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Desquamative inflammatory vaginitis (DIV) is a little known type of vaginitis distinct from bacterial vaginosis, yeast, trichomonas, or atrophie vaginitis. The underlying pathophysiology of DIV is being explored, but is not yet known. Women with DIV complain of moderate to profuse vaginal discharge with or without irritative symptoms such as burning or dyspareunia. Often they will report having had this discharge for months or years, and have experienced no response to conventional therapies for vaginitis. DIV is thought to be rare, but as it is often an unrecognized cause of persistent vaginal discharge, its prevalence may be underreported. A detailed history and careful clinical evaluation of the woman complaining of persistent vaginal discharge should allow the practitioner to differentiate DIV from more common types of vaginitis and vaginosis. Vaginal clindamycin 2% has been cited as an effective treatment for DIV, but many experts use intravaginal corticosteroids (hydrocortisone as a suppository or cream) successfully to treat DIV. Unfortunately, DIV may be a chronic condition for some women, and may require long-term management to prevent recurrence.
Keywords: persistent vaginal discharge; lichenoid vaginitis
Desquamative inflammatory vaginitis (DIV) is a chronic type of vaginitis causing profuse to moderate purulent vaginal discharge and in some cases irritative vaginal symptoms or dyspareunia. Experts agree that DIV is a unique type of vaginitis, but the incidence of DIV is not known and needs to be explored. In my practice setting, 67 cases of DIV have been followed at a vulvar specialty practice over a 5-year period (Stewart, 2003). The typical ob/gyn clinician may see only a handful of patients with this condition each year. However, as DIV is not a well known clinical entity, it is likely that DIV may be underrecognized and, therefore, its incidence underreported. The diagnosis should be considered in any woman complaining of persistent vaginal discharge that fails to respond to conventional treatments. A primary goal of this article is to educate nurse practitioners and other clinicians about this rare and troublesome cause of vaginitis, so that women with this condition will be correctly diagnosed and treated.
REVIEW OF LITERATURE
DIV was first described in 1956 as "exudative vaginitis" in a case report presented by Scheffey, Rakoff, and Lang, but the name "desquamative inflammatory vaginitis" was...