Vaginitis

  • Basics

    Vaginitis is an inflammation of the vagina, and affects women of all ages. Infections and allergies can cause vaginitis. Inflammation occurs when hormones, hygiene, bacteria, or sexual activity throw off the delicate balance of microorganisms inside the vagina. Vaginitis symptoms and treatment differ depending on the causative agent: bacteria, the protozoan parasite Trichomonas vaginalis, yeast, an allergen, or a decrease in estrogen. About 75% of all women will suffer from at least one yeast infection; half will have more than one during their lifetimes. Some vaginal infections, such as bacterial vaginosis and trichomoniasis, put women at greater risk for more serious conditions, such as premature delivery of a baby.

    Of the millions of cases of vaginitis each year, most are caused by bacterial vaginosis (about 40% to 50%), followed by yeast infections (20% to 25%) and then trichomoniasis (15% to 20%).

    Some types of vaginitis can be sexually transmitted. If vaginitis results from a sexually transmitted disease, some research says that partners also should receive treatment. In addition, women with bacterial vaginosis and trichomoniasis may have been exposed to other sexually transmitted organisms, such as N. gonorrhoeae that causes gonorrhea, and the human immunodeficiency virus (HIV) that causes AIDS. Unless women who have chlamydiosis or gonorrhea receive treatment, up to 40% will develop pelvic inflammatory disease, according to the Centers for Disease Control (CDC) and Prevention.

  • Causes

    Vaginitis results from certain infections, or when the bacterial flora of the vagina is disrupted.

    Bacterial vaginosis, trichomoniasis, and candidiasis are the three most common types of vaginal infections. More than one causative agent may be present.

    Bacterial vaginosis occurs if the number of Lactobacillus bacteria declines, allowing other organisms to multiply rapidly. Douching, spermacides containing nonoxynol-9, and new sex partners contribute to the loss of Lactobacillus bacteria. Bacterial vaginosis was previously known as nonspecific vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge. Although linked with sexual activity, bacterial vaginosis is not caused by a single sexually transmitted microbe. Researchers are not sure if treating a woman's partner can help prevent bacterial vaginosis from recurring.

    Trichomoniasis, which is caused by a parasite not normally found in the vagina, is sexually transmitted. Men rarely exhibit symptoms of trichomoniasis, but may harbor the parasite and pass it on to a partner during intercourse. The woman may develop symptoms 4 to 20 days after exposure.

    Candidiasis, or yeast infections, occur when the normal vaginal environment is disrupted, or the immune system is weakened and cannot stop the yeast from proliferating. About 80% of yeast infections are caused by Candida albicans.

    Gonorrhea, chlamydiosis, and genital herpes are sexually transmitted diseases that can cause abnormal vaginal discharge.

    Allergic vaginitis occurs after exposure to products that create an allergic response. Vaginal hygiene products, douches, bubble bath, detergents, fabric softeners, colored or scented toilet paper, perfumes, panty liners, and other products used in the genital area can cause an allergic reaction. Sometimes a tampon left in too long will produce symptoms, as can swimming or sitting in a hot tub with chemically treated water. Contraceptives such as latex condoms, intrauterine devices, diaphragms, and spermacides can also cause the condition.

    Atrophic vaginitis refers to an irritation of the vaginal lining caused by a decrease in estrogen during menopause, or by having your ovaries removed. Drops in estrogen levels cause the vaginal lining to become thinner and drier.

    Many different organisms can cause vaginitis or an abnormal vaginal discharge Table 01.

    Table 1.  Organisms That Cause Vaginitis or Abnormal Vaginal Discharge

    Condition Predominant pathogens Comments
    Vaginitis
    Bacterial vaginosis (previously known as Gardnerella vaginitis, nonspecific vaginitis) Gardnerella vaginalis, Mycoplasma hominis, anaerobic bacteria (Prevotella spp.) G. vaginalis is normally present in one-third to one-half of sexually active women.Bacterial vaginosis is due to an intermicrobial interaction with anaerobic bacteria and M. hominis.Bacterial vaginosis is associated with sex, but is not a sexually transmitted disease.
    Vulvovaginal candidiasis Candida albicans Although 80%-95% of clinical isolates responsible for vulvovaginal candidiasis are C. albicans, data suggest that clinical failures may be due to a predominance of Candida glabrata.Not a sexually transmitted disease.
    Trichomoniasis Trichomonas vaginalis Sexually transmitted and not part of the normal vaginal flora.
    Vaginal discharge (associated with sexually transmitted disease)
    Gonorrhea Neisseria gonorrhoeae Vaginal discharge results from endocervicitis.Women are frequently asymptomatic until complications have occurred.Co-infections with C. trachomatis are common.
    Chlamydiosis Chlamydia trachomatis Vaginal discharge results from endocervicitis.C. trachomatis produces infection of the genital tract, including mucopurulent (containing mucus and pus) cervicitis and salpingitis.
    Genital herpes Herpes simplex virus types 1 and 2 (HSV-1, HSV-2) Genital discharge results from cervical, vaginal, or vulval lesions. HSV-1 is more frequently associated with oral herpes and HSV-2 with genital herpes; however, up to 40% of new cases of genital herpes are due to HSV-1.

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