Vaginitis

Vaginitis is a term for any infection or inflammation of the vagina. Vaginitis is a very common disease affecting millions of women each year. The three most common vaginal infections are bacterial vaginosis (BV), Candida vaginitis (yeast infection) and Trichomonas vaginitis.

Types

It is normal for women to have vaginal discharge. This discharge or fluid contains a combination of secretions made by glands in the vagina, vaginal cells that have sloughed off and certain types of bacteria and even yeast. Lactobacillus are bacteria that help keep the pH (acid level) in the vagina at the correct level. Normally, there are a small number of yeast fungus cells that are seen in the vagina. However, if there is an overgrowth of another type of bacteria or of yeast cells, the woman will become symptomatic.

There are a several different kinds of vaginitis, each with their own causes and symptoms. The three most common causes are:

• Candida or “yeast” infections – Yeast infections of the vagina are probably the most familiar form of vaginitis. They occur when too much of the fungus Candida grows in the vagina.

Yeast infections produce a thick, white discharge from the vagina that can look like cottage cheese. The discharge can be watery and often has no smell. Yeast infections usually cause the vagina and vulva (the area outside the vagina) to become itchy and red.

• Bacterial vaginosis – is the most common vaginal infection in women of reproductive age. It is caused by an overgrowth of bacteria that are usually present in the vagina.

This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells,” epithelial cells that have had bacteria adhere to their surface, obscuring their borders, and imparting a stippled appearance. The presence of clue cells is a sign that the patient has bacterial vaginosis. Source: CDC PHIL/M. Rein.

Bacterial vaginosis will often cause a thin, milky discharge from the vagina that may have a “fishy” odor. Often, the "fishy" odor (caused by amines) will increase after sexual intercourse. However, many women with bacterial vaginosis have no symptoms and only discover they have it during a routine gynecologic exam.

• Trichomoniasis – Trichomoniasis is a sexually transmitted disease that is caused by a single-cell parasite called Trichomonas. It can cause vaginal itching, burning, and soreness of the vagina and vulva, as well as burning during urination. But, usually women with trichomoniasis do not develop any symptoms.

Less common causes of vaginitis are:

• Chlamydia, a sexually transmitted disease, can cause vaginitis. Most women do not have symptoms. An increase in vaginal discharge is sometimes present with this infection but not always. More often a woman might experience light bleeding especially after intercourse. Chlamydial vaginitis is most common in young women under the age of 30 who have multiple sex partners.
• Viral vaginitis can be caused by herpes simplex virus that is spread by sexual intercourse. The primary symptom of herpes vaginitis is acute pain associated with lesions or sores. These sores start as blisters and then pop to release more virus. The sores are usually visible on the vulva (lips of the vagina), vagina, anal area or on the penis.
• Non-infectious vaginitis – This form of vaginitis is usually caused by an allergic reaction or irritation from vaginal sprays, douches, spermicidal products, sanitary pads, soaps, detergents, or fabric softeners. It can cause burning, itching, or vaginal discharge even if there is no infection.

Symptoms

The common symptoms of vaginitis are itching, burning, and vaginal discharge that is different from the normal secretions. The itching and burning can be on the inside of the vagina or on the vulva (lips) just outside the vagina. Discomfort during urination or sexual intercourse also sometimes occurs.

Often there are no symptoms of vaginitis. A routine gynecologic exam can confirm vaginitis even if symptoms are not present. For this reason, it is important to have a gynecologic exam at regular intervals.

Treatment

The key to treating vaginitis is knowing which type a woman has. The treatment must be specific to the type of vaginitis present.

• Yeast infections are usually treated with an anti-yeast cream or suppository placed inside the vagina. Although you can also buy medicine to treat yeast infections over-the-counter (such as miconozole), it is a good idea to see a health care provider the first time you have symptoms of a yeast infection. Because this medicine will not cure other types of vaginitis, it is important to be sure you actually have a yeast infection before using these treatments.
• Bacterial vaginosis is treated with an antibiotic (by mouth or by using a vaginal cream) that gets rid of the “bad” bacteria and leaves the “good” lactobacillus bacteria. There is no over-the-counter treatment for bacterial vaginosis.
• Sexually transmitted forms of vaginitis need to be treated right away. It is important to avoid sexual contact until you have been treated to prevent spreading the infection. Any sexual partner(s) will need treatment as well.

