The Nugent Score is now rarely used by physicians due to the time it takes to read the slides and requires the use of a trained microscopist. A score of 0-10 is generated from combining three other scores. The scores are as follows:

- 0–3 is considered negative for BV

- 4–6 is considered intermediate

- 7+ is considered indicative of BV.

At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.

DNA hybridization testing with Affirm VPIII was compared to the Gram stain using the Nugent criteria. The Affirm VPIII test may be used for the rapid diagnosis of BV in symptomatic women but uses expensive proprietary equipment to read results, and does not detect other pathogens that cause BV, including Prevotella spp, Bacteroides spp, & Mobiluncus spp.

To make a diagnosis of bacterial vaginosis, a swab from inside the vagina should be obtained. These swabs should be tested for:

- A characteristic "fishy" odor on wet mount. This test, called the "whiff test", is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis.

- Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis.

- The presence of "clue cells" on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria.

Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all three criteria are needed.

Differential diagnosis for bacterial vaginosis includes the following:

- Normal vaginal discharge.

- Candidiasis (thrush, or a yeast infection).

- Trichomoniasis, an infection caused by "Trichomonas vaginalis".

- Aerobic vaginitis

The Center For Disease Control (CDC) defines STIs as "a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity." But the CDC does not specifically identify BV as sexually transmitted infection.

Diagnosis is typically suspected based on a women's symptoms. Diagnosis is made with microscopy (mostly by vaginal wet mount) and culture of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. Determining the agent is especially important because women may have more than one infection, or have symptoms that overlap those of another infection, which dictates different treatment processes to cure the infection. For example, women often self-diagnose for yeast infections but due to the 89% misdiagnosis rate, self-diagnoses of vaginal infections are highly discouraged.

Another type of vaginitis, called desquamative inflammatory vaginitis (DIV) also exists. The cause behind this type is still poorly understood. DIV corresponds to the severe forms of aerobic vaginitis. About 5 to 10% of women are affected by aerobic vaginitis.

The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:

Prevention of candidiasis, the most common type of vaginitis, includes using loose cotton underwear. The vaginal area should be washed with water. Perfumed soaps, shower gels, and vaginal deodorants should be avoided. Douching is not recommended. The practice upsets the normal balance of yeast in the vagina and does more harm than good.

Prevention of bacterial vaginosis includes healthy diets and behaviors as well as minimizing stress as all these factors can affect the pH balance of the vagina.

Prevention of trichomoniasis revolves around avoiding other people's wet towels and hot tubs, and safe-sex procedures, such as condom use.

Some women consume good bacteria in food with live culture, such as yogurt, sauerkraut and kimchi, or in probiotic supplements either to try to prevent candidiasis, or to reduce the likelihood of developing bacterial vaginitis following antibiotic treatment. There is no firm evidence to suggest that eating live yogurt or taking probiotic supplements will prevent candidiasis.

Studies have suggested a possible clinical role for the use of standardized oral or vaginal probiotics in the treatment of bacterial vaginosis, either in addition to or in place of the typical antibiotic regimens. However, recent articles question their efficacy in preventing recurrence compared with other means, or conclude that there is insufficient evidence for or against recommending probiotics for the treatment of bacterial vaginosis.

In the United Kingdom, NGU is more often called non-specific urethritis; "" is a medical term meaning "specific cause has not been identified", and in this case refers to the detection of urethritis, and the testing for but found negative of gonorrhea. In this sense, the most likely cause of NSU is a chlamydia infection.

However, the term NSU is sometimes distinguished and used to mean that both gonorrhea and chlamydia have been ruled out. Thus, depending on the sense, chlamydia can either be the most likely cause or have been ruled out, and frequently detected organisms are "Ureaplasma urealyticum" and "Mycoplasma hominis".

Use of male condoms or female condoms may help prevent the spread of trichomoniasis, although careful studies have never been done that focus on how to prevent this infection. Infection with Trichomoniasis through water is unlikely because "Trichomonas vaginalis" dies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in d urine after 5–6 hours.

