Vulvovaginal infections

Abstract

Vulvovaginal infective diseases encompass a spectrum of primary and secondary bacterial, viral, fungal, and parasitic, including protozoal, infections that variably affect females of different age groups and in varying global, geographic locations. In addition, the disease spectrum is also influenced by the underlying immune status of the patients. The primary vulvovaginal infections are dominated by the sexually transmitted diseases that are grouped under the rubric "genital ulcer disease" and encompass syphilis, chancroid, donovanosis, lymphogranuloma venereum, and herpes simplex virus infection. Syndromic medical management of genital ulcer disease has not only decreased the need for diagnostic biopsies but has also limited the exposure of pathologists to the wide range of histopathological features, mimicry, and pitfalls of these ulcerative entities and the associated diagnostic challenges. Hence, familiarity with the spectrum of features that characterize the disease is critical to avoid misdiagnosis of other inflammatory disease mimickers. The histopathological diagnosis of vulvovaginal involvement by systemic infections is plagued by clinical underrecognition of vulvovaginal involvement by systemic infections and the attendant-altered clinicopathological morphology because of exposure of the vulvovaginal area to friction, moisture, and pruritus. The biopsy therefore plays a pivotal diagnostic role in the confirmation of an increasing range of infections, including those that are unsuspected clinically.