THREATMENT AREAS

Vaginal Infections

1. What Is Vaginal Infection (Vaginitis)?

Vaginitis is the inflammation of vaginal mucosa and is one of the diseases that are the most frequent reason to consult gynecologists. Vaginitis affect the 90% of adolescent women and two or more infections proceed together on the 30% of the mature1,2,3.

Vaginal secretion is a clear and glairy secretum, which helps the vaginal environment stay wet in normal cases. Vaginal secretion may rise in natural conditions like pregnancy, sexual arousal, and laying, yet this does not cause any complaint as well as being a usual case. Thus, vaginal secretion's rise does not necessarily mean it is a sign of a medical problem.

If rash, irritancy, and fetor is felt together with a rise in the amount of vaginal secretion and a change in its texture and colour, and if these symptoms have been running on for over 2-3 days, the vaginal secretion might be indicating the presence of a problem.

Vaginitis is not generally a life-critical disease. Nonetheless, it may cause more serious health issues unless treated accurately and timely.

 

2. How Does Vaginitis Develop?

Three factors are often (90%) responsible for occurence of Vaginitis:

- Mycetes (Candida albicans)

- Bacteria (Gardnerella vaginalis)

- Parasites (Trichomonas vaginalis)

Apart from these, bacteria of Chlamydia and Micoplasma groups are the microorganisms that may be the answer for the vaginitis tables of Neisseria gonorrhoea, Escherichia coli, Giardia lamblia, Balantidum coli, Entamoeba histolytica and Ureaplasma urealiticum 4.

The spoil of the usual vaginal environment (flora) and the change of pH are the leading factors that play a part in the development of Vaginitis.

Mixed vaginal infections are mentioned when, sometimes, two of these factors, and sometimes all of them exist together.

3. What Are The Types of Vaginitis That Are Frequent?

The types of vaginitis that are the most frequent are candidal vulvovaginitis caused by mycetes, bacterial vaginosis caused by bacteria, and trichomonal vaginitis caused by parasites.

 

What Is Candidal Vulvovaginitis (Vaginal Fungal Infection)?

The determinant of candidal vulvovaginitis, which is a frequent kind of vaginitis, is majorly blastomycetes, which are named Candida albicans. Candida albicans is the most important one of the mycetes that cause infection as a result of the collapse of the natural resistance of the organism that is present in skin and mucouse membranes and normal flora of healthy individuals. This kind of vaginitis occurs at least once in the lifetime of about 75% percent of adult women and twice or more in that of 40-50% of them1.

 

What Are The Symptoms of Candidal Vulvovaginitis?

Its main symptom is severe itching and irritation around vagina. In parallel with this, there is also rash and swelling, and a little and intensive cheesy leakage on outer genitals2.

 

What Are The Reasons Lying Behind Candidal Vulvovaginitis?

These mycetes, which normally exist in mouth, throat, bowel (colon), and vaginal flora, cause disease in cases which change the body balance such as pregnancy, diabetes, obesity, and if birth control products, spermicides, intrauterine device (IUD), and intense antibiotics are used5.

 

How To Cure Candidal Vulvovaginitis?

In the treatment of these infections, products that are called antifungal and used against mycetes and that are administered orally and by vaginal route are used.

 

What Is Vaginal Infection Originating From Bacteria (Bacterial Vaginosis)?

Bacterial vaginosis, also known as Gardnerella vaginalis or non-specific vaginitis, is the most frequent bacterial vaginal infection observed on women in reproductive age group. Throughout this disease, the usual vaginal flora changes, the helpful bacteria that are named Lactobacillus and, which must exist in healthy flora, disappear, and other sorts of bacteria (Peptococcus sp., Prevotela sp., G. Vaginalis and Mobiluncus sp.) increase6.

Since bacterial vaginosis proceeds indefinitely by 50%, its frequency ratio can not be determined precisely. In addition, it is possible to say that bacterial vaginosis has been detected in 15%-19% of the patients who apply to polyclinics due to their gynecologic disorders, in 10%-30% of pregnant women, and in 24%-40% of individuals who carry a disease that is sexually transmitted1.

 

What Are The Symptoms of Bacterial Vaginosis?

In bacterial vaginosis, no symptoms occur at the rate of 50%. The most crucial symptom is the fishy vaginal secretion. Itching and irritation can be observed in some cases.

 

What Are The Reasons Lying Behind Bacterial Vaginosis?

