Vaginal
infection
Vaginitis is infection or
inflammation of the vagina.
The most common symptoms are
itching and burning of the vagina and vulva (outer genitals), and abnormal
vaginal discharge.
Vaginitis is a common
condition, affecting about a third of women during their lifetimes.
Some, but not all, vaginal
infections can be transmitted through sexual contact.
Fortunately, effective and
relatively inexpensive cures are available.
The most common vaginal infections are vulvovaginal candidiasis (yeast
infections), bacterial vaginosis and trichomoniasis.
Description
Vaginitis is a general term including several kinds of vaginal infections, which
result in inflammation of the vagina. Often the vulval (outer genital) region is
secondarily involved. Sometimes the urethra (passage for urine), bladder and
skin around the genitals are also affected.
Most
women experience one type of vaginitis; however, some suffer from several at
once. Non-specific vaginitis implies that any of several germs have caused the
infection.
Types of
vaginitis
The
most common vaginal infections are vulvovaginal candidiasis, bacterial vaginosis
and trichomoniasis. There are several other forms of vaginitis, such as atrophic
vaginitis, and allergic and irritative vaginitis.
Vulvovaginal
candidiasis (yeast infection)
Vulvovaginal candidiasis (VVC)
is caused by a yeast-like fungus.
VVC is not serious, but can
be very annoying, since it causes itching.
It affects females of all
ages, especially after puberty.
Candida
are organisms living in the healthy vagina, rectum and mouth. When the vagina's
balance is disturbed, these organisms can multiply and cause infections.
VVC may be spread by sexual
contact; symptoms of burning and itching may be worse after intercourse.
A
distinguishing symptom is a white vaginal discharge that may have a texture
resembling that of cottage cheese and a yeasty smell.
Some
antifungal creams (miconazole and clotrimazole) are available over the counter,
but an accurate medical diagnosis should be obtained before using these. Other
non-prescription products contain antihistamines or topical anaesthetics that
mask symptoms and do not treat the underlying problem. Note: some yeast
medicines weaken condoms and diaphragms.
Newer types of treatment are
a single oral dose of fluconazole (Diflucan 150mg) or itraconazole.
It is advisable to treat
sexual partners with an anti-fungal cream which is applied twice daily for one
week on the male genitals. Infection in the male may be asymptomatic (without
symptoms)
Candida hyphae sometimes
penetrate under the vaginal epithelial cells. The infection then tends to recur
repeatedly during menstruation. To prevent recurrence, vaginal suppositories or
cream can be inserted into the vagina a few days before and a few days after
menstruation for 2-3 months.
Vaginal candidiasis commonly
occurs during pregnancy. The infection is usually harmless, but a few cases of
infection of the membranes has been reported. Treatment is with local vaginal
suppositories or cream e.g. clotrimazole (such as Canesten). Oral ketoconazole
(such as Nizoral) is contra-indicated during pregnancy.
Bacterial
infection
Bacterial
vaginosis (BV) is also sometimes called anaerobic vaginitis, non-specific
vaginitis, Gardnerella vaginitis or Haemophilis vaginitis.
BV is vaginal inflammation
due to rapid growth of several kinds of bacteria that naturally live in the
vagina.
A possible distinguishing
symptom is a thin, off-white, grey vaginal discharge, and a "fishy" or "musty"
odour, which is stronger during menstruation and after sex.
The redness and itching
accompanying yeast infections tend to be milder or absent with BV.
Nearly half of women with BV
report no symptoms.
BV
can probably be transmitted through sexual activity, although the organisms
responsible have also been found in young women who are not sexually active.
BV
can be treated with antibiotics such as metronidazole or clindamycin (vaginally
or orally), and may require long-term or repeat treatments. Many doctors believe
metronidazole shouldn't be used during the first three months of pregnancy.
BV may play a role in pelvic
infections that result in infertility and tubal (ectopic) pregnancy. Gardnerella
vaginalis vaginitis shows a possible association with premature rupture of the
membranes.
There
is evidence that BV facilitates and enhances the transmittal of certain STDs.
Condoms
are recommended during intercourse to prevent reinfection. Both partners should
be re-examined after treatment.
In
general, it is not necessary to treat male sex partners, except in intractable
cases or frequent recurrences. Sometimes doctors advise antibiotic treatment for
your sexual partner to prevent reinfection.
BV may spread between female
sex partners.
Trichomoniasis
Trichomoniasis is an STD caused by
the parasite Trichomonas vaginalis, which may affect men and women.
It is not part of the normal
vaginal flora.
The
vagina is the most common site of infection in women.
Trichomoniasis may also be passed
between individuals non-sexually, as it can survive in bodily fluids outside the
body for a few hours.
Trichomoniasis
not infrequently involves post-menopausal women in their 60s and 70s.
