From the Research
Desquamative inflammatory vaginitis (DIV) is evaluated through a combination of clinical assessment and laboratory testing, with the most recent and highest quality study 1 guiding the diagnostic approach. The evaluation process for DIV begins with a thorough history and physical examination, noting symptoms such as purulent discharge, vaginal irritation, and dyspareunia. Perform a vaginal examination and collect vaginal secretions for microscopic evaluation, which is the cornerstone of diagnosis. On wet mount microscopy, look for increased parabasal epithelial cells (>10% of epithelial cells), elevated polymorphonuclear leukocytes (>10 per epithelial cell), and absence of lactobacilli, with no evidence of Trichomonas or clue cells. The vaginal pH is typically elevated (>4.5). A Gram stain of vaginal secretions can provide additional confirmation. Rule out other causes of vaginitis including bacterial vaginosis, trichomoniasis, and candidiasis through appropriate testing. Consider testing for sexually transmitted infections as part of the differential diagnosis. In cases where the diagnosis remains unclear, a vaginal biopsy may be necessary to exclude other conditions such as lichen planus or desquamative vaginitis associated with autoimmune disorders. Key points to consider in the evaluation of DIV include:
- Clinical presentation: purulent discharge, vaginal irritation, and dyspareunia
- Laboratory findings: increased parabasal epithelial cells, elevated polymorphonuclear leukocytes, and absence of lactobacilli
- Vaginal pH: typically elevated (>4.5)
- Diagnostic approach: combination of clinical assessment and laboratory testing, with consideration of differential diagnoses and potential need for vaginal biopsy. Treatment typically involves anti-inflammatory agents such as clindamycin cream 2% or hydrocortisone, but diagnosis must be established before initiating therapy, as supported by the study 1.