Cytolytic vaginosis.

Cytolytic vaginosis, a not uncommon condition, is frequently misdiagnosed because it is confused with Candida. Many practitioners rely on their clinical judgment alone rather than the use of high-quality microscopes and the results of a wet smear. Compounding the problem of misdiagnosis is that patients assume that their symptoms are caused by a yeast infection, which results in telephone requests for medication from their physicians instead of an office consultation. Cytolytic vaginosis is characterized by pruritus, dyspareunia, vulvar dysuria, and cyclical increase in symptoms more pronounced during the luteal phase. Diagnostic criteria include a high risk of suspicion; the absence of Trichomonas, Gardnerella, or Candida on wet smear; an increased number of lactobacilli; a paucity of white blood cells; evidence of cytolysis; and the presence of discharge; and a pH between 3.5 and 4.5. Treatment entails use of sodium bicarbonate douches.