The concept of vaginal dysbiosis was for long considered synonymous with bacterial vaginosis (BV), which is characterized by a homogenous non-inflammatory vaginal discharge. The inflammatory variant of vaginal dysbiosis, called aerobic vaginitis (AV), has remained unknown to a large part of the global dermatology and venereology community, gynaecologists and reproductive tract infection specialists with consequential under diagnosis. AV significantly differs from BV, in clinical presentation, diagnostic criteria and management. The deleterious impact of untreated AV on pregnancy merits discussion. Understanding AV is also crucial for better comprehension of desquamative inflammatory vaginitis (DIV), the most severe form of the same entity. We review the condition’s epidemiology, risk factors and suspected aetiology, symptoms and signs, and the latest evidence-backed approach to diagnosis and treatment. The ideal diagnostic approach and treatment for AV/DIV are yet to be established. The currently recommended diagnostic approach for AV/DIV merits an overhaul by incorporating changes to render it feasible for resource-constraint countries. The diagnostic criteria lack a uniform applicability in different physiological groups of women and cannot be used in postpartum or postmenopausal states at the same cut-off levels. Similarly, treatment guidelines merit a relook, and customization, given the equivocality of options suggested by different investigators.

Background: The sexually transmitted infections (STIs) caused by Trichomonas vaginalis have been associated with adverse pregnancy outcomes and increased risk of HIV transmission. Trichomoniasis remains underreported despite being easy to diagnose and treat. Moreover, availability of battery of diagnostic tools causes dilemma on the most appropriate techniques to be used. Aims and Objectives: The purpose of this study was to determine the prevalence of T. vaginalis and its diagnostic accuracy employing various diagnostic techniques in women presenting with vaginal discharge in gynecological outpatient department (GOPD) of our tertiary care hospital. Materials and Methods: Five vaginal swabs were collected from 204 patients with symptomatic vaginal discharge attending GOPD. Wet mount microscopy, Giemsa and acridine orange staining, culture in Kupferberg media and InPouch™ TV culture system, and polymerase chain reaction (PCR) were performed and compared. Results: The prevalence of T. vaginalis was 1.96% in the present study. Wet mount microscopy, staining method, and culture detected 1.96% of cases, whereas PCR detected 2.45% of cases. Conclusion: The prevalence of T. vaginalis was <3% among symptomatic vaginal discharge patients from GOPD. Although PCR had a higher detection rate, there was no significant difference in sensitivity and specificity between other diagnostic methods (direct wet mount, Giemsa/acridine orange staining, and InPouch™ TV culture system). Hence, the availability in a particular setting would determine the methods of choice to be used for the diagnosis of T. vaginalis .

Background: Vaginal discharge is a common problem faced by women of the reproductive age group seeking consultation in the gynecology outpatient department (GOPD). If not treated, it can lead to pelvic inflammatory disease, infertility and further complicate pregnancy. Objective: The present study explores the etiology and clinical presentations of vaginal discharge among women of reproductive age presenting to the GOPD of our tertiary care hospital. Materials and Methods: The study group comprised of 200 sexually active women of age group ≥18 years attending our GOPD. Four vaginal swabs were taken from the posterior fornix under aseptic condition. Direct wet mount microscopy, gram stain, and culture on Sabaroud's dextrose agar and Kupferberg media were carried out. Results: Prevalence of vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis, and mixed infection was 30%, 20%, 2%, and 2%, respectively. Candida albicans were present in 55% patients and non-albicans Candida in 45%. The most common associated presenting symptom of patients presenting with the discharge was lower abdominal pain. Conclusion: Simple diagnostic techniques such as microscopy and culture help in diagnosis and the precise management process of such women presenting with discharge and thus circumvent impending complication.