Veterinary Medicine - October 2008 - (Page 562)

CE PEER-REVIEWED Vaginitis in dogs: A simple approach to a complex condition A deﬁnitive cause of vaginitis, which can range from anatomical abnormalities to systemic conditions, often cannot be determined. But this theriogenologist’s clear diagnostic and treatment plan can help you eliminate the condition’s irritating effects. Margaret V. Root Kustritz, DVM, PhD, DACT V aginitis, by its simplest de nition, is in ammation of the vagina. Vaginitis is not, however, a simple condition. Its pathophysiology is poorly understood, prohibiting our ability to treat it speci cally. This article is a review of what we know about this common condition, with suggestions for diagnosis and treatment. FORMS OF VAGINITIS Two forms of vaginitis are recognized in dogs—juvenile, or puppy, vaginitis and adult-onset vaginitis. Juvenile vaginitis is vaginal in ammation and associated clinical signs in bitches that have not yet undergone puberty. No breed predisposition has been reported. Most affected dogs show minimal or no clinical signs; scant mucoid discharge at the vulvar lips is most commonly described. Often this discharge is an incidental nding at a routine physical examination, seen as whitish-yellow discharge gluing together the vulvar lips. Some bitches may exude a large enough volume of discharge to be of concern to the owner, and some bitches may lick at the vulva. Adult-onset vaginitis is much more common in spayed bitches than in intact ones. The age at onset of clinical signs is variable, and no breed predisposition has been reported. In 80% to 90% of cases, the presenting complaint is mucoid to purulent vulvar discharge.1,2 The next most common presenting complaints are vulvar licking, pollakiuria, and urinary incontinence.2 Occasionally, dogs have clinical signs associated with a concurrent disease (e.g. diabetes mellitus or hepatic disease) that exacerbates the vaginitis. partum lochia. Such pathologic conditions may arise from the reproductive tract (e.g. ovarian remnant syndrome, pyometra or uterine stump pyometra, vaginitis, vaginal neoplasia, a vaginal foreign body such as a foxtail), the urinary tract (e.g. urinary incontinence, a urinary tract infection [UTI], urinary tract neoplasia), or a systemic condition (e.g. canine brucellosis, canine herpesvirus infection, a coagulopathy, atopy). Diagnostic test are the same for juvenile and adult-onset vaginitis. These tests include a cytologic examination of vaginal epithelial cells and vaginal discharge, vaginal and urine bacterial cultures and antimicrobial sensitivity testing, urinalysis, a digital vaginal examination, and vaginoscopy (Figure 1). Juvenile dogs, who generally have mild, self-limiting vaginitis, may not require a complete work-up. Cytologic examination A cytologic examination of the vaginal epithelium in dogs with vaginitis reveals noncorni ed epithelial cells (Figure 2). Vaginal discharge usually appears mucoid to mucopurulent on cytologic examination. In a survey of 15 dogs with vaginitis, 33% had mucoid discharge, 20% had mucopurulent discharge, and 27% had purulent discharge.1 Occasionally, dogs with vaginal in ammation have no vulvar discharge.1,2 Rarely, the discharge is blood-tinged; however, true hemorrhagic discharge has not been described in dogs with uncomplicated vaginitis.1,2 DIAGNOSTIC OVERVIEW Several physiologic and pathologic conditions in dogs may be evidenced by vulvar discharge and vulvar licking. Such physiologic conditions include estrus, whelping, and post- Margaret V. Root Kustritz, DVM, PhD, DACT Department of Veterinary Clinical Sciences College of Veterinary Medicine University of Minnesota St. Paul, MN 55108 Vaginal bacterial culture Any infectious component of vaginitis is considered to occur secondary to some underlying cause of in ammation since the bacteria most commonly cultured from dogs with vaginitis are the normal ora in the vagina, which originate on the skin and Illustration by Joel and Sharon Harris 562 October 2008 VETERINARY MEDICINE

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Veterinary Medicine - October 2008 Contents Leading Off Clinical Exposures Idea Exchange Stalking Stones Vaginitis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - October 2008

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