Regardless of whether or not the patient complains of such symptoms, it is important to routinely question all women presenting for care whether or not they are experiencing vaginal discharge or vulval itching or burning. If symptomatic, the patient should be evaluated for vaginitis, which is caused by bacterial vaginosis, trichomoniasis, and candidiasis. Diagnosis of vaginitis is made based on exam findings, wet mount and gram stain microscopy, and pH and KOH tests per Protocol 2.7; empiric treatment can also be considered without a pelvic exam or in the absence of laboratory evaluations.

In pregnant women, bacterial vaginosis has been associated with increased risk of preterm labor, premature rupture of membranes, late miscarriages, and MTCT of HIV. Treatment of asymptomatic vaginal infections during pregnancy has been shown to reduce preterm delivery by 50 percent.¹⁴⁷ All pregnant women, whether symptomatic or asymptomatic, should thus be screened for vaginal infections and treated as necessary early during the second trimester.