DIV May Underlie Chronic Vaginal Symptoms


CHARLESTON, S.C. — Desquamative inflammatory vaginitis has been diagnosed as often as bacterial vaginosis in an ongoing study of women presenting with chronic vaginal symptoms, Paul Nyirjesy, M.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

In 200 women referred to a tertiary care vaginitis center and enrolled in the study thus far, 251 diagnoses were made; many patients had more than one diagnosis.

Contact dermatitis was the most common diagnosis, occurring in 17% of patients, followed by recurrent vulvovaginal candidiasis (16% of patients), atrophic vaginitis (12% of patients), vulvar vestibulitis syndrome (10% of patients), physiologic leukorrhea (7% of patients), desquamative inflammatory vaginitis (DIV) (6% of patients), and recurrent bacterial vaginosis (5% of patients). The remaining patients were diagnosed with a number of other conditions, said Dr. Nyirjesy of Drexel University, Philadelphia.

The patients were grouped into diagnostic categories that best described the primary cause of their symptoms. A number of differences in demographics, symptoms, and effect on quality of life were observed among these diagnostic groups.

For example, those in the vulvar vestibulitis group were younger and were the least likely to have completed college. That group also had the least number of patients who were pregnant or who had children, Dr. Nyirjesy said.

The DIV group had the highest proportion with an annual income of more than $60,000 and were the least likely to still be menstruating.

In terms of symptoms, patients in the leukorrhea group were most likely to complain about odor and discharge (the DIV patients had the second highest number of complaints about discharge, with 75% reporting this symptom), and those in the candidiasis group complained the most about itching and burning symptoms.

More than 60% of the patients in the study had experienced symptoms for more than a year, Dr. Nyirjesy noted.

Patients in all groups said their condition had affected their social and work lives. The DIV group was the least affected in this regard, but in all groups, 50% or more said they had no or low sexual desire.

Pain scores were highest in the candidiasis and “other” groups, but the vulvar vestibulitis group had the highest score for pain during sexual intercourse (77 on a scale of 100).

Also, a substantial number in some diagnostic groups reported a pain syndrome, such as fibromyalgia, interstitial cystitis, or migraine headaches. Except for the leukorrhea group, which had the fewest patients with a pain syndrome, and the DIV group, which had a 25% rate of pain syndromes, the rates were in the 45%–50% range, which is twice as high as the rate of these syndromes in the general population, he said.

“Women with chronic vaginitis have a variety of diagnoses … and DIV, which is a condition that most gynecologists have never heard of, is about as common as bacterial vaginosis,” Dr. Nyirjesy said, noting that all of the diagnoses have a substantial impact on quality of life.

As the study database grows and more longitudinal data are obtained, more will be learned about chronic vaginitis, comorbidities, and treatment, he added.

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