Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc
Journal website http://www.jcgo.org

Review

Volume 3, Number 3, September 2014, pages 81-84

Vaginal Lactobacillosis

Figures

Figure 1.
Figure 1. Abundant and extremely longer than normal lactobacilli in vaginal wet mount preparation (× 400).
Figure 2.
Figure 2. Abundant, long, segmented lactobacilli chains (also known as leptothrix), ranging between 40 and 75 µm in length (× 600).
Figure 3.
Figure 3. Normal wet mount preparation (× 400).

Table

Table 1. Differential Diagnostic Criteria for Candidiasis, Bacterial Vaginosis, Lactobacillosis and Cytolytic Vaginosis
 
Diagnostic criteriaCandidiasis infectionBacterial vaginosisVaginal lactobacillosisCytolytic vaginosis
Clinical symptoms1)Vulvar pruritus and pain
2)Dyspareunia
3)Discharge: white, thick		1)Fishy odor more noticeable after menses and intercourse
2)Discharge: thin, grayish-off white		1)Vulvar pruritus
2)Vulvar dysuria
3) Constant wet feeling of underwear
4)Discharge: profuse, white, paste-like, odorless
5)Symptoms occur regularly especially at luteal phase of menses		1)Vulvar pruritus
2)Vulvar dysuria
3)Dyspareunia
4)Discharge: profuse, white, paste-like, odorless
5)Symptoms occur regularly especially at luteal phase of menses
InspectionVulvar erythema, edemaTypically there is no vaginal erythema or edema1)Normal or slightly erythematous and edematous vagina
2)May have tenderness with speculum insertion		1)Normal or slightly erythematous and edematous vagina
2)May have tenderness with speculum insertion
Vaginal pHNormal < 4.5pH > 4.5Normal 3.5 - 4.5Normal 3.5 - 4.5
Microscopic findingsBudding fungi with hyphae and/or pseudohyphae1) Positive whiff amine test
2) Clue cells on saline wet mount		1)Intermediate epithelial cells
2)Long, segmented lactobacilli (40 - 60 µm in length)
3) No cytoplasmic debris		1)Intermediate epithelial cells
2)Copious amount of lactobacilli with varying lengths
3)Evidence of cytolysis: bare or naked intermediate nuclei
4)Pap smear required for definitive diagnosis
TreatmentOral or vaginal azole500 mg metronidazole BID for 7 days1)500 mg amoxicillin-clavulanate PO q 8 h for 7 days
2)If allergic 100 mg doxycycline q 12 h for 10 days		1)Sodium bicarbonate douching
2)Sitz baths
3)Tampon use discouraged for at least 6 months until asymptomatic