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing. The Centers for Disease Control and Prevention (CDC) recommends Trichomoniasis testing for females with vaginal discharge and can be considered for females at higher risk for infection or of HIV-positive serostatus.

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women. Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis in the U.S., which can lead to better prevention efforts.

A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments.

About 5-8% of the reproductive age female population will have four or more episodes of symptomatic Candida infection per year; this condition is called recurrent vulvovaginal candidiasis (RVVC). Because vaginal and gut colonization with Candida is commonly seen in people with no recurrent symptoms, recurrent symptomatic infections are not simply due to the presence of Candida organisms. There is some support for the theory that RVVC results from an especially intense inflammatory reaction to colonization. Candida antigens can be presented to antigen presenting cells, which may trigger cytokine production and activate lymphocytes and neutrophils that then cause inflammation and edema.

It has been easy to test for the presence of gonorrhea by viewing a Gram stain of the urethral discharge under a microscope: The causative organism is distinctive in appearance; however, this works only with men because other non-pathogenic gram-negative microbes are present as normal flora of the vagina in women. Thus, one of the major causes of urethritis can be identified (in men) by a simple common test, and the distinction between gonococcal and non-gonococcal urethritis arose for this reason.

Non-gonococcal urethritis (NGU) is diagnosed if a person with urethritis has no signs of gonorrhea bacteria on laboratory tests. The most frequent cause of NGU (23%-55% of cases) is "C. trachomatis".

For infrequent recurrences, the simplest and most cost-effective management is self-diagnosis and early initiation of topical therapy. However, women whose condition has previously been diagnosed with candidal vulvovaginitis are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an over the counter preparation, or who has a recurrence of symptoms within 2 months, should be evaluated with office-based testing. Unnecessary or inappropriate use of topical preparations is common and can lead to a delay in the treatment of other causes of vulvovaginitis, which can result in worse outcomes.

When there are more than four recurrent episodes of candidal vulvovaginitis per year, a longer initial treatment course is recommended, such as orally administered fluconazole followed by a second and third dose 3 and 6 days later, respectively.

Other treatments after more than four episodes per year, may include ten days of either oral or topical treatment followed by fluconazole orally once per week for 6 months. About 10-15% of recurrent candidal vulvovaginitis cases are due to non-"Candida albicans" species. Non-"albicans" species tend to have higher levels of resistance to fluconazole. Therefore, recurrence or persistence of symptoms while on treatment indicates speciation and antifungal resistance tests to tailor antifungal treatment.

Salpingitis may be diagnosed by pelvic examination, blood tests, and/or a vaginal or cervical swab.

There are three main ways to test for Trichomoniasis.

- The first is known as saline microscopy. This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope. The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60-70%) often due to an inadequate sample, resulting in false negatives.

- The second diagnostic method is culture, which has historically been the "gold standard" in infectious disease diagnosis. Trichomonas Vaginalis culture tests are relatively cheap; however, sensitivity is still somewhat low (70-89%).

- The third method includes the nucleic acid amplification tests (NAATs) which are more sensitive. These tests are more costly than microscopy and culture, and are highly sensitive (80-90%).

Regular testing for sexually transmitted infections is encouraged for prevention. The risk of contracting pelvic inflammatory disease can be reduced by the following:

- Using barrier methods such as condoms; see human sexual behavior for other listings.

- Seeking medical attention if you are experiencing symptoms of PID.

- Using hormonal combined contraceptive pills also helps in reducing the chances of PID by thickening the cervical mucosal plug & hence preventing the ascent of causative organisms from the lower genital tract.

- Seeking medical attention after learning that a current or former sex partner has, or might have had a sexually transmitted infection.

- Getting a STI history from your current partner and strongly encouraging they be tested and treated before intercourse.

- Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.

- Reducing the number of sexual partners.

- Sexual monogamy.

