Vaginitis

Vaginitis refers to the inflammation of the vagina and is one of the most common gynecological conditions. Vaginitis can be due to infections by bacteria, viruses, or fungi, or it can be due to irritating chemicals or allergies. It leads to foul-smelling vaginal discharge, irritation, and itching. It is treated with medicines and supportive therapy. When left untreated, it can lead to complications, especially during pregnancy. 

Among various types, the following are the most common types of vaginitis;

Bacterial Vaginosis: Your vagina contains some bacteria which normally reside and maintain an optimum environment. Due to some causes, there is an overgrowth of one type of bacteria, disrupting the normal milieu. Some studies have identified the overgrowth of the bacterium Gardnerella vaginalis and some other anaerobic bacteria over lactobacillus.

Candidal Vaginitis: We normally have different fungi in the body playing an essential role in the normal flora. Among these, the most common is Candida albicans. Pathology occurs when it gets a favorable environment and it divides rapidly causing infection. A weak immune system, pregnancy, diabetes, usage of birth control pills, broad-spectrum antibiotics, and some vaginal sprays can be some of the reasons for its growth.

Trichomoniasis: It is caused by a small parasite and can be transmitted during sex.

Viral Vaginitis: It is caused by some viruses, the most common of which are herpes simplex virus (HSV) and Low-risk human papillomavirus (HPV). They are transmitted sexually.

Non-infectious Vaginitis: It can be due to an allergic reaction to some vaginal sprays, douches, feminine perfumed products, or spermicidal products.

Atrophic Vaginitis: After menopause, a decrease in sex hormones, especially Estrogen, can lead to a dry and atrophic vagina. Some medicines such as aromatase inhibitors or Lupron Depot can also reduce estrogen levels leading to atrophic vaginitis. 

Vaginitis most commonly occurs in women of reproductive age. It is a very common disease worldwide. 40-50% 0f vaginitis cases are caused by bacterial vaginosis. 20-25% by vaginal candidiasis and 15-20% by trichomoniasis. In the USA, bacterial vaginosis affects around 30% of women between the ages of 14-49. Vaginitis is more common in African American women for unknown reasons. Some of the factors linked with increased prevalence are smoking cigarettes, obesity, induced abortion, and being unmarried. Trichomoniasis affects around 3 million people in the USA each year. 

The following risk factors may predispose you to the development of vaginitis;

·         Exercising frequent douching: Washing your vagina with cleaning agents may lead to a change in the normal flora of the vagina and hence can predispose you to vaginitis. It is not advised to douche the vagina.

·         Having new or multiple sexual partners: Many people might be suffering from some sexual infections that you may not know about and can cause different infections.

·         Recent antibiotic use: Recent use of a broad-spectrum antibiotic may affect the normal flora of the vagina and cause vaginitis.

·         Being pregnant: Pregnancy is accompanied by many changes in the body, hormones, and fluids. These changes can alter the normal flora.

·         Bubble baths: Taking bubble baths in the tubs is one of the risk factors.

·         Implanted IUD: Women with an intrauterine contraceptive device are prone to suffer from vaginitis.

·         Presence of other STDs: Co-occurrence of other sexually transmitted diseases may lead to the development of vaginitis.

·         Diabetes mellitus: Uncontrolled blood sugar is a favorable environment for the growth of yeast causing infection.

·         Weather and clothing: Wearing tight clothing in a hot humid climate can lead to the growth of fungi. 

Most of the women do not show any symptoms. Some of them may have;

·         Vaginal itching or irritation,

·         Burning sensation while passing urine

·         Pain during sex.

·         Vaginal discharge may be of different color and smell depending upon the infectious agent; for example, it is grey to white in color with a typical fishy odor in bacterial vaginosis. In candidiasis it may be thick and white like Cottage cheese. In trichomoniasis, the discharge may be greenish-yellow and sometimes frothy. 

After taking a history of your symptoms, your doctor may perform a physical examination with special emphasis on the pelvis to look for the presence and characteristics of a discharge, its smell, color, and consistency. You may be advised laboratory tests, including testing for bacteria or fungi in the discharge by simple staining method and by growing bacteria in the lab (culture). Discharge may be tested for fishy odor by whiff test. An alkaline pH and the presence of clue cells are pathognomic of bacterial vaginosis.

Urine may be collected to test for urinary tract infection. You may be tested for other STDs especially gonorrhea, chlamydia, and HIV if you have risk factors. 

Following diseases may present like vaginitis;

·         Chlamydia infection

·         Other sexually transmitted infections

·         Urinary tract infection

·         Cervicitis

·         Contact dermatitis

Treatment follows the causative agent identification and specific treatment against it.

For Bacterial vaginosis: It is a bacterial infection that will need a course of antibiotics. The most common antibiotics prescribed are Metronidazole or Clindamycin, which may be given in cream or gel form to be applied to the vagina. You may also be prescribed oral antibiotics to be taken by mouth. Most people get treated with a single course of 7 days. Few may need two courses. Women with recurrent infections may benefit from extended courses.

For candida infections:  Application of antifungal creams for mild genital fungal infection. Antifungal medications that can be applied in the vagina include Flucocytosine, Nystatin, and boric acid.

For trichomoniasis: You may be prescribed Metronidazole or Tinidazole tablets.

Estrogen Vaginal creams, tablets, or rings are prescribed for atrophic vaginitis. For allergic vaginitis, you may need to identify the irritating agent, such as soap, chemicals, tampoons, etc. 

The outcome is usually good after treatment. Infections are easily cured with antibiotics/antifungals. If not appropriately cured, complications like preterm delivery in pregnant women, increased chances of other sexually transmitted diseases, pelvic inflammatory disease, infections after gynecological surgery, etc., bacterial vaginosis can reoccur. 

·         Avoid douching or using cleaning agents for the vagina

·         Keep things that have touched your anus, away from your vagina like your hand while washing poop, toilet paper, and sex toys.

·         Adapting safe sex (using condoms)

·         Having limited sexual partners

·         Not having sex with someone suffering from STD

·         Avoid sex until completing your full course of antibiotics

·         Change sanitary pads or tampons frequently.

·         Wear breathable undergarments.

·         Avoid hot baths.

·         Lifestyle modification to manage obesity and diabetes.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on June 02, 2023.

References

Vaginitis | ACOG

https://www.acog.org/womens-health/faqs/vaginitis

Vaginitis (Vaginal Infections): Symptoms, Types, Causes, Treatment (webmd.com)

https://www.webmd.com/women/guide/sexual-health-vaginal-infections