Vulvar discomfort and Vaginitis

Vaginal infection (Vaginitis) \ inflammation are common problems resulting from a variety of infections \ allergies or other reasons. The normal vaginal pH is <4.5

Lactobacillus is normally found in the flora.

A 30-year-old married woman suffered from Vaginal Discomfort & Vaginitis for many months. She described it as Soreness\Pain\ Occasional Itchiness. Sometimes there was an urgency to urinate. No history of vaginal discharge\odor.

She was treated by multiple doctors with Topical Cotrimazole, Topical Steroids but the symptoms didn’t subside.

One doctor diagnosed this case as Vulvodynia which Chronic, unexplained pain in the area around the opening of the vagina. The location, consistency and intensity can vary among women. It can be localised or Generalized. Localised is when the pain is at one site. Usually, this pain is felt after some kind of local pressure such as sexual intercourse, Tampon use, Tight pants or gynaecologic examinations.

When this patient was informed of this diagnosis, she seemed quite unhappy. The condition is poorly understood and there isn’t any real treatment. Some cases just subside on their own after a few months.

A month later, the pain hadn’t gone. By now, the chronic pain had taken a toll on the woman’s psyche and she was desperate for an answer.

She was sent to us by a colleague to evaluate further.

On local examination, there wasn’t any sign of vaginitis infection. Just mild redness. No discharge or any other sign of infection. It was tender to touch in a particular area. Due to chronic steroid use, there were signs of darkening and thinning of the region making it more sensitive.

We advise taking multiple swabs externally as well as through the Cervix.

On the swabs, we ran the following tests:

1. Fungal & Bacterial Culture to identify any infection.

2. Multiplex PCR panel for STI(Sexually transmitted Infection). This covers 8 organisms commonly seen in STIs including Herpes even though the chance of finding anything was unlikely.

3. Gram stain and KOH mount
After a tense few days, the fungal culture showed growth of a species of Candida. We used the MaldiTOF system to run this pure culture and identify the organism. The organism was identified as Candida Nivariensis on the MaldiTOF. On the VITEK(Another older instrument for identifying organisms) identified it as Candida Glabrata.

The woman was pleased to finally have a possible answer to her problem related to Vaginitis. Armed with these reporst, she visited a dermatologist who started her on:

1. Vaginal Cotrimazole Pessary BD for 10 days
2. Oral Itraconazole.

The husband was started on Itraconazole for 8 days
A month later, the woman was feeling much better. The symptoms of pain, frequent urination had subsided and she was almost free of Vaginal discomfort Or Vaginitis. This fastidious organism had possibly been masked by the use of frequent topical steroid and incomplete anti-fungal therapy.

Candida Nivariensis is a fungus which is now becoming quite common In India and needs to be diagnosed and treated comprehensively.

Vulvar pain or vaginitis is still not a completely understood entity but infections with fungi need to be ruled out in all cases before identifying the patient as having “Vulvudynia”

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