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Vaginitis Due to Vaginal Infections
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.
National Institutes of Health
June 1998
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