Vaginitis Diagnosis

  • Diagnosis

    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.

    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.

    Vaginitis causes abnormal vaginal discharge; however, some women with vaginitis do not have any discharge. Not all changes in a woman's vaginal discharge indicate vaginitis. Normal hormonal changes may alter the amount and appearance of the discharge.

    While bacterial vaginosis may produce a fishlike odor, half of patients with this type of vaginitis do not complain of any symptoms.

    Trichomoniasis often occurs without symptoms in women and men. Women, however, may experience profuse, thin, yellow-green or gray discharge, painful urination and intercourse, external itching and redness, and sometimes lower abdominal pain. Trichomoniasis may also produce a fishlike odor.

    Yeast infections create a burning or itching sensation, and may produce a thick, white, cottage cheese-like discharge. Not all patients experience the discharge. Intercourse and urination may become painful. Men often have no symptoms, or they may develop a rash after having sex with a woman who is infected. Doctors are not certain if yeast infections can be transmitted by sexual contact.

    An abnormal discharge may occur with allergic vaginitis.

    Post-menopausal women with atrophic vaginitis may experience vaginal itching, burning, and pain with light bleeding after intercourse.

    Risk factors differ depending on the type of vaginitis.

    A new sexual partner, multiple sex partners, cigarette smoking, and douching increase the risk of bacterial vaginosis.

    Yeast infections often occur (in order of relative frequency) as a result of pregnancy, antibiotic use, poor nutrition, stress, using oral contraceptives, or as a result of uncontrolled diabetes mellitus, HIV/AIDS, or use of immunosuppressive drugs. Antibiotics kill the normal bacteria that live in the vagina, allowing yeast to grow unchecked. HIV/AIDS limits the body's ability to fight an infection. Pregnancy and oral contraceptives alter hormone levels, and uncontrolled diabetes changes the normal vaginal environment. Douching, feminine hygiene sprays, sitting around in a wet bathing suit, and wearing tight pants can contribute to yeast infections.

    Sex without a condom puts women at risk for sexually transmitted diseases, including HIV/AIDS, gonorrhea, and trichomoniasis, among others.

    It is impossible to diagnose vaginitis based on symptoms alone. Therefore, your doctor will perform a medical exam and inspect the vaginal fluid under a microscope to make an accurate diagnosis. Doctors will obtain a swab from inside the vagina, and then test the pH and look under a microscope at the type of cells present before making a diagnosis. If your doctor is concerned that you could be infected with gonorrhea or chlamydia, he or she will also send a swab of your vaginal fluid to a lab to check for these infections.

    Condoms can help prevent the spread of trichomoniasis and other sexually transmitted diseases. Always change condoms between anal and vaginal intercourse.

    Since yeast thrive in moist conditions, keeping the genital area dry and well-ventilated will decrease the risk of candidiasis. To decrease the risk of a yeast infection, do not sit around in a wet bathing suit; do not wear tight-fitting clothes or synthetic pants; wear cotton underpants; avoid pantyhose and leotards; thoroughly dry the genital area before dressing.

    Avoid allergic vaginitis by eliminating use of perfumes, scented and colored toilet paper, harsh, scented, or deodorant soaps, and scented or deodorant sanitary pads or panty liners. Do not use douches, feminine hygiene sprays, bubble bath, or scented or deodorant sanitary pads or tampons. Use unscented, white toilet paper.

    Wipe from front to back after using the toilet to help prevent bacteria and fungi common in the intestines from coming in contact with the opening to the vagina.

  • Prevention and Screening

    Condoms can help prevent the spread of trichomoniasis and other sexually transmitted diseases. Always change condoms between anal and vaginal intercourse.

    Since yeast thrive in moist conditions, keeping the genital area dry and well-ventilated will decrease the risk of candidiasis. To decrease the risk of a yeast infection, do not sit around in a wet bathing suit; do not wear tight-fitting clothes or synthetic pants; wear cotton underpants; avoid pantyhose and leotards; thoroughly dry the genital area before dressing.

    Avoid allergic vaginitis by eliminating use of perfumes, scented and colored toilet paper, harsh, scented, or deodorant soaps, and scented or deodorant sanitary pads or panty liners. Do not use douches, feminine hygiene sprays, bubble bath, or scented or deodorant sanitary pads or tampons. Use unscented, white toilet paper.

    Wipe from front to back after using the toilet to help prevent bacteria and fungi common in the intestines from coming in contact with the opening to the vagina.

Recommended Reading

Meet the Pharmacists

I'm Kristen Dore, PharmD. Welcome to PDR Health!

Check out my latest blog post on heartburn medication

Vaginitis Related Drugs

Vaginitis Related Conditions