Clinical Parasitology of the Female Genital Tract: Parasitic Etiologies in the Differential Diagnosis of Persistent Vulvovaginal Symptoms: A Narrative Review

Abstract

Background: Persistent or recurrent vulvovaginal symptoms are frequently attributed to vulvovaginal candidiasis, bacterial vaginosis, or dermatitis. However, a purely syndromic approach often leads to repeated empirical treatment and may overlook parasitic etiologies that require specific diagnostic testing and targeted management.

Objective: To critically review the clinical relevance of parasitic infections affecting the female genital tract and their role in the differential diagnosis of persistent vulvovaginal symptoms, integrating evidence from parasitology and gynecological practice.

Methods: A structured narrative review was conducted using clinical guidelines, review articles, observational studies, and case reports addressing Trichomonas vaginalis, Enterobius vermicularis, Giardia duodenalis, and diagnostic approaches to persistent vulvovaginal symptoms. Recent publications and authoritative guidelines were prioritized, while case reports were included as low-level evidence for rare ectopic parasitic infections.

Results: Trichomonas vaginalis is a common sexually transmitted infection with well-established molecular diagnostic methods and standardized treatment. Enterobius vermicularis is primarily an intestinal helminth but may cause vulvoperineal pruritus and, rarely, ectopic involvement of the female genital tract. Evidence regarding Giardia duodenalis in the female genital tract remains scarce and heterogeneous, with no convincing data supporting its role as an established cause of vulvovaginitis.

Conclusions: The clinical value of parasitology in this setting lies in adopting a targeted diagnostic approach: testing for T. vaginalis in women presenting with vaginal discharge and risk factors for sexually transmitted infections, investigating enterobiasis in patients with nocturnal pruritus or a compatible epidemiological context, and avoiding attribution of genital symptoms to Giardia in the absence of supportive intestinal or epidemiological evidence.