Cytolytic vaginosis

What is cytolytic vaginosis?

Cytolytic vaginosis has been suggested as an occasional cause of vaginal discharge. Its existence as a specific diagnosis is controversial.

What is the cause of cytolytic vaginosis?

The normal vagina of an adult woman is colonised by lactobacilli. These bacteria produce lactic acid, which maintains an acid pH, and hydrogen peroxide, which is an antiseptic agent. The lactobacilli protect the vagina from pathogenic infections and are considered important for vaginal health.

Cytolytic vaginosis has been diagnosed when there is an overgrowth of the lactobacilli. It has been suggested that they can irritate the cells that make up the vaginal lining, causing them to break up. The damaged or fragmented cells are then shed with the normal vaginal secretions.

What are the symptoms?

Many women with cytolytic vaginosis are unaware of it. It may be reported after a vaginal swab or cervical smear. It has been associated with the following symptoms:

• Abundant whitish vaginal discharge, which may be thin and watery or thick and curd-like
• Vaginal and/or vulval itching (pruritus vulvae)
• Burning (vulvodynia), especially on passing urine (dysuria)
• Discomfort during sexual intercourse (dyspareunia)

These symptoms are similar to those of vaginal thrush. Like thrush, they have been reported to get worse in the second half of the menstrual cycle. However, it cytolytic vaginosis, high vaginal swabs do not culture the yeast that causes thrush, Candida albicans, and topical antifungal and oral antifungal agents are not effective. The vaginal pH is acidic (3.3 to 5.5).

How is the diagnosis made?

Cytolytic vaginosis has been diagnosed in women with vaginal symptoms that have not settled down or have recurred after treatment for thrush. The laboratory reports numerous lactobacilli and epithelial cells on vaginal swab. There should be no sign of candida or other infective organisms.

What is the treatment for cytolytic vaginosis?

If cytolytic vaginosis is diagnosed, no specific treatment is required. Antifungal medications should be discontinued.

In those with symptoms similar to thrush in the absence of confirmation on swabs, the following measures may be helpful:

• Pads instead of tampons for menstruation.
• Baking soda (sodium bicarbonate) sitz baths or douches to increase vaginal pH and thus discourage the growth of lactobacilli. Use 2-4 tablespoons of baking soda in 5cm of water in a warm bath several times in a week, then once or twice per week to prevent recurrences.