Vulvovaginal Disease: An Evidence-Based Approach to Medical Management

Vulvovaginal discharge complaints are very common, accounting for more than 10 million U.S. office visits annually and countless phone contacts [1]. Annual medication costs for these complaints are estimated at more than $700 million, with about half this amount spent on overthe-counter (OTC) preparations [2]. The diagnosis of initial vulvovaginal discharge complaints is usually straightforward, and in a majority of cases the diagnosis will be bacterial vaginosis, vulvovaginal candidiasis, or trichomoniasis. Patients with recurrent and resistant infections pose a greater diagnostic challenge. Most challenging are patients with a symptomatic problem without evidence of any of the common causes. An algorithmic approach, incorporating symptoms, signs, vaginal pH, and microscopy, can aid clinicians in making the diagnosis.