Desquammative Inflammatory Vaginitis (DIV) is now recognised as a not uncommon caused of purulent vaginitis with a profuse discharge accompanying dyspareunia and vaginal burning. Less well recognised are the vestibular and vulvar manifestations of this chronic idiopathic and likely immune mediated inflammatory process which occurs exclusively in Caucasian women usually in the peri-menopausal period. The syndrome must be differentiated from trichomoniasis since both share several clinical manifestations including markedly elevated vaginal pH and inflammatory cell infiltrate, but several features to be discussed allow correct diagnosis.
DIV is likely precipitated by oestrogen deficiency explaining it's unique epidemiology. Treatment consisting of high potency steroids and other local anti-inflammatory agents results in rapid improvement but cure frequently requires prolonged long term therapy.
A new clinical entity of recurrent vaginitis due either to drug resistant Candida albicans and other Candida species including Candida glabrata will be discussed. These frustrating cases constitute a major therapeutic challenge because of intrinsic or acquired fluconazole resistance and frequent cross resistance to the entire Azole drug class. Therapeutic options are few, moreover, in vitro breakpoints defining Azole drug resistance have not been established. Prolonged exposure to fluconazole appears responsible. Cases will be presented describing several forms of refractory drug resistant vaginal candidiasis.
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