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| Women's Guide to Vaginal Infections | |||||||||||||||||||||||||||||||||||||
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Bacterial Vaginosis While many physicians once believed vaginal infections were largely harmless, mounting evidence indicates that certain types of vaginitis may lead to complications if left untreated. Bacterial vaginosis is the most common and by far the most serious type of vaginal infection. The disease has been found in 12 to 25 percent of women in routine clinic populations, 10 to 26 percent of women in obstetrics and 32 to 64 percent of women in clinics for sexually transmitted diseases (STD). Most importantly, BV has been associated with pelvic inflammatory disease, which can result in infertility, as well as increased risk of endometritis, cervicitis, pregnancy complications, post-operative infections and other health problems. Some recent study data has also suggested that BV may be linked with cervical intraepithelial neoplasia. In a comprehensive study of 13,500 pregnant women sponsored by the National Institutes of Health, women with BV in the 23rd to 26th weeks of pregnancy were 40 percent more likely to deliver a low birth-weight baby - one that weighs under 5.5 pounds. Studies are now under way to determine whether treatment of BV during pregnancy can reduce complications. It is especially important to discuss vaginal symptoms with your health care provider if you are pregnant or considering pregnancy. Cause Bacterial vaginosis is caused by an overgrowth of bacteria rather than yeast or other organisms. These are primarily anaerobic bacteria (requiring no oxygen) and an organism call Gardnerella, all of which can be found in low numbers in the health vagina. But in women with BV, the vaginal balance is disrupted so that these bacteria overgrow at the expense of protective bacteria known as lactobacilli. Lactobacilli excrete the natural disinfectant hydrogen peroxide to help maintain a healthy and normal balance of microorganisms in the vagina. Women who have been diagnosed with BV have been found to have up to 1,000 times more anaerobic bacteria than women without the disease. The exact reasons behind this overgrowth are unknown. While bacterial vaginosis is especially common among patients attending STD clinics, some experts believe this may occur because BV might enhance the transmittal of STDs rather than because BV itself is transmitted by sexual contact. While sexual activity may increase the likelihood of developing BV, the condition has also been found in sexually inexperienced and monogamous women. A few studies have also correlated BV with increased douching, an increased number of sexual partners and use of intrauterine devices. Symptoms The outward signs of BV may include an unpleasant vaginal odor in varying degrees and an excessive white or gray vaginal discharge with a milk-like consistency that can stain undergarments. Vaginal itching or burning are also sometimes present. Women often report that the odor is especially apparent after sexual intercourse. When semen mixes with vaginal secretions, it lowers the acidity level to make the odor particularly strong. Odor may also be more apparent around the time of menses. Other sighs of BV can be determined only through an examination by a health care professional. These include a decreased vaginal acidity ( a vaginal pH of more than 4.5 as measured with pH paper) and the presence of "clue" cells - epithelial cells coated with bacteria, seen in a vaginal discharge sample when viewed under a microscope. Potassuim hydroxide may also be added to a vaginal discharge sample to enhance and help detect any fishy or foul odor. It has been estimated that up to 40 percent of women with BV may experience no outward symptoms or discomfort at all, although this perception may be due to lack of communication by patients. It can be embarrassing to tell your health care provider about vaginal odor or other symptoms, but open communication is critical to ensuring an accurate diagnosis. Because of the increased health risks associated with BV, a growing number of physicians advocate the use of simple office procedures to screen for this condition during routine gynecological examinations. However, treatment may not be offered unless your health care provider is alerted to the fact the vaginal symptoms are present. Treatment The most commonly prescribed treatment for BV is a medication called metronidazole, administered orally or intravaginally. Metronidazole has a targeted action against anaerobic bacteria, yet it does not destroy the lactobacilli that protect against yeast and pathogenic bacteria. Clindamycin, an antibiotic available in oral and intravaginal form, may also be used to treat BV. Products like douches or deodorant sprays that mask vaginal odor should not be used to treat BV. Although they may temporarily eliminate odor, they will not cure the condition. It is especially important not to douche or use feminine hygiene spray for a few days before an appointment with your doctor. These products may actually hide important clues that can help your physician in diagnosing BV, and may make the condition worse. Unlike many of the medications now available to treat yeast infections, medications to treat BV are available only by prescription. Nonprescription medications should not be used in treatment of BV and can also interfere with proper diagnosis. Yeast Infections While far more women have heard of yeast infection than other forms of vaginitis, it is actually the second most common type of vaginal infection. Nonetheless, yeast infection (sometimes called Candida infection) has been estimated to affect most women at least once during a lifetime. Awareness of yeast infection may be especially high because of widespread consumer advertising for non-prescription yeast medications, which now rank among the largest-selling products found in drugstores. Although yeast infections often cause intense discomfort, prompting most sufferers to seek treatment, they have not been associated both serious health risks. Because the outward symptoms of yeast infection may be similar to those of other infections, women are urged to obtain a diagnosis by a health care professional prior to treating themselves with over-the-counter yeast remedies. These medications are generally effective against yeast, but have no utility in the treatment of other forms of vaginitis that may have more serious health consequences. Cause Yeast infections are caused by one of the many types of fungus called Candida, popularly known as yeast. Candida and other organisms are found in small numbers in the normal vagina as well as in the mouth and digestive tract. However, when the delicate balance of organisms in the vagina is upset, the yeast over may overgrow and cause an infection. For example, when a woman takes certain antibiotics to treat a bacterial infection, it may also kill the lactobacilli that produce hydrogen peroxide to protect against yeast overgrowth. Other factors that may upset the balance and lead to yeast infection include pregnancy, obesity, birth control pills, steroids, prolonged exposure to moisture and poor feminine hygiene. Symptoms Yeast infections may produce a white, cottage cheese-like discharge that has no odor, and the vagina and vulva will nearly always become itchy and sometimes red. A health care professional can confirm a yeast infection by adding potassium hydroxide and viewing a vaginal discharge sample under a microscope to detect an overgrowth of yeast organisms. Treatment Yeast infections are usually treated intravaginally with anti-yeast creams or suppositories. Drugs that act against yeast may also be prescribed in oral tablet form. Popular intravaginal treatment, such as miconazole and clotrimazole, are now available without prescription. However, while such nonprescription anti-yeast products are effective against most common types of yeast, they should not be used unless a yeast infection has been diagnosed by a medical professional. These products do not work against other kinds of vaginal infections that may be more health threatening, and may hinder correct diagnosis. Other topical treatments may also be used to control itching. These products, however, do not act against the yeast that cause the infection. Trichomoniasis Another common form of vaginitis is trichomoniasis. This type of infection is caused by a single-cell parasite known as a trichomonad. Unlike BV and yeast infection, it is usually transmitted through sexual intercourse, but in rare instances may be passed on by wet towels, washcloths and bathing suits. The infection often persists because the parasite rarely causes symptoms in men, so that reinfection of women by untreated me is common. Some women can e infected for months to years as the infection is passed back and forth between the woman and her sexual partner. For this reason, both sexual partners must be treated at the same time, even if they are in a monogamous relationship. The outward signs of trichomoniasis are a yellow-gray-green, frothy vaginal discharge that may have a foul or fishy odor. Burning, itching, soreness and redness of the vagina may also occur. In addition, urination and intercourse may be painful, and the symptoms may worsen during menstruation. On the other hand, many women with this infection may not have any symptoms. A medical professional can confirm trichomoniasis when the vaginal pH (acidity) level is higher than 4.5, potassium hydroxide intensifies the odor and the trichomonad parasite can be seen under the microscope. Occasionally a diagnosis may be made by Pap Smear or culture. Trichomoniasis is normally treated by prescribing metronidazole tablets to both the women and her partner. Chlamydia and Other Infections A common and primarily sexually transmitted infection of the cervix is caused by chlamydia. Although chlamydia is estimated to affect more than 4 million annually in the United States, most women and their sexual partners experience no symptoms. However, since chlamydia has been found to be a frequent cause of infertility, it is yet another reason some physicians believe women should be tested for infection of the reproductive system during their regular gynecological examination. The most common symptoms of chlamydia infection include light bleeding, especially after intercourse, burning during urination and sometimes and increased vaginal discharge. It is detected by medical professionals through culture examination of the cervical discharge. It is treated with anitbiotics for both sexual partners. Viruses may also be a source of vaginal infection. Herpes infection, which may be spread through sexual intimacy, result in lesions or sores on the vulva or vagina. Another viral infection is caused by the human papilloma virus, which causes warts in the vagina, rectum, vulva or groin, and can lead to cervical cancer. Genital warts are treated by a variety of measures, including topical medications or freezing. Noninfectious Vaginitis Some women may experience vaginal itching, burning, increased discharge or painful intercourse without having an infection. A noninfectious condition known as atrophic vaginitis is common following menopause or hysterectomy, when the vagina becomes dry. It can be treated with oral or intravaginal estrogen replacement therapy. Other noninfectious vaginitis can result from reaction or irritation from vaginal spray, douches, spermicides, chemically treated sanitary napkins, cervical sponges and caps, tampons, soaps, detergents and fabric softeners. Such products should be avoided when vaginal irritation is present. Prevention of Vaginal Infections Because the key to successful treatment of vaginal infections is correct diagnosis, it is essential that you openly discuss your symptoms and other background that may help your health care provider make an accurate diagnosis. Pay close attention to which symptoms you have, what they are like and when they occur. Then be sure to take all of the prescribed medication exactly as directed. Do not discontinue therapy just because the symptoms go away, since the cause of the infection may not be completely eliminated and the problem may therefore reappear. If symptoms persist or some back following treatment, see a medical professional again. A different treatment may be necessary. Do not self-medicate with non-prescription anti-yeast products, unless you have recently been diagnosed for yeast infection and the exact same symptoms recur. Most vaginal infections are not caused by yeast. Moreover, anti-yeast products do not work against the kinds of infections that may be more serious, and may make accurate diagnosis difficult. Only a medical professional can reliably diagnose the cause of vaginal infections and prescribe the proper therapy. Douching should be avoided. Studies have found that douching may disrupt the delicate balance of natural organisms in the vagina, leading to infection from overgrowth of bacteria or yeast, and may also spread harmful organisms into the upper reproductive tract. Once you have an infection, further douching can make it worse and hinder accurate diagnosis. Since many infection-causing organisms thrive on moisture, remove a wet bathing suit immediately. Be sure to dry yourself thoroughly after showering or bathing. Also avoid tight clothing, and use cotton undergarments to help absorb moisture. Keep the vaginal area clean. To avoid spreading organisms from the anus to the vagina, wipe front to back after a bowel movement. Do not use scented or chemically treated toilet paper or sanitary napkins, feminine deodorants, perfumes, spermicides, harsh soaps or detergents if the vaginal area is irritated, since they may cause the problem to make it worse. Practice safe sex to avoid sexually transmitted infections. Use condoms and avoid medicated vaginal creams and other products containing mineral oil, since they may weaken latex condoms and diaphragms. Also thoroughly clean diaphragms, cervical caps and applicators of spermicides or medication after each use. Most importantly, recognize that vaginal infections are common among women of all ages, regardless of whether they are sexually active - and that they may pose increased health risk unless properly treated. If you experience vaginal symptoms, see a medical professional for diagnosis and effective therapy. And remember that your health care provider will be better able to help you if openly discuss your concerns. Most Common Vaginal Infections BACTERIAL VAGINOSIS
YEAST INFECTION
TRICHOMONIASIS
GLOSSARY Anaerobic bacteria: Bacteria that do not require oxygen, found in the normal vagina Bacterial vaginosis: A common type of vaginal infection caused by an overabundance of bacteria found in the normal vagina, with a loss of protective lactobacilli. Chlamydia: A common infection of the cervix caused by a sexually transmitted microorganism with this name. Clotrimazole: A widely used treatment for yeast infections. Clue cell: Epithelial cell coated with bacteria, seen under a microscope, indicating BV. Culture: A laboratory test used to diagnose infections caused by microorganisms not found in the normal vagina. Microorganisms in a discharge sample are allowed to grow so they can easily be identified. Lactobacilli: The predominant bacteria in the normal vagina, which serve to provide natural protection against infection. Metronidazole: A widely used treatment for bacterial vaginosis and trichomoniasis. pH: A unit for measuring alkaline/acid levels. Normal vaginal pH is approximately 4.0. Elevated pH may indicate the presence of BV or trichomoniasis. Trichomoniasis: A vaginal infection caused by a one-cell parasite known as a trichomonad. Vaginitis: An infection of the vagina. Yeast infection: A common vaginal infection caused by an overabundance of yeast found in the normal vagina. |
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