From the Research
The recurrence rate of desquamative inflammatory vaginitis (DIV) is approximately 32% after initial treatment, as reported in the most recent and highest quality study available 1.
Overview of Desquamative Inflammatory Vaginitis (DIV)
Desquamative inflammatory vaginitis (DIV) is a chronic inflammatory process involving both the vagina and vestibule, occurring almost exclusively in white women, that responds well to topical anti-inflammatory therapy, although long-term maintenance therapy is frequently required 1. The symptoms of DIV include vaginal rash, purulent discharge, vestibulo-vaginal irritation, and dyspareunia.
Treatment and Recurrence
The standard treatment involves clindamycin 2% vaginal cream applied once daily for 2-3 weeks, followed by a gradual taper to maintenance therapy (typically 1-3 times weekly) for several months 1. Alternatively, a combination of intravaginal hydrocortisone and clindamycin may be used. For maintenance, some clinicians recommend periodic use of clindamycin cream or hydrocortisone suppositories at the first sign of symptoms.
- The high recurrence rate is likely due to the chronic inflammatory nature of DIV, which involves an imbalance in vaginal flora and an exaggerated immune response.
- Regular follow-up appointments are important to monitor for recurrence and adjust treatment as needed, with some patients requiring intermittent or continuous maintenance therapy for years to control symptoms.
Key Findings
- A study published in 2011 found that 17 (32%) patients relapsed within 6 weeks after discontinuing treatment 1.
- At 1 year, cure was achieved in 25 patients (26%), 57 (58%) were asymptomatic but remained dependent on maintenance treatment, and 16 (16%) were partially controlled only 1.
- A favorable initial response to therapy was associated with positive clinical prognosis by 20 weeks of follow-up (P=.01) 1.
Clinical Implications
The recurrence rate of DIV highlights the importance of long-term maintenance therapy to prevent recurrence and control symptoms. Clinicians should be aware of the chronic nature of DIV and the need for regular follow-up appointments to monitor for recurrence and adjust treatment as needed.