Trichomoniasis and Chlamydia are both treated by antibiotics. Genital herpes cannot be cured, but there are effective medicines which can help prevent outbreaks.

• Non-infectious vaginitis (allergic vaginitis) can be treated by stopping the use of the product that caused the allergic reaction or irritation. Your health care provider may also be able to provide medicated cream to help reduce the symptoms until the reaction goes away.

It is important to remember that each type of vaginitis has a different treatment. Therefore it is very important to see a health care provider to be sure you are using the right treatment for your condition. Also, some kinds of vaginitis have no symptoms so it is important to have regular gynecologic exams.

Prevention

There are some things a woman can do to lower her chances of getting vaginitis.

• If a woman get yeast infections often, she should avoid clothes that hold in heat and moisture. It is better to wear cotton underwear and avoid nylon underwear (even if the synthetic underwear has a cotton crotch). Panty hose and tight jeans can also increase yeast infections.

In addition, it is always best to not stay in gym clothes. After a workout, these clothes are often moist and warm and this is a breeding ground for yeast. If a woman gets yeast infections very often, she should be checked for diabetes. The high sugar levels in a diabetic woman's tissues can increase the risk of yeast infections.

• Avoid douches and vaginal sprays because they can kill “good” bacteria or cause irritation.
• Practicing safe sex by using condoms can help protect against sexually transmitted forms of vaginitis.

Related Problems

Complications

Complications of vaginitis can occur.

• If bacterial vaginosis is left untreated, it can increase the risk of developing pelvic inflammatory disease, pregnancy complications including preterm birth and infections after gynecologic surgery.
• Chlamydia and Gonorrhea can cause Pelvic Inflammatory Disease(PID) which can cause scaring in the fallopian tubes which leads to infertility. These infections can also cause abcesses (pockets of pus) in the fallopian tubes and ovaries which may require removal of these organs and the uterus.

Research

To control vaginitis, research is under way to determine the factors that promote the growth and disease-causing potential of harmful vaginal microbes. This information could help improve efforts to treat and prevent vaginitis. Some scientists are trying to clarify its role in such conditions as pelvic inflammatory disease and pregnancy-related complications.

Recent research has uncovered important information about yeast’s reproductive behavior, which could lead the way to new treatments for yeast infections.

Additionally, researchers discovered an association between lactobacilli and protection from bacterial vaginitis (BV). They then developed a Lactobacillus vaginal suppository that helps beneficial bacteria grow in the vagina. Researchers are now studying the use of vaginal lactobacilli suppositories with oral metronidazole to treat and prevent BV.

Other researchers completed sequencing the genetic code of Trichomonas vaginalis. Scientists are beginning to understand its biology and to find new and innovative ways to prevent the disease it causes. Trichomonas vaginalis is also of particular interest to medical researchers because of its role in HIV transmission, infant morbidity, and the predisposition to cervical cancer. ^[1]

Other Resources

There are several commercially available test kits for home diagnosis of vaginal yeast infection. It is important to visit a health care professional if symptoms change or worsen of if self-treatment is ineffective.

• Savvycheck Yeast Test
• Vagisil Screening Kit

References

1. ↑ JM Carlton, RP Hirt, JC Silva, AL Delcher, M Schatz, Q Zhao et al. Draft Genome Sequence of the Sexually Transmitted Pathogen Trichomonas vaginalis. 2007 Science 315 (5809), 207. Abstract | Full Text | Press Release

External Links

• American College of Obstetricians and Gynecologists: Vaginitis, Causes and Treatments
• CDC: Candidiasis
• MayoClinic.com: Vaginitis
• MedicineNet:Bacterial Vaginosis
• FamilyDoctor.org:Bacterial Vaginosis
• National Institutes of Health:Bacterial Vaginosis
• CDC: Bacterial Vaginosis
• WomensHealth.gov: STD Bacterial Vaginosis