VAGINITIS types, causes and treatment

VAGINITIS types, causes and treatment

VAGINITIS

Inflammation and infection of the vagina are common gynecologic complaints, resulting from a variety of patho­gens, allergic reactions to vaginal contraceptives or other products, vaginal atrophy, or friction during coitus. The normal vaginal pH is 4.5 or less, and Lactobacillus is the predominant organism. Normal secretions during the middle of the cycle, or during pregnancy, can be confused with vaginitis by concerned women.

What causes vaginitis?

Bacterial vaginosis (BV) is the most common vaginal infection in women ages 15-44. It happens when there is an imbalance between the “good” and “harmful” bacteria that are normally found in a woman’s vagina. Many things can change the balance of bacteria, including:

  • Taking antibiotics
  • Douching
  • Using an intrauterine device (IUD)
  • Having unprotected sex with a new partner
  • Having many sexual partners

Yeast infections (candidiasis) happen when too much candida grows in the vagina. Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. You may have too much growing in the vagina because of:

  • Antibiotics
  • Pregnancy
  • Diabetes, especially if it is not well-controlled
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  • Corticosteroid medicines

Trichomoniasis can also cause vaginitis. Trichomoniasis is a common sexually transmitted disease. It is caused by a parasite.

You can also have vaginitis if you are allergic or sensitive to certain products that you use. Examples include vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. They can cause burning, itching, and discharge.

Hormonal changes can also cause vaginal irritation. Examples are when you are pregnant or breastfeeding, or when you have gone through menopause.

Sometimes you can have more than one cause of vaginitis at the same time.

Types

A. Vulvovaginal Candidiasis

Pregnancy, diabetes, and use of broad-spectrum antibiotics or corticosteroids predispose patients to Candida infec­tions. Heat, moisture, and occlusive clothing also contrib­ute to the risk. Pruritus, vulvovaginal erythema, and a white curd-like discharge that is not malodorous are found. Microscopic examination with 10% potas­sium hydroxide reveals hyphae and spores. A swab for cultures with Nickerson medium or for PCR testing may be performed if Candida is suspected but not demonstrated.

B. Trichomonas vaginalis Vaginitis

This sexually transmitted protozoal flagellate infects the vagina, Skene ducts, and lower urinary tract in women and the lower genitourinary tract in men. Pruritus and a mal­odorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema and red macular lesions on the cervix in severe cases. Motile organisms with flagella are seen by microscopic examination of a wet mount with saline solution.

C. Bacterial Vaginosis

This condition is a polymicrobial disease that is not sexu­ally transmitted. An overgrowth of Gardnerella and other anaerobes is often associated with increased malodorous discharge without obvious vulvitis or vaginitis. The dis­charge is grayish and sometimes frothy, with a pH of 5.0–5.5. An amine-like (“fishy”) odor is present if a drop of discharge is alkalinized with 10% potassium hydroxide. On wet mount in saline, epithelial cells are covered with bacteria to such an extent that cell borders are obscured. Vaginal cultures are generally not useful in diagnosis; however, PCR testing is available.

Treatment

A. Vulvovaginal Candidiasis

A variety of topical and oral regimens are available to treat vulvovaginal candidiasis. Women with uncomplicated vulvo­vaginal candidiasis will usually respond to a 1- to 3-day regi­men of a topical azole or a one-time dose of oral fluconazole. Women with complicated infection (including four or more episodes in 1 year [recurrent vulvovaginal candidiasis], severe signs and symptoms, non-albicans species, uncontrolled dia­betes, HIV infection, corticosteroid treatment, or pregnancy) should receive 7–14 days of a topical regimen or two doses of oral fluconazole 3 days apart. In recurrent non-albicans infections, 600 mg of boric acid in a gelatin capsule intravagi­nally once daily for 2 weeks is approximately 70% effective. If recurrence occurs, referral to a gynecologist or an infectious disease specialist is indicated.

B. Trichomonas vaginalis Vaginitis

Treatment of both partners simultaneously is recom­mended; metronidazole or tinidazole, 2 g orally as a single dose or 500 mg orally twice a day for 7 days, is usually used.

In the case of treatment failure with metronidazole in the absence of reexposure, the patient should be re-treated with metronidazole, 500 mg orally twice a day for 7 days, or tinidazole, 2 g orally as a single dose. If treatment failure occurs again, give metronidazole or tinidazole, 2 g orally once daily for 5 days. If this is not effective in eradicating the organisms, metronidazole and tinidazole susceptibility testing can be arranged. Women infected with T vaginalis

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are at increased risk for concurrent infection with other sexually transmitted diseases and should be offered comprehensive STD testing.

C. Bacterial Vaginosis

The recommended regimens are metronidazole (500 mg orally, twice daily for 7 days), clindamycin vaginal cream (2%, 5 g, once daily for 7 days), or metronidazole gel (0.75%, 5 g, twice daily for 5 days). Alternative regimens include clindamycin (300 mg orally twice daily for 7 days), clindamycin ovules (100 g intravaginally at bedtime for 3 days), tinidazole (2 g orally once daily for 3 days), or tinidazole (1 g orally once daily for 7 days).

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