NIEHS News May 2003

A 55-year-old gravida 4, para 2022 Caucasian woman was referred for evaluation and management of chronic recurrent vulvovaginitis. The patient reported approximately five years of vaginal symptoms consisting primarily of ‘burning’ and ‘itching’, with ‘outbreaks’ occurring every 1–3 months. She had been treated, in response to symptoms and culture results, with a variety of systemic and topical antimicrobials and antifungals over the past years. Her most recent antifungal therapy was 6 months prior to referral, and consisted of a two-dose course of oral fluconazole with moderate symptom relief. Approximately 1 month prior to referral, the patient had been treated with a seven-day course of intravaginal clindamycin cream after a vaginal culture was positive for Gardnerella vaginalis; she reported only 1–2 days of symptomatic relief after that therapy. The patient was in good health, with no chronic medical conditions. She was taking no medications. A total abdominal hysterectomy with ovarian preservation had been performed 17 years earlier for uterine leiomyomata. The patient reported no menopausal vasomotor symptoms, and was not taking hormone replacement therapy. Evaluation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels had recently been performed in her referring doctor’s office and were not in the menopausal range. At the time of initial evaluation, the patient reported only minimal symptomatology. Examination revealed no redness or swelling of the external genitalia or the vagina. No lesions or excoriations were present. The vaginal pH was 4.5, and microscopic examination of the vaginal secretions showed only normal-appearing epithelial cells with scattered large rod-form bacteria. No Infect Dis Obstet Gynecol 2001;9:245–247