ABSTRACT
BACKGROUND This is a grouping of clinical infections that is not part of the daily, weekly, or monthly outpatient office routine of most gynecologists. Physicians in clinics, emergency rooms, or sexually transmitted disease (STD) clinics that service the urban poor around the world, more commonly encounter STDs of the vulva and vagina. For the physician in private practice, these vulvovaginal conditions are rarely seen, and because of this, most physicians are unfamiliar with both the clinical manifestations and the available laboratory tests that can help confirm the diagnosis. Because these infections are uncommon, there can be problems with any diagnostic work-up. For an exercise in frustration, try to arrange for a dark field microscopic examination of the exudate of a suspicious vulvar lesion to rule out syphilis in a patient seen in an office, separate from a hospital! The equipment is rarely available and there are few physicians both competent and available to acquire the specimen properly and to evaluate the microscopic findings accurately. The more frequently seen, but still uncommon vulvar lesions, molluscum contagiosum, pediculosis pubis, and scabies, are most
frequently seen in urban, poor young women. In the United States, these women have limited or no access to the private health care system. These patients are more likely to be seen in hospital emergency rooms, gynecologic clinics, or STD clinics. In the referral vulvovaginitis clinic at Cornell, an occasional patient is seen with molluscum contagiosum, and patients with pediculosis pubis are rarely encountered. These are not common entities for the average physician in practice.
