Desquamative inflammatory vaginitis: a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy

Abstract

Objective: Desquamative inflammatory vaginitis is an uncommon clinical syndrome of unknown cause characterized by diffuse exudative vaginitis, epithelial cell exfoliation, and a profuse purulent vaginal discharge. The purpose of this report is to describe 51 patients with desquamative inflammatory vaginitis, the majority of whom were treated with 2% topical clindamycin in an open observational study.

Study design: A retrospective chart review found 51 patients seen in a referral university vaginitis clinic between 1987 and 1993 who met the case definition of desquamative inflammatory vaginitis. All patients had diffuse exudative purulent vaginitis, signs of epithelial cell exfoliation (increased parabasal cells), elevated vaginal pH, and Gram stain findings of complete or relative absence of the normal long gram-positive bacilli and their replacement by gram-positive cocci.

Results: No consistent microbiologic pathogen was identified except for the absence of lactobacilli and an overall increase in prevalence of group B streptococci. Intravaginal treatment with 2% clindamycin suppositories resulted in clinical improvement in > 95% of patients and, although relapse occurred in 30%, overall antimicrobial cure was accomplished in all patients. Postmenopausal patients with desquamative inflammatory vaginitis occasionally required supplementary estrogen therapy to maintain remission.

Conclusion: Desquamative inflammatory vaginitis responsive to topical clindamycin 2% therapy represents an uncommon cause of purulent vaginitis with unique clinical and laboratory characteristics. Evidence suggests a microbial, possibly gram-positive coccal, cause for this syndrome, although a specific bacterial species responsible for all cases has not been identified. The majority of cases occurred in patients in whom estrogen deficiency may have played a role in pathogenesis.