- Abstinence

A vaginal yeast infection results from overgrowth of candida albicans, or yeast, in the vagina. This is a relatively common infection, with over 75% of women having experienced at least one yeast infection at some point in their life. Risk factors for yeast infections include recent antibiotic use, diabetes, immunosuppression, increased estrogen levels, and use of certain contraceptive devices including intrauterine devices, diaphragms, or sponges. It is not a sexually transmitted infection. Candida vaginal infections are common; an estimated 75% of women will have at least one yeast infection in their lifetime. Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. Vaginal itching is the most common symptom of candida vulvovaginitis. Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. The diagnosis of Candida vulvovaginitis is made by looking at a sample taken from the vagina under the microscope that shows hyphae (yeast), or from a culture. It is important to note that the symptoms described above may be present in other vaginal infections, so microscopic diagnosis or culture is needed to confirm the diagnosis. Treatment is with intra-vaginal or oral anti-fungal medications.

Trichomonas vaginitis is an infection acquired through sex that is associated with vaginal discharge. It can be transmitted by way of the penis to the vagina, the vagina to the penis, or from vagina to vagina. The discharge in Trichomonas is typically yellowish-green in color. It sometimes is frothy and can have a foul smell. Other symptoms may include vaginal burning or itching, pain with urination, or pain with sexual intercourse. Trichomonas is diagnosed by looking at a sample of discharge under the microscope showing trichomonads moving on the slide. However, in women with trichomonas the organism is typically detected in only 60-70% of cases. Other testing, including a culture of the discharge or a PCR assay, are more likely to detect the organism. Treatment is with a one time dose of oral antibiotics, most commonly metronidazole or tindazole.

Over one million cases of acute salpingitis are reported every year in the US, but the number of incidents is probably larger, due to incomplete and untimely reporting methods and that many cases are reported first when the illness has gone so far that it has developed chronic complications. For women age 16–25, salpingitis is the most common serious infection. It affects approximately 11% of females of reproductive age.

Salpingitis has a higher incidence among members of lower socioeconomic classes. However, this is thought of being an effect of earlier sex debut, multiple partners, and decreased ability to receive proper health care rather than any independent risk factor for salpingitis.

As an effect of an increased risk due to multiple partners, the prevalence of salpingitis is highest for people age 15–24 years. Decreased awareness of symptoms and less will to use contraceptives are also common in this group, raising the occurrence of salpingitis.

A number of other causes may produce similar symptoms including appendicitis, ectopic pregnancy, hemorrhagic or ruptured ovarian cysts, ovarian torsion, and endometriosis and gastroenteritis, peritonitis, and bacterial vaginosis among others.

Pelvic inflammatory disease is more likely to reoccur when there is a prior history of the infection, recent sexual contact, recent onset of menses, or an IUD (intrauterine device) in place or if the partner has a sexually transmitted infection.

Acute pelvic inflammatory disease is highly unlikely when recent intercourse has not taken place or an IUD is not being used. A sensitive serum pregnancy test is typically obtained to rule out ectopic pregnancy. Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix).

Pelvic and vaginal ultrasounds are helpful in the diagnosis of PID. In the early stages of infection, the ultrasound may appear normal. As the disease progresses, nonspecific findings can include free pelvic fluid, endometrial thickening, uterine cavity distension by fluid or gas. In some instances the borders of the uterus and ovaries appear indistinct. Enlarged ovaries accompanied by increased numbers of small cysts correlates with PID.

Laparoscopy is infrequently used to diagnose pelvic inflammatory disease since it is not readily available. Moreover, it might not detect subtle inflammation of the fallopian tubes, and it fails to detect endometritis. Nevertheless, laparoscopy is conducted if the diagnosis is not certain or if the person has not responded to antibiotic therapy after 48 hours.

No single test has adequate sensitivity and specificity to diagnose pelvic inflammatory disease. A large multisite U.S. study found that cervical motion tenderness as a minimum clinical criterion increases the sensitivity of the CDC diagnostic criteria from 83 percent to 95 percent. However, even the modified 2002 CDC criteria do not identify women with subclinical disease.

Leukorrhea may be caused by sexually transmitted diseases; therefore, treating the STD will help treat the leukorrhea.

