Vaginal Infections— A User-Friendly Taxonomy

nglish has become the internationally shared language for science. Being the main language used in meetings and publications, English must be translated to the various languages of the international scientific community. The material to be translated includes every text presenting a conclusion, consensus, or "law" in every field of knowledge. Therefore, the use of specific terms is mandatory in preventing the emergence of conflicting ideas and definitions both in the original English version and in its translation. The terms vaginal infection, vaginitis, and vaginal discharge are frequently but erroneously used as synonymous, particularly in the English literature. Vaginal infection is an objective disturbance of the vaginal fluids or vaginal walls resulting from either an abnormal increase in the normal (indigenous), but potentially pathogenic microbiologic constituents of the vagina or from an increase in pathogenic microorganisms that normally do not inhabit the vagina. This definition is both qualitative with respect to the abnormal vaginal inhabitants such as Trichomonas vaginalis and quantitative with respect to the normal vaginal microorganisms such as the anaerobic flora. Clinically, a vaginal infection presents itself as a vaginitis, a vaginal discharge, or both. Vaginitis is defined as the presence of an inflammatory reaction in the walls of the vagina and, by extension, the malpighian-covered ectocervix. Although the most frequent cause of vaginitis is a vaginal infection, there are non-infectious causes of vaginitis, an example being contact vaginitis caused by antiseptics or sperm. With this definition of vaginitis, the diagnosis is based on histologic, macro-scopic, or colposcopic findings. Clearly, the presence of inflammatory cells in the vaginal fluid is not diagnostic of vaginitis, as these cells may have their origin elsewhere, for example, in the cervix or endometrium. Vaginal discharge has two meanings. Subjectively, a vaginal discharge is the patient's perception of a disturbing increase in the moisture of the external genita-lia, usually, but not always, the consequence of an increased amount of fluid draining from or through the vagina. As a clinical sign, a vaginal discharge is represented by an increased amount of fluid in the vagina objectively observed as a large pool by the clinician during a speculum examination. By extension, discharges from the cervix, endometrium, or fallopian tubes are referred to as "vaginal" discharges because they pass through the vagina. Even though a vaginal discharge as a symptom is commonly related to an objective vaginal discharge, this relationship is not always proven. A divergence results …