HOME  •  HEALTH  •  LIBRARY  •  AREAS  •  CENTERS  •  BOARDS  •  CHATS  •  JOIN FREE

Sexually Transmitted Diseases (STDs)
MDAdvice.com Home > Health Topics > Informative Material >

Vaginal Infections and Vaginitis

August 1992

Vaginal infections are frequent causes of distress and discomfort in adult women. The most common vaginal infections are bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Some vaginal infections are transmitted through sexual contact, but others such as candidiasis (yeast infections) are not.

Vaginal infections are often accompanied by vaginitis, which is an inflammation of the vagina characterized by discharge, irritation, and/or itching. The cause of vaginitis cannot be adequately determined solely on the basis of symptoms or a physical examination. Laboratory tests allowing microscopic evaluation of vaginal fluid are required for a correct diagnosis. A variety of effective drugs are available for treating vaginal infections and accompanying vaginitis.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. BV--previously called nonspecific vaginitis or Gardnerella-associated vaginitis--can be transmitted through sexual activity, although the organisms responsible also have been found in young women who are not sexually active. BV is due to a change in the balance among different types of bacteria in the vagina. Instead of the normal predominance of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis are found in the vagina in women with BV. Investigators are studying the role that each of these microbes may play in causing BV. The role of sexual activity in the development of BV is not understood. Additionally, intrauterine devices (IUDs) may increase the risk of acquiring bacterial vaginosis.

Symptoms. The primary symptom of BV is an abnormal vaginal discharge with a fishy odor, which is especially noticeable after intercourse. However, nearly half the women with clinical signs of BV report no symptoms. A physician observes these signs during a physical examination and from various tests of vaginal fluid.

Diagnosis. A sample of vaginal fluid can be examined under a microscope to detect the presence of the organisms associated with BV. Diagnosis is based on the presence of numerous "clue cells" (vaginal lining cells that are coated with G. vaginalis and other BV organisms), a fishy odor, and decreased acidity of vaginal fluid.

Treatment. All women with BV should be informed of their diagnosis, including the possibility of sexual transmission, and offered treatment. BV can be treated with antibiotics such as metronidazole or clindamycin. Generally, male sex partners are not treated. However, in cases of BV that do not respond to drug therapy, treatment of male partners may be helpful. Many women with symptoms of BV do not seek medical treatment, and many asymptomatic women decline treatment. Until the long-term consequences of untreated BV are known, routine treatment of all asymptomatic carriers is not necessary.

Complications. Researchers are investigating the role of BV in pelvic infections that result in infertility and tubal (ectopic) pregnancy. There is a growing body of evidence suggesting an increase in adverse outcomes of pregnancy such as premature and low-birth-weight infants among women with BV.

Trichomoniasis

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 men, and the vagina is the most common site of infection in women.

Symptoms. Trichomoniasis, like many other STDs, often occurs without any symptoms. When symptoms occur, they usually appear within 4 to 20 days of exposure, although symptoms can appear years after infection. 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 include a thin, whitish discharge from the penis and painful or difficult urination. However, most men do not experience any symptoms.

Diagnosis. Trichomoniasis is usually diagnosed in women by examining vaginal fluid under the microscope for evidence of the parasite; in some cases it can be detected on a Pap smear. Because only small numbers of parasites may be present during infection in a male, microscopic examination of discharge from the penis often does not reveal the presence of parasites. However, a sample of fluid from the penis may be taken from which the parasite can be grown in culture in the laboratory. Cultures may be required to establish the diagnosis in women who have no symptoms but are at high risk of infection. Cultures can also confirm the diagnosis in symptomatic women whose microscopic examinations are negative.

Treatment. Although symptoms of trichomoniasis in men may disappear within a few weeks without treatment, men can transmit the disease to their sex partners even when symptoms are not present. Therefore, it is preferable to treat both partners to eliminate the parasite. Metronidazole is the drug used to treat trichomoniasis. It is administered in a single dose. People taking this drug should not drink alcohol; mixing the two substances can cause severe nausea and vomiting.

Complications. Although previously trichomoniasis was not thought to result in any important complications, recent studies have linked it to two serious sequelae. Data now suggest that trichomoniasis may increase the risk of transmission of human immunodeficiency virus (HIV), the virus that causes AIDS, and may cause delivery of low-birth-weight or premature infants. Additional research is needed to fully explore these relationships.

Prevention. Condoms and diaphragms may be helpful in preventing the spread of trichomoniasis. Although there is some laboratory evidence that spermicides can kill STD organisms, scientists are still evaluating the usefulness of spermicides in preventing STDs. Some studies have found that frequent use of spermicides (more than three times a week) may cause vaginal inflammation.

Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC), sometimes referred to as candidal vaginitis, monilial infection, or vaginal yeast infection, is a common cause of vaginal irritation. It has been estimated that approximately 75 percent of all women will experience at least one episode of VVC during their lifetime. VVC is caused by an overabundance or overgrowth of yeast cells (primarily Candida albicans) that normally colonize in the vagina. Several factors are associated with increased rates of VVC in women, including pregnancy, uncontrolled diabetes mellitus, and the use of oral contraceptives or antibiotics. Other factors that may increase the incidence of VVC include the use of douches, perfumed feminine hygiene sprays, topical antimicrobial agents, and tight, poorly ventilated clothing and underwear. There is no direct evidence that VVC is transmitted by sexual intercourse.

Symptoms. The most frequent symptoms of VVC in women are itching, burning, and irritation of the vagina. Painful urination and/or intercourse are common. Abnormal vaginal discharge is not always present and may be minimal. The discharge is typically described as cottage-cheese-like in nature, although it may vary from watery to thick in consistency. Most male partners of women with VVC do not experience any symptoms of the infection. However, a transient rash and burning sensation of the penis 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. VVC is usually diagnosed through microscopic examination of vaginal secretions for evidence of yeast forms.

Treatment. Various antifungal vaginal creams are available to treat VVC. Some antifungal creams (miconazole and clotrimazole) are available over the counter for use in the vagina; however, because BV, trichomoniasis, and VVC are difficult to distinguish on the basis of symptoms alone, a woman with vaginal symptoms should see a 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 VVC may need to be treated for extended periods of time and may be given oral antifungal drugs. They should work with their physicians to determine possible underlying causes of their chronic yeast infections. Because there is no evidence for sexual transmission of VVC, routine treatment of male partners is unlikely to reduce recurrence.

Other Causes of Vaginitis

Although most vaginal infections in women are due to bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis, it is clear that there are other causes. 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 infections are also often associated with abnormal vaginal discharge, but these infections can be distinguished from true vaginal infections by appropriate tests. Finally, in uninfected women, vaginal discharge may be present during ovulation and may become so heavy that it raises concern.

In an effort to control vaginal infections, 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.

 Home  |  Help  |  Feedback  |  Privacy Policy  |  Register  |  Contact Us  |  Visitor Survey  |  Subscribe to HealthMail  |  Advertising  |  About MDAdvice.com

Copyright © The Online Medical Network Inc. All rights reserved. All material provided by MDAdvice.com is intended for informative purposes only and is not a substitute for professional medical advice. Please consult your physician with any questions or concerns you may have regarding your health. Use of this site indicates your agreement with the Terms of Use.