Treatment may include antibiotics, such as metronidazole. Other antibiotics common for the treatment of STDs include clindamycin or trinidazole.

The following measures are advisable for keeping the vulva and vagina healthy:

- Avoiding washing with soap, since soap disturbs the natural pH balance of the vagina. Some pH-balanced soaps exist, but their effects remain unclear. Other measures are seldom necessary or advisable. Two notable examples: so-called "feminine hygiene sprays" are unnecessary, may be generally harmful, and have been known to cause severe allergic reactions. Vaginal douching is generally not necessary and has been implicated in helping to cause bacterial vaginosis (BV) and candidiasis ("yeast infections").

- After using the toilet, wipe from the front toward the back to avoid introducing bacteria from the anal area into the vulva. Use non-perfumed, undyed toilet paper.

- Drink plenty of water and urinate frequently and as soon as possible when you feel the need, to help flush bacteria out of the urinary tract and avoid urinary tract infections. For the same reason, try to urinate before and after sex.

- Change out of a wet swimsuit or other wet clothes as soon as possible.

- Avoid fragrances, colours, and "deodorants" in products that contact the vulva/vagina: sanitary napkins, tampons, and toilet paper. Some women who are sensitive to these substances should also avoid bubble baths and some fabric detergents and softeners.

- Use a menstrual cup instead of sanitary pads or tampons. Menstrual cups are a new form of menstrual product that has recently been rapidly gaining in popularity as a greener, more cost-effective and healthier alternative to tampons and sanitary pads.

- Avoid wearing leather trousers, tight jeans, panties made of nylon or other synthetic fabrics, or pantyhose without an all-cotton crotch (not cotton covered by nylon - cut out the nylon panel if necessary).

- Anything which has been in contact with the anal area (see anal sex) should be thoroughly washed with soap and water or a disinfectant before coming in contact with the vulva or vagina.

- Use condoms during heterosexual intercourse, practise safer sex, know your sex partners, ask sex partners to practise basic hygiene of their genitals. Use artificial lubrication during the intercourse if the amount naturally produced is not enough.

- Be careful with objects inserted inside the vagina. Improper insertion of objects into any body opening can cause damage: infection, cutting, piercing, trauma, blood loss, etc.

- Avoid letting any contaminants inside the vagina, including dirt but especially sand.

- See your gynecologist regularly.

- Be careful while removing hair in this area.

Women who are unable to walk are more likely to have infections. The problem can be prevented according to above-mentioned and following measures:

- Wash crotch and rectal areas (with a soap-substitute if desired) and large amount of warm running water, every morning and evening. The disabled person can sit on a shower chair with an open seat or on a toilet. Use a shower head or water container to wash more directly.

- Use towel to dry.

- DO NOT use talcum/body powder, if desired use corn starch powder (corn-flour) on the skin of the genital area to absorb perspiration.

- Avoid sitting on plastic or synthetic materials for extended lengths of time.

- Wear loose underpants and change if soilage or wetness occurs.

The diagnosis usually is made serologically (through complement fixation) and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Serologic testing has a sensitivity of 80% after 2 weeks. Serologic testing may not be specific for serotype (has some cross reactivity with other chlamydia species) and can suggest LGV from other forms because of their difference in dilution, 1:64 more likely to be LGV and lower than 1:16 is likely to be other chlamydia forms (emedicine).

For identification of serotypes, culture is often used. Culture is difficult. Requiring a special medium, cycloheximide-treated McCoy or HeLa cells, and yields are still only 30-50%. DFA, or direct fluorescent antibody test, PCR of likely infected areas and pus, are also sometimes used. DFA test for the L-type serovar of C trachomatis is the most sensitive and specific test, but is not readily available.

If polymerase chain reaction (PCR) tests on infected material are positive, subsequent restriction endonuclease pattern analysis of the amplified outer membrane protein A gene can be done to determine the genotype.

Recently a fast realtime PCR (TaqMan analysis) has been developed to diagnose LGV. With this method an accurate diagnosis is feasible within a day. It has been noted that one type of testing may not be thorough enough.

