What is vaginitis?

Vaginitis is an irritation and/or inflammation of the vagina characterized by discharge, irritation and/or itching. The cause of vaginitis cannot be determined solely on the basis of symptoms or a physical examination. Laboratory tests are required for a correct diagnosis. Many effective drugs are available for treating vaginal infections and accompanying vaginitis.

What are common vaginal infections?

Bacterial Vaginosis
Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. BV reflects a change in the vaginal ecosystem. This imbalance, including pH changes, occurs when abnormal bacteria outnumber the normal ones. 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. Women with BV also may have burning during urination or itching around the outside of the vagina, or both. However, nearly half of the women with clinical signs of BV 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 health care 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 the possibility of sexual transmission and offered treatment. They can be treated with antibiotics. Generally, male sex partners are not treated. Women with symptoms of BV do not always seek medical treatment, and many women without symptoms 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, including premature delivery and low-birth weight infants. In addition, BV can increase a woman’s susceptibility to other STDs, such as chlamydia and gonorrhea.

Trichomoniasis
Trichomoniasis, sometimes referred to as “trich,” is a common sexually transmitted disease (STD) that affects approximately 7 million Americans yearly. It is caused by a single-celled protozoan parasite called Trichomonas vaginalis. 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 five to 28 days of exposure. The symptoms in women include a heavy, yellow-green or gray vaginal discharge with a strong odor, discomfort during intercourse and painful urination. Irritation and itching of the female genital area and, on rare occasions, lower abdominal pain also can be present.

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 can cause severe nausea and vomiting.

Complications - 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 – The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact or to be in a long-term monogamous relationship with a partner who has been tested and is known to be uninfected. Use of latex 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, 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 pain during 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.

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 a yeast infection through microscopic examination of vaginal secretions for evidence of yeast forms.

Treatment - Various antifungal vaginal medications are available to treat yeast infection. Women can buy 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.

More information about vaginitis and vaginal infections can be obtained by contacting:

The Centers for Disease Control and Prevention National Center for HIV, STD and TB Prevention Division of Sexually Transmitted Diseases
www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_gen_g.htm

National Institutes of Health, U.S. Department of Health and Human Services
http://www.niaid.nih.gov/factsheets/vaginitis.htm