Infectious diseases of the lower female genital tract include a variety of bacterial, viral, fungal, and parasitic infections that are commonly, but not exclusively, sexually transmitted. Some pathogens can cause significant discomfort, but the infection resolves without complications in most cases, whereas others are associated with serious complications such as infertility or cancers of the lower genital tract. Sexually transmitted diseases (STDs) are a global public health issue and have serious impact on health care costs in the USA. Most infections of the lower female genital tract are diagnosed clinically, and tissue biopsies are rarely performed. In the setting of cases with atypical clinical presentations or rare infections, tissue biopsy may be acquired; therefore, it is important for pathologists to be familiar with these entities and their histopathologic features to avoid misdiagnosis of these rather common infections. This chapter reviews clinical and pathologic presentations of common infections of the lower female genital tract, and incorporates the latest guidelines available for each entity. Human papillomavirus infection is briefly discussed under common sexually transmitted infections and generalized genital warts in patients with immunosuppression, and further reviewed in detail in other chapters. It also includes rare entities in the USA that should be considered in the differential diagnosis of patients with human immunodeficiency virus infection and vulvovaginal involvement by systemic infections in immunosuppressed individuals.