Leukorrhea is also caused by trichomonads, a group of parasitic protozoan, specifically "Trichomonas vaginalis". Common symptoms of this disease are burning sensation, itching and discharge of frothy substance, thick, white or yellow mucous.

Sexually transmitted disease that affect the vagina include:

- Herpes genitalis. The herpes simplex virus (HSV) can infect the vulva, vagina, and cervix, and this may result in small, painful, recurring blisters and ulcers. It is also common for there to be an absence of any noticeable symptoms.

- Gonorrhea

- Chlamydia

- Trichomoniasis

- Human papillomavirus (HPV), which may cause genital warts.

HIV/AIDS can be contracted through the vagina during vaginal intercourse, but it is not associated with any local vaginal or vulval disease.

Because of STIs, health authorities and other health outlets recommend safe sex practices when engaging in sexual activity.

Vaginitis an inflammation of the vagina, such as caused by infection, hormone disturbance and irritation/allergy.

As with all STIs, sex partners of patients who have LGV should be examined and tested for urethral or cervical chlamydial infection. After a positive culture for chlamydia, clinical suspicion should be confirmed with testing to distinguish serotype. Antibiotic treatment should be started if they had sexual contact with the patient during the 30 days preceding onset of symptoms in the patient. Patients with a sexually transmitted disease should be tested for other STDs due to high rates of comorbid infections. Antibiotics are not without risks and prophylaxtic broad antibiotic coverage is not recommended.

Vulvitis, inflammation of the vulva, can have a variety of etiologies in children and adolescents, including allergic dermatitis, contact dermatitis, lichen sclerosus, and infections with bacteria, fungi, and parasites. Dermatitis in infants is commonly caused by a soiled diaper being left on for an extended period of time. Increasing the frequency of diaper changes and topical application of emollients are sufficient to resolve most cases. Dermatitis of the vulva in older children is usually caused by exposure to an irritant (e.g. scented products that come into contact with the vulva, laundry detergent, soaps, etc.) and is treated with preventing exposure and encouraging sitz baths with baking soda as the vulvar skin heals. Other treatment options for vulvar dermatitis include oral hydroxyzine hydrochloride or topical hydrocortisone.

Lichen sclerosus is another common cause of vulvitis in children, and it often affects an hourglass or figure eight-shaped area of skin around the anus and vulva. Symptoms of a mild case include skin fissures, loss of skin pigment (hypopigmentation), skin atrophy, a parchment-like texture to the skin, dysuria, itching, discomfort, and excoriation. In more severe cases, the vulva may become discolored, developing dark purple bruising (ecchymosis), bleeding, scarring, attenuation of the labia minora, and fissures and bleeding affecting the posterior fourchette. Its cause is unknown, but likely genetic or autoimmune, and it is unconnected to malignancy in children. If the skin changes are not obvious on visual inspection, a biopsy of the skin may be performed to acquire an exact diagnosis. Treatment for vulvar lichen sclerosus may consist of topical hydrocortisone in mild cases, or stronger topical steroids (e.g. clobetasol propionate). Preliminary studies show that 75% of cases do not resolve with puberty.

Organisms responsible for vulvitis in children include pinworms ("Enterobius vermicularis"), "Candida" yeast, and group A hemolytic "Streptococcus". Though pinworms mainly affect the perianal area, they can cause itching and irritation to the vulva as well. Pinworms are treated with albendazole. Vulvar "Candida" infections are uncommon in children, and generally occur in infants after antibiotic therapy, and in children with diabetes or immunodeficiency. "Candida" infections cause a red raised vulvar rash with satellite lesions and clear borders, and are diagnosed by microscopically examining a sample treated with potassium hydroxide for hyphae. They are treated with topical butoconazole, clotrimazole, or miconazole. "Streptococcus" infections are characterized by a dark red discoloration of the vulva and introitus, and cause pain, itching, bleeding, and dysuria. They are treated with antibiotics.

Proper treatment will usually relieve the symptoms, at least to some extent.