Vaginal Itching (Pruritus Vulvae): Test and Diagnosis

Laboratory parameters of the 1st order – obligatory laboratory tests.

  • Amine test (Whiff test) – by sprinkling the vaginal secretion with a 10% potassium hydroxide solution typical fishy odor (= amine colpitis).
  • Measurement of the pH of the vaginal secretion (vaginal secretion) [alkaline?]
  • Phase contrast microscopy of the vaginal secretion – living, unstained cells appear extremely low in contrast in the normal bright field microscope, these are well visualized by the phase contrast method
  • Urine examination by means of a test strip:
    • A rapid test for nitrite detects nitrite-forming bacteria in urine, if applicable. [Nitrate detection in urinary tract infection: 95% with positive nitrate test have positive cultures, however, also 45% with negative test, this especially in infants].
    • Likewise, leukocyturia (excretion of white blood cells in the urine) may be detectable.
    • Urine pH values > 7.0 in the pH daily profile = indication of a urinary tract infection with urease-forming bacteria (risk of infection stone formation).
  • Urine sediment
  • Urine culture* (pathogen detection and resistogram) from midstream urine if necessary catheter urine.

Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. — for differential diagnostic clarification.

  • Small blood count
  • Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
  • Fasting glucose (fasting blood glucose), if necessary oral glucose tolerance test (oGTT).
  • Thyroid parameters – TSH, fT3, fT4
  • Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin.
  • Renal parameters – urea, creatinine, cystatin C or creatinine clearance, if necessary.
  • Bacteriological/mycological/virological culture – cultivation of bacteria/fungi/viruses from the vulva and or from vaginal secretions or vesicles (herpes) in acute and recurrent inflammation.
  • Virus detection
    • Molecular genetic diagnostics (DNA or PCR): HIV (AIDS), herpes simplex virus type 1/2 (genital herpes), human papilloma virus (HPV; condylomata acuminata).
    • Other detection: herpes viruses:
      • From vesicle smear applied to a microscope slide. Determination of the virus type by fluorescence test using type-specific immune sera if necessary direct antigen test (fluorescence test).
      • Histologically after biopsy (fine tissue examination of a tissue sample).
      • Colposcopic: dabbing with 3% acetic acid (affected skin areas turn white).
      • Cytological smear (“cancer smear”).
  • Parasite detection (microscopic): crabs (Pediculi pubis), oxyurans (pinworms), scabies (scabies), Trichomonas vaginalis (trichomoniasis).
  • Antibodies against Chlamydia trachomatis, Treponema pallidum (TPHA, VDRL, etc.) – due toexclusion of sexually transmitted infections).
  • Biopsy for histological examination
  • Cytology