Vaginitis
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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 (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).
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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.
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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.
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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.
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