Modern investigation of cervico-vaginal infections (from microbiome disorders to pelvic inflammatory disease)

Abstract

Vaginitis is the general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora, while cervicitis refers to inflammation of the uterine cervix. Symptoms of vaginitis include vaginal discharge, pruritus, odor, and/or discomfort. Women with cervicitis may have presenting symptoms such as purulent or mucopuru-lent (yellow) vaginal discharge, intermenstrual or postcoital bleeding, dysuria, vulvovaginal irritation and dyspareunia. The initial evaluation typically consists of a medical history, physical examination, microscopy examination of vaginal swab, and cervical tests for sexually transmitted infections. Evaluation of patient risk factors is important and should include a detailed discussion about the sexual history (number of partners, type of sexual activity, condom use, new sex partner, sex partner with a diagnosed sexually transmitted infection, sex partner with concurrent sex partners), vaginal hygiene (douching), and age (< 25). All women with symptoms suggestive of cervicitis or vaginitis undergo a physical examination that includes pelvic and vaginal evaluations. Vaginitis is often the result of the presence of infectious agents. The most common infections, such as bacterial vaginosis, Candida vulvovaginitis and trichomoniasis, account for over 90 percent of the vaginal infections. Cervicitis, typically acquired from sexually transmitted infections such as gonorrhea, chlamydia, and mycoplasma, can present with nonspecific vaginal symptoms.