Many women and most men never
have symptoms and are asymptomatic carriers.
When
symptoms occur, they usually appear within four to 20 days of exposure, although
symptoms can appear years later.
A
possible distinguishing symptom is a yellow-green or grey, thin, foamy and
foul-smelling vaginal discharge.
Symptoms may worsen during
menstruation.
Although symptoms of trichomoniasis
in men may disappear within a few weeks without treatment, they can still
transmit the disease to their partners. It is preferable for both partners to
receive treatment to eliminate the parasite.
Treatment for trichomoniasis is
usually metronidazole, which is usually prescribed in one large oral dose or
several smaller doses taken over three to seven days. Note: Drinking alcohol
while taking this drug can cause nausea and vomiting.
Recurrences can be due to
re-infection or relapse. Re-infection can be due to failure to treat all sexual
partners. Recurrences generally require a higher dose of metronidazole and a
longer treatment plan.
Talk to your doctor about
getting tested for other STDs.
To prevent re-infection, a
condom should be used during sexual intercourse until treatment is complete.
Re-examination after treatment is essential.
Trichomoniasis may increase
risk of transmission of HIV.
The
organisms are not transmitted to the foetus or newborn, but there is a possible
association with premature rupture of the membranes.
Women in the first three months of
pregnancy should not take medicine for trichomoniasis.
Condoms
and diaphragms may help prevent trichomoniasis.
Postmenopausal
(atrophic) vaginitis
Postmenopausal vaginitis is
infection or inflammation of the vagina caused by lowered oestrogen levels that
upset the vagina's normal balance.
After
menopause the vaginal tissues are no longer being stimulated by oestrogen, and
may become dried out and prone to infection. Tiny sores may appear in the
vaginal wall, causing a blood-tinged discharge.
There
may be a bad-smelling vaginal discharge, which is usually thin, whitish and
sometimes blood-tinged.
Treatment
consists of oestrogen replacement therapy either topically, transdermally, or
orally, and treatment of the secondary infection if present. A water-soluble
lubricant may be used if oestrogen cannot be taken.
Other causes
of vaginitis
Other
causes may include allergic and irritative factors or other STDs.
Non-infectious
allergic symptoms can be caused by chemicals in products such as spermicides,
vaginal hygiene products, detergents, fabric softeners, spermacides and, more
rarely, latex.
Cervical infections are also
often associated with abnormal vaginal discharge, but these infections can be
distinguished from true vaginal infections by appropriate tests.
In uninfected women, vaginal
discharge may be present during ovulation and may become so heavy that it raises
concern.
Cause
The
healthy vagina is slightly acidic, and contains a balance of several kinds of
organisms. When the natural balance is disrupted, one or more types of organism
normally present in the vagina can multiply. Harmful bacteria may grow too
quickly and cause infections (see above).
Symptoms
Symptoms may include:
Abnormal vaginal discharge, which
may irritate tissues and have an unpleasant odour. (The healthy vagina produces
a slight discharge, which changes in amount, consistency, and colour over the
course of your monthly cycle and throughout your lifetime. Discharge is usually
clear, cloudy or whitish, moderate in quantity, thin or slightly viscous, and
with mild odour.)
Vaginal and vulval discomfort,
which may include burning and itching
Genital
swelling
Change
in vaginal colour from pale pink to red
Discomfort during sexual
intercourse
Frequent or painful urination
Occasionally, pain in the lower
abdomen
Prevalence
Vaginitis is a common condition, affecting about one third of women during their
lifetimes. Vaginal infections are frequent causes of discomfort in post-pubertal
and adult women, whether sexually active or not. Vaginitis most often occurs
during the reproductive years, but can also affect infants and elderly women.
Risk Factors
The
following can increase the likelihood of vaginitis:
General
poor health, including lack of sleep, poor diet and stress
Hot weather, non-ventilating
clothing (especially underwear) or any condition that increases genital
moisture, warmth and darkness
Changes in hormone levels through
pregnancy, breast-feeding, menopause, some oral and intramuscular contraceptives
and steroid use
Drugs or diseases that lower the
body's resistance to infection - women with HIV infection, for example, are more
prone to yeast infections.
Diabetes
mellitus or a prediabetic condition
Unprotected sexual
intercourse, especially with multiple partners
Sexually
transmitted diseases (STDs)
Infection elsewhere in the
body
Douching
- this can upset the natural vaginal balance, as can other chemically treated
products such as "feminine hygiene" sprays
Antibiotics - can kill
beneficial vaginal bacteria
Antibacterial
soaps and topical antimicrobial agents
Over-the-counter medications
improperly used
Spermicides
Hereditary
and genetic factors
Obesity
High carbohydrate intake,
especially sugars and alcohol - may stimulate yeast infection
Menstruation
Cuts, abrasions, or other
irritations to the vagina, such as sexual intercourse without enough lubrication
Childbirth
Poor hygiene
When to see a Doctor
Consult your doctor if:
A vaginal infection is your first
You have a yellow or green
vaginal discharge
Symptoms persist longer than
a week or worsen despite treatment
After
treatment, symptoms recur
More than three yeast
infections occur in a year
Unusual
vaginal bleeding or swelling develops
You are pregnant - vaginitis is
seldom dangerous and usually responds well to treatment, but may create special
problems during pregnancy
You have been exposed to an
STD
Complications of untreated
vaginitis may include secondary infections of the vagina and other pelvic
organs.