Among risk factors, there are use of IUD, vaginal douching, and pregnancy.

 

How To Cure Bacterial Vaginosis?

In its treatment process, various antibiotics that are incepted or applied by vaginal route against bacteria are used.

 

What Is Trichomonal Vaginitis?

The cause of trichomonal vaginitis is Trichomonas vaginalis, which is a sexually transmitted parasite. Trichomonas vaginalis affects nearly 180 million people all around the world in a year7.

 

What Are The Symptoms of Trichomonal Vaginitis?

Symptoms intensify especially in gestation period and after period of menstruation. The most frequent symptom is the sniffy excessive flix. The flix is generally observed in yellow-green colour. The pain during sexual relation, the irritancy while urinating, and the ache some patients feel at their hypogastrium are among other symptoms.

 

What Are The Reasons Lying Behind Trichomonal Vaginitis

As trichomonal vaginitis is a sexually transmitted disease, it may emerge as a result of sexual intercourse with an individual that is a carrier of this disease.

 

How To Cure Trichomonal Vaginitis?

In its treatment, remedies that are called antiprotozoal and that are incepted or used by vaginal route against parasites are taken. These remedies contain the products.

Since it is a disease passed on sexually, the sexual partner should also be treated for the success of the treatment and for the recurrence rate to be decreased to the lowest level. Sexual relationship should be forbidden during treatment8.

 

What Are The Effects That Facilitate Vaginitis To Emerge?

Such causes as

- Using synthetic, tight clothes

- Pregnancy (hormonal changes)

- Diabetes

- Taking birth control pills

- Inaccurate hygiene habits

- Immune deficiency

are the factors promoting vaginitis development.

 

What Are The Precautions To Take To Protect From Vaginitis?

Hygiene is the primary factor at avoiding diseases. It is useful to change, boil, and iron underclothes daily.

Often washing vagina with soap and intime douche causes inflammatory diseases spoiling the protective layer of vagina. Using pad and tamp for a long time is also a negative determinant.

Public baths and over chlorinated pools must not be used and public toilets and public toilet materials must not be utilized.

In cleaning of external genitals, washing and drying must be done front to back. With this method, germs might be prevented from being carried to vagina from perianal, which is a location rich in microbes.

Preference of clothes is a vital factor for avoiding diseases. Clothes that are too tight, such as trousers, underwears with synthetic fibre, are especially factors increasing development of mycetes as they let very little air in and boost the heat and moisture around vagina. Such clothes as swimming suit, which is worn wetly for too long, are harmful due to the same reason. Therefore, casual dresses and cotton underwears must be preferred.

Chemical contact might cause vaginitis by changing the vaginal environment as a result of local allergy and hypersensitivity. This is why the use of scented toilet papers must be evaded.

Antibiotics should only be used in control of doctor as long-standing and unrestrained use of them is one of the frequent causes of vaginitis.

Eating habits may be preparative for vaginitis as well. Especially, well-sugared nutrients  may enable the occurence of the disease considering that feeding on them would raise blood glucose.

 

How Should Sex Life Be During Treatment of Vaginitis?

Throughout treatment, sexual intercourse should be avoided for other types of vaginitis as well because scratchiness caused by sexual intercourse enables infections to develop and pain is a high incidence symptom for any kind of vaginitis.


References

1.    Egan, ME, Lipsky, MS. Diagnosis of Vaginitis; American Family Physician, 2000   Sep 1; 62(5): 1095-104.

2.    Hetal B Gor, Vaginitis: Differential Diagnoses & Workup. Updated: May 19, 2010.

3.    Coco AS, Vandenboscheet M. Postgraduate Medicine, 2000, 107: No.4: 63-74.

4.    Family Practice News. A Clinical Update In Treatment of Bacterial Vaginosis.

5.    Mardh, PA., Tchoudomirova, K., Elshiby, S., Hellberg, D. Symptoms and signs in single and mixed genital infections. Int. J Gynecol Obstet 1998; 63: 145-152.

6.    Balcı O, Çağar M.: Vajinal enfeksiyonlar. Magazine of Turkish Gynecology Obstetrics Association, 2005; Volume:2 Issue: 5 Page 14-20.

7.    Jack D. Sobel. Vaginitis. The New England Journal of Medicine. December 25th, 1997.

               8.    Sexually Transmitted Diseases Treatment Guidelines, 2006, MMWR.