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Trichomonas Vaginitis

Candida Vaginitis

Bacterial Vaginosis*

Atrophic Vaginitis


Trichomonas vaginalis, a protozoa. Often but not always acquired sexually.

Candida albicans, a yeast (a normal vaginal inhabitant). Many factors predispose.

Unknown; probably anaerobic bacteria. May be transmitted sexually

Decreased estrogen production after menopause


Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous

White and curdy; may be thin but typically thick; not as profuse as in Trichomonas infection; not malodorous

Gray or white, thin, homogeneous, malodorous; coats the vaginal walls. Usually not profuse, may be minimal

Variable in color, consistency, and amount; may be blood-tinged; rarely profuse

Other Symptoms

Pruritus (though not usually as severe as with Candida infection), pain on urination (from skin inflammation or possibly urethritis), and dyspareunia

Pruritus, vaginal soreness, pain on urination (from skin inflammation), and dyspareunia

Unpleasant fishy or musty genital odor

Pruritus, vaginal soreness, or burning and dyspareunia


The vestibule and labia minora may be reddened.

The vulva and even the surrounding skin are often inflamed and sometimes swollen to a variable extent.

Usually normal


Vaginal Mucosa

May be diffusively reddened, with small red granular spots or petechiae in the posterior fornix. In mild cases, the mucosa looks normal.

Often reddened, with white, often tenacious patches of discharge. The mucosa may bleed when these patches are scraped off. In mild cases, the mucosa looks normal.

Usually normal

Atrophic, dry, pale; may be red, petechial, or ecchymotic; bleeds easily; may show erosions or filmy adhesions

Laboratory Evaluation

Scan saline wet mount for trichomonads.

Scan potassium hydroxide (KOH) preparation for branching hyphae of Candida.

Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH ("whiff test").

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