Vaginitis Due to Vaginal Infections
Vaginitis is an inflammation of the vagina characterized by discharge,
odor, irritation, and/or itching. The cause of vaginitis may not always
be determined adequately solely on the basis of symptoms or a physical
examination. For a correct diagnosis, a doctor should perform laboratory
tests including microscopic evaluation of vaginal fluid. A variety of
effective drugs are available for treating vaginitis.
Vaginitis often is caused by infections, which cause distress and discomfort.
Some infections are associated with more serious diseases. The most
common vaginal infections are bacterial vaginosis, trichomoniasis, and
vaginal yeast infection or candidiasis. Some vaginal infections are
transmitted through sexual contact, but others such as yeast infections
probably are not, depending on the cause.
Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms
among women of childbearing age. Previously called nonspecific vaginitis
or Gardnerella-associated vaginitis, BV is associated with
sexual activity. BV reflects a change in the vaginal ecosystem. This
imbalance, including pH changes, occurs when different types of bacteria
outnumber the normal ones. Instead of Lactobacillus bacteria
being the most numerous, increased numbers of organisms such as Gardnerella
vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis
are found in the vaginas of women with BV. Investigators are studying
the role that each of these microbes may play in causing BV, but they
do not yet understand the role of sexual activity in developing BV.
A change in sexual partners and douching may increase the risk of
acquiring bacterial vaginosis.
Symptoms. The primary symptom of BV is an abnormal,
odorous vaginal discharge. The fish-like odor is noticeable especially
after intercourse. Nearly half of the women with clinical signs of
BV, however, report no symptoms. A physician may observe these signs
during a physical examination and may confirm the diagnosis by doing
tests of vaginal fluid.
Diagnosis. A healthcare worker can examine a sample
of vaginal fluid under a microscope, either stained or in special
lighting, to detect the presence of the organisms associated with
BV. They can make a diagnosis based on the absence of lactobacilli,
the presence of numerous "clue cells" (cells from the vaginal
lining that are coated with BV organisms), a fishy odor, and decreased
acidity or change in pH of vaginal fluid.
Treatment. All women with BV should be informed of
their diagnoses, including the possibility of sexual transmission,
and offered treatment. They can be treated with antibiotics such as
metronidazole or clindamycin. Generally, male sex partners are not
treated. Many women with symptoms of BV do not seek medical treatment,
and many asymptomatic women decline treatment.
Complications. Researchers have shown an association
between BV and pelvic inflammatory disease (PID), which can cause
infertility and tubal (ectopic) pregnancy. BV also can cause adverse
outcomes of pregnancy such as premature delivery and low-birth-weight
infants. Therefore, the U.S. Centers for Disease Control and Prevention
(CDC) recommends that doctors check all pregnant women for BV who
previously have delivered a premature baby, whether or not the women
have symptoms. If these women have BV, they should be treated with
oral metronidazole or oral clindamycin. A pregnant woman who has not
delivered a premature baby should be treated if she has symptoms and
laboratory evidence of BV. BV is also associated with increased risk
of gonorrhea and HIV infection (HIV, human immunodeficiency virus,
Trichomoniasis, sometimes referred to as "trich," is a
common STD that affects 2 to 3 million Americans yearly. It is caused
by a single-celled protozoan parasite called Trichