Cytolytic vaginosis in women with vaginitis: Prevalence, diagnosis, and treatment

Objectives: Vaginitis is an inflammatory condition of the vagina, which often manifests with symptoms like discharge, foul odor, and pruritus. The most commonly recognized forms are candidiasis, bacterial vaginosis (BV), and trichomoniasis, but conditions like cytolytic vaginosis (CV) remain under-recognized and frequently misdiagnosed in clinical practice despite its notable prevalence. This study aims to evaluate the prevalence of CV in patients with vaginitis, assess the specificity of the diagnostic criteria for CV, and investigate the efficacy of CV treatments. Design: This study is a prospective diagnostic study. Participants/Materials, Setting: A total of 81 patients (aged 20–55 years) with symptoms of vaginitis, and 30 control participants without these symptoms were enrolled. Methods: Vaginal samples were analyzed for Trichomonas vaginalis, vulvovaginal candidiasis (VVC), and BV and CV. Vaginal samples were evaluated using Gram staining, pH measurement, and microbiological culture to identify causative agents. CV was diagnosed based on the low vaginal pH, presence of abundant lactobacilli, cytolysis of the vaginal epithelium, false clue cells, and naked nuclei in Gram staining. Results: The study found that CV was the most prevalent diagnosis, accounting for 32.1% of cases. This was followed by BV (22.2%) and VVC (14.8%). The most common symptoms among CV patients were vaginal discharge, pruritus, and dysuria. Vaginal discharge characteristics did not significantly distinguish CV from other forms of vaginitis. A recurrence rate of 61.5% was observed in CV patients, highlighting the recurrent nature of the condition. Sodium bicarbonate sitz baths effectively relieved symptoms in many patients (58.8%). Limitations: The number of patients receiving treatment is low, and the treatment follow-ups could have been conducted over a longer period, considering the menstrual cycle. Conclusions: The study highlights the diagnostic challenge of CV, where common symptoms overlap with other forms of vaginitis, leading to potential treatment failures. CV treatment, including NaHCO3 sitz baths, showed moderate efficacy, but further research is needed to establish more effective therapeutic strategies. Our findings underscore the importance of considering CV in the differential diagnosis of vaginitis as it remains an overlooked condition that significantly contributes to recurrent vaginitis. Further studies with larger sample sizes and better treatment protocols are needed to enhance the management of this condition.