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Vaginitis
 

Vaginitis Introduction

Infections of the vaginal tract (vaginitis) account for approximately 10 percent of all visits by women to their health care providers. There are three general categories of vaginitis: hormonal vaginitis, irritant vaginitis and infectious vaginitis.

  • Hormonal vaginitis can be due to the change of hormones that is experienced in puberty, postpartum, and in menopause.
  • Irritant vaginitis is caused by irritants to the vaginal area, and may include; condoms, soaps, perfumes, toilet tissue, hot tubs, semen and douches.
  • Infectious vaginitis causes 90% of vulvovaginitis in women, and can be attributed to one of three types of organisms: bacterial vaginosis, candidiasis or trichomoniasis. [1]

The signs and symptoms of each organism help with diagnosis. Testing by a health care provider is required and considered critical for differentiating among the possible causes. Testing is also important for avoiding the more serious side effects of untreated vaginitis. Treatment options for this conditiona are often simple and easy to administer.

Vaginitis causes physical discomfort and can also be an indication of a more serious underlying issue. Chronic inflammation of the cervix or a sexually transmitted illness like gonorrhea, Chlamydi, or herpes, can cause symptoms that are very similar. The infection may travel up the vagina to deeper tissues and lead to pelvic inflammatory disease - a condition that can scar the fallopian tubes and contribute to infertility. [2] A thorough work-up by a trained health practitioner is always important to rule out some of the more serious conditions that mimic the more benign causes of vaginitis. Factors that can influence the vaginal environment include; pH, blood sugar levels, the presence of healthy bacteria, and the natural flushing of the vagina by secretions and menstruation.

The most common cause of vaginitis in the U.S. is from bacterial vaginosis (BV). Unfortunately, many women self diagnosis themselves with Candida (the second most common cause of vaginitis), and do not treat the condition properly. This often leads to reoccurring symptoms and discomfort. Candida has been increasing in frequency, mostly due to the widespread use of antibiotics. Predisposing factors such as diabetes mellitus, steroids, pregnancy, and gastrointestinal candidiasis have made it the most common diagnosis in causes of vaginitis. Reoccurring yeast infections that fail to clear with over the counter medications may be due to a resistant strain or a misdiagnosis. Many women treat their “yeast” infections and fail to get any results. Testing and microscopic examination may yield a different diagnosis.

Trichomoniasis is the most prevalent nonviral sexually trasnsmitted disease. Its prevalence varies widely in certain populations, and is estimated to account for over 180 million cases worldwide. [3]

As the population is becoming older and women are living longer lives, Atrophic vaginitis is becoming a more common cause of vaginitis. Commonly found in postmenopausal women, atrophic vaginitis is a thinning of the vaginal and labial tissue caused by specific hormonal changes. A lower amount of estrogen in a woman’s body can cause the skin to thin and lose its elasticity, making it more susceptible to irritation and pathogens.

Vaginitis Symptoms

The most commonly reported symptoms of vaginitis are of vaginal discomfort and discharge. Vaginal discharge can be from normal changes in a woman’s body during the month. A normal discharge should be non-odorous, clear or creamy in color and can be sticky or tacky in texture. A discharge that is excessive, has a color or odor change, or results in any physical discomfort, should be examined.

Acute itching, vaginal soreness, irritation, pain with sexual activity, and urinary discomfort are symptoms also described by many women. Differentiating among the organisms is based on the clinical signs prevalent to each:

Bacterial vaginosis:

  • Thin, frothy discharge
  • Vaginal pH of 4.5
  • Fishy odor

Candida:

  • Curdy, thick discharge
  • Vaginal pH of < 4.5
  • No odor

Trichomoniasis:

  • Greenish, yellow discharge
  • Vaginal pH of > 5.0
  • Fishy odor may be present

Vaginitis Conventional Treatment

Bacterial Vaginosis:

Conventional treatments usually include a regimen of oral medications such as metronidazole, or an intravaginal application of metronidazole gel. Treatment of the sexual partner may be warranted if the patient becomes re-infected.

Vulvovaginal candidiasis:

With over 45 over-the-counter products available and countless prescription drugs, women have a variety of treatment options. Creams are typically applied intravaginally, with treatments varying from overnight to a week long regime. More resistant cases may respond to a single-dose oral medication.

Trichomonal vaginitis:

A single dose of metronidazole is often used. The sexual partner must also be treated to avoid re-infection.

Atrophic vaginitis:

Treatment is limited to hormone therapy, both orally and intravaginally.

Alternative Treatments for Vaginitis

The goals of therapy is to identify and eliminate the contributing factors, to improve immune function, and reestablish proper bacterial flora. Some infections, such as Chlamydia, require medical/pharmaceutical intervention. Although many vaginal conditions an be treated effectively with the dietary inclusion of natural supplements and herbs.

A general diet for treating vaginitis include avoiding simple sugars, avoiding foods with a high level of molds and yeast, and avoiding all known food allergens.

Lactobacillus

Treating vaginal infections requires re-establishing the normal vaginal flora. This “recolonization” of friendly bacteria can be accomplished by douching or by ingesting a high quality acidophilus supplement.

Boric Acid

Used most effectively for candida infections, boric acid has been shown to be up to 98% effective in causes of reoccurring vaginitis. [4] In a study that compared the effectiveness of boric acid to the use of nystatin, cure rates for boric acid were 92% after 10 days compared to 64% for nystatin. [5] The most effective dose proved to be 600 milligrams twice daily, for a duration of no less than two weeks. Administration of boric acid was accomplished via vaginal suppository .

Gentian violet

Gentian violet is a purple dye that acts against Candida albicans. Swabbing the vagina or inserting a tampon that has been soaked in this purple dye, is one of the most effective treatments studied for the treatment of Candida infection. [6]

Tea tree oil

Tea tree oil has been studied for trichomonas, Candida, and other vaginal infections. A diluted amount that is applied as a rinse or as a saturated tampon, has been shown to be extremely effective, even with as few as six treatments. [7, 8]

References

[1] D. Eschenbach, “Vaginal Infection”, Clin Ob Gyn 26 (1986): 186-202

[2] Gravett M, Nelson H, DeRouen T et al. “Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome” JAMA 1986; 256 (14): 1899-1903.

[3] Thomason J, Gelbart S. “Trichomonas vaginalis” Obstet Gynecol 1989; 74: 536-41.

[4] Jovanovic R, Congema E, Nguyen H. “Antifungal agents vs. boric acid for treating chronic mycotic vulvovaginitis: J Rep Med 1991; 36 (8): 593-97.

[5] Van Slyke K, Michel V, Rein M. “Treatment of vulvovaginal candidiasis with boric acid powder”. Am J Obstet Gynecol 1981: 141 (2): 145-48.

[6] C.I.Meeker, “Candidiasis-an Obstinate Problem”, Med Times 106 (1978): 26-32

[7] Williams L, Home V. “A comparative study of some essential oils for potential use in topical applications for the treatment of the yeast Candida albicans.” Aust J Med Herbal 1995; 7 (3): 57-62.

[8] Pena, E. “Melaleuca alternifolia oil: its use for trichomonal vaginitis and other vaginal infections.” Obstet Gynecol 1962; 19(6): 793-95.