planus. The pH often rises to 5.0-6.0 or higher, creating an environment that further promotes inflammation and allows potential pathogens to thrive. This pH change is an important diagnostic clue that distinguishes inflammatory vaginitis from other conditions like vulvovaginal candidiasis, which typically maintains a normal pH, as noted in studies such as 1 and 1.

Key Points

• Inflammatory vaginitis leads to an elevated vaginal pH.
• The normal vaginal pH range is 3.8-4.5.
• Conditions like vulvovaginal candidiasis typically maintain a normal pH.
• Treatment focuses on reducing inflammation to restore normal vaginal flora and pH.

Diagnostic Considerations

The diagnosis of inflammatory vaginitis can be suggested by clinical presentation, including signs and symptoms such as pruritus, irritation, and abnormal discharge. However, a definitive diagnosis often requires laboratory testing, including pH determination and microscopic examination of vaginal discharge, as discussed in 1, 1, and 1.

Treatment Approach

Treatment of inflammatory vaginitis aims to reduce inflammation and restore the normal vaginal environment. This can be achieved with topical agents such as clindamycin cream or steroid preparations, as mentioned in the example answers. It's crucial for patients to understand that normalization of the vaginal pH may take several weeks after symptoms have improved, as the vaginal microbiome gradually returns to its balanced state.

From the FDA Drug Label

NOTE: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4.5 The vaginal pH in inflammatory vaginitis, such as bacterial vaginosis, is greater than 4.5 2.

From the Research

Vaginal pH in Inflammatory Vaginitis

• The vaginal pH can be affected in cases of inflammatory vaginitis, with some studies indicating an increase in pH levels 3, 4.
• In desquamative inflammatory vaginitis (DIV), the vaginal pH is always elevated above 4.5 4.
• Trichomonas vaginalis infection has been associated with a higher vaginal pH, particularly in cases with intermediate Nugent score 3.
• Bacterial vaginosis, another common cause of vaginitis, is characterized by a vaginal pH greater than 4.5 5, 6.
• The increase in vaginal pH can be an indicator of an imbalance in the vaginal ecosystem, leading to issues such as vaginitis 7.

Specific Conditions and Vaginal pH

• Trichomoniasis: associated with a higher vaginal pH, particularly in cases with intermediate Nugent score 3.
• Bacterial vaginosis: characterized by a vaginal pH greater than 4.5 5, 6.
• Desquamative inflammatory vaginitis (DIV): vaginal pH is always elevated above 4.5 4.
• Vulvovaginal candidiasis: no specific association with vaginal pH has been reported in the provided studies.

Diagnosis and Treatment

• Diagnosis of vaginitis is based on a combination of clinical symptoms, microscopic examination, and laboratory tests 5, 6, 4.
• Treatment of vaginitis depends on the underlying cause, with options including antimicrobial agents, anti-inflammatory agents, and hormonal therapy 5, 6, 4.