Vaginitis
Due to Vaginal Infections
Article courtesy of the NIAID:
Vaginitis is an inflammation of the
vagina characterized by discharge, odor, irritation, and/or
itching. The cause of vaginitis may not always be determined
adequately solely on the basis of symptoms or a physical
examination. For a correct diagnosis, a doctor should perform
laboratory tests including microscopic evaluation of vaginal
fluid. A variety of effective drugs are available for treating
vaginitis.
Vaginitis often is caused by infections,
which cause distress and discomfort. Some infections are
associated with more serious diseases. The most common vaginal
infections are bacterial vaginosis, trichomoniasis, and vaginal
yeast infection or candidiasis. Some vaginal infections are
transmitted through sexual contact, but others such as yeast
infections probably are not, depending on the cause.
Bacterial Vaginosis
Bacterial vaginosis (BV) is the most common
cause of vaginitis symptoms among women of childbearing age.
Previously called nonspecific vaginitis or Gardnerella-associated
vaginitis, BV is associated with sexual activity. BV reflects a
change in the vaginal ecosystem. This imbalance, including pH
changes, occurs when different types of bacteria outnumber the
normal ones. Instead of Lactobacillus bacteria being the
most numerous, increased numbers of organisms such as Gardnerella
vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis
are found in the vaginas of women with BV. Investigators are
studying the role that each of these microbes may play in causing
BV, but they do not yet understand the role of sexual activity in
developing BV. A change in sexual partners and douching may
increase the risk of acquiring bacterial vaginosis.
Symptoms. The primary symptom
of BV is an abnormal, odorous vaginal discharge. The fish-like
odor is noticeable especially after intercourse. Nearly half of
the women with clinical signs of BV, however, report no symptoms.
A physician may observe these signs during a physical examination
and may confirm the diagnosis by doing tests of vaginal fluid.
Diagnosis. A healthcare
worker can examine a sample of vaginal fluid under a microscope,
either stained or in special lighting, to detect the presence of
the organisms associated with BV. They can make a diagnosis based
on the absence of lactobacilli, the presence of numerous
"clue cells" (cells from the vaginal lining that are
coated with BV organisms), a fishy odor, and decreased acidity or
change in pH of vaginal fluid.
Treatment. All women with BV
should be informed of their diagnoses, including the possibility
of sexual transmission, and offered treatment. They can be
treated with antibiotics such as metronidazole or clindamycin.
Generally, male sex partners are not treated. Many women with
symptoms of BV do not seek medical treatment, and many
asymptomatic women decline treatment.
Complications. Researchers
have shown an association between BV and pelvic inflammatory
disease (PID), which can cause infertility and tubal (ectopic)
pregnancy. BV also can cause adverse outcomes of pregnancy such
as premature delivery and low-birth-weight infants. Therefore,
the U.S. Centers for Disease Control and Prevention (CDC)
recommends that doctors check all pregnant women for BV who
previously have delivered a premature baby, whether or not the
women have symptoms. If these women have BV, they should be
treated with oral metronidazole or oral clindamycin. A pregnant
woman who has not delivered a premature baby should be treated if
she has symptoms and laboratory evidence of BV. BV is also
associated with increased risk of gonorrhea and HIV infection
(HIV, human immunodeficiency virus, causes AIDS).
Trichomoniasis
Trichomoniasis, sometimes referred to as
"trich," is a common STD that affects 2 to 3 million
Americans yearly. It is caused by a single-celled protozoan
parasite called Trichomonas vaginalis. Trichomoniasis is
primarily an infection of the urogenital tract; the urethra is
the most common site of infection in man, and the vagina is the
most common site of infection in women.
Symptoms. Trichomoniasis,
like many other STDs, often occurs without any symptoms. Men
almost never have symptoms. When women have symptoms, they
usually appear within four to 20 days of exposure. The symptoms
in women include a heavy, yellow-green or gray vaginal discharge,
discomfort during intercourse, vaginal odor, and painful
urination. Irritation and itching of the female genital area, and
on rare occasions, lower abdominal pain also can be present. The
symptoms in men, if present, include a thin, whitish discharge
from the penis and painful or difficult urination.