Visit
preparation
To
help with diagnosis:
Schedule the exam for when
you're not menstruating.
Don't
douche or use vaginal sprays 24 hours before your exam.
If you have sex less than 24
hours before the exam, use condoms.
Diagnosis
If
you have symptoms of vaginitis, a correct diagnosis is needed before the
condition can be treated.
Your
doctor will take a medical history, noting your own observation of symptoms, and
perform a physical exam (including a pelvic exam). However, laboratory tests to
allow for microscopic evaluation of vaginal fluid are required for correct
diagnosis. Your doctor may insert swabs into the vagina and cervix to take
samples.
Self-diagnosing and self-treating can be dangerous, and may delay correct
treatment. Recurrent vaginitis may indicate a serious underlying disorder, such
as diabetes or HIV infection.
Treatment
Home
If
you are prone to frequent infections, an occasional acidic douche may be helpful
- for example, two tablespoons of white vinegar added to a litre of warm water
or a solution of baking soda and water. However, douching itself can promote
vaginitis, and many doctors advise against it.
Plain
yoghurt made with live cultures, either eaten or put into the vagina, may help
restore the natural balance of yeast and bacteria, especially if there is an
overgrowth of yeast as a result of antibiotic therapy.
Medication
Your
doctor may prescribe:
Antibiotics or antifungals,
directed at the specific organism causing the infection. Yeast infections are
treated with antifungal suppositories, creams and ointments. If vaginitis is
caused by bacteria, antibiotics may clear up the underlying cause.
Soothing
vaginal creams or lotions for non-specific forms of vaginitis.
Use
all the medication as prescribed. Disappearance of symptoms may not mean
disappearance of the infection.
If
you use a cream or suppository, use a small sanitary pad to protect clothing.
After treatment, you may want to keep a refill of the medication so you can
begin treatment quickly if the condition recurs. Keep creams or suppositories in
the refrigerator. Check with your doctor about any other medication you may be
taking. Some medications may make your vagina more susceptible to infection.
Other
If
urination causes burning, urinate through a tubular device, such as a
toilet-paper roll, or pour a cup of warm water over the genital area while you
urinate.
Avoid
overexertion, heat and excessive sweating.
Abstain
from sex until after treatment, or use condoms.
When allergy causes vaginitis,
avoiding the allergic agent may end the irritation.
Vaginitis is usually curable in two weeks with treatment. Your sexual partner
may need treatment also.
Prevention
Keep the genital area clean
and dry. Use mild soap and rinse well.
Be
sure your sexual partner is clean.
Wear loose, natural-fibre
clothing, particularly cotton underpants or pantyhose. Wash them in hot soapy
water, and rinse and dry thoroughly. Tight clothing and nylon underwear can trap
moisture and encourage growth of organisms, especially in hot weather. Change
underwear at least every 24 hours.
Dry
off thoroughly after bathing and swimming; don't stay in wet clothing for long
periods.
After
urination or bowel movements, wipe from front to back to prevent bacteria from
the anus entering the vagina.
Lose weight if you are obese.
Avoid chemical products that can
upset the vagina's acidic balance such as vaginal douches and "feminine hygiene"
sprays, bubble baths and coloured or scented toilet paper, soaps, detergents and
sanitary towels or tampons. These products can also mask an odour signalling
infection. If you want to douche, do so infrequently and use water or a vinegar
and water mixture.
If you have diabetes, adhere
to your treatment program.
Change
tampons or sanitary towels frequently.
If you use a diaphragm, don't
leave it in longer than recommended. Clean your diaphragm, cervical cap, and
spermacide applicators thoroughly in warm soapy water and dry.
Avoid
broad-spectrum antibiotics unless necessary. Consider using yeast medications
while taking antibiotics if you get frequent yeast infections.
Limit
your number of sex partners.
Use condoms with a new
partner or with multiple partners.
Avoid sexual activity when you have
an infection.
Birth control jellies have been
found to slow the growth of bacteria that cause certain forms of vaginitis.
Practise a healthy
life-style, which includes good nutrition, adequate sleep, regular exercise and
stress management.
Eat yoghurt with live
cultures, as well as buttermilk and sour cream, which may help to maintain the
vaginal balance.