Treatment. Because men can
transmit the disease to their sex partners even when symptoms are
not present, it is preferable to treat both partners to eliminate
the parasite. Metronidazole is the drug used to treat people with
trichomoniasis. It usually is administered in a single dose.
People taking this drug should not drink alcohol because mixing
the two substances occasionally can cause severe nausea and
vomiting.
Complications. Research has
shown a link between trichomoniasis and two serious sequelae.
Data suggest that trichomoniasis is associated with increased
risk of transmission of HIV and may cause a woman to deliver a
low-birth-weight or premature infant. Additional research is
needed to fully explore these relationships.
Prevention. Use of male
condoms may help prevent the spread of trichomoniasis, although
careful studies have never been done that focus on how to prevent
this infection.
Vaginal Yeast Infection
Vaginal yeast infection or vulvovaginal
candidiasis is a common cause of vaginal irritation. Doctors
estimate that approximately 75 percent of all women will
experience at least one symptomatic yeast infection during their
lifetimes. Yeast are always present in the vagina in small
numbers, and symptoms only appear with overgrowth. Several
factors are associated with increased symptomatic infection in
women, including pregnancy, uncontrolled diabetes mellitus, and
the use of oral contraceptives or antibiotics. Other factors that
may increase the incidence of yeast infection include using
douches, perfumed feminine hygiene sprays, and topical
antimicrobial agents, and wearing tight, poorly ventilated
clothing and underwear. Whether or not yeast can be transmitted
sexually is unknown. Because almost all women have the organism
in the vagina, it has been difficult for researchers to study
this aspect of the natural history.
Symptoms. The most frequent
symptoms of yeast infection in women are itching, burning, and
irritation of the vagina. Painful urination and/or intercourse
are common. Vaginal discharge is not always present and may be
minimal. The thick, whitish-gray discharge is typically described
as cottage-cheese-like in nature, although it can vary from
watery to thick in consistency. Most male partners of women with
yeast infection do not experience any symptoms of the infection.
A transient rash and burning sensation of the penis, however,
have been reported after intercourse if condoms were not used.
These symptoms are usually self-limiting.
Diagnosis. Because few
specific signs and symptoms are usually present, this condition
cannot be diagnosed by the patient's history and physical
examination. The doctor usually diagnoses yeast infection through
microscopic examination of vaginal secretions for evidence of
yeast forms.
Scientists funded by the National Institute
of Allergy and Infectious Diseases (NIAID) have developed a rapid
simple test for yeast infection, which will soon be available for
use in doctors’ offices. If such a test were available for
home screening, it would help them to appropriately use yeast
medication.
Treatment. Various antifungal
vaginal medications are available to treat yeast infection. Women
can buy some antifungal creams, tablets, or suppositories
(butoconazole, miconazole, clotrimazole, and tioconazole) over
the counter for use in the vagina. But because BV,
trichomoniasis, and yeast infection are difficult to distinguish
on the basis of symptoms alone, a woman with vaginal symptoms
should see her physician for an accurate diagnosis before using
these products.
Other products available over the counter
contain antihistamines or topical anesthetics that only mask the
symptoms and do not treat the underlying problem. Women who have
chronic or recurring yeast infections may need to be treated with
vaginal creams for extended periods of time. Recently, effective
oral medications have become available. Women should work with
their physicians to determine possible underlying causes of their
chronic yeast infections. HIV-infected women may have severe
yeast infections that are often unresponsive to treatment.
Other Causes of Vaginitis
Although most vaginal infections in women
are due to bacterial vaginosis, trichomoniasis, or yeast, there
may be other causes as well. These causes may include allergic
and irritative factors or other STDs. Noninfectious allergic
symptoms can be caused by spermicides, vaginal hygiene products,
detergents, and fabric softeners. Cervical inflammation from
these products often is associated with abnormal vaginal
discharge, but can be distinguished from true vaginal infections
by appropriate diagnostic tests.
In an effort to control vaginitis, research
is under way to determine the factors that promote the growth and
disease-causing potential of vaginal microbes. No longer
considered merely a benign annoyance, vaginitis is the object of
serious investigation as scientists attempt to clarify its role
in such conditions as pelvic inflammatory disease and
pregnancy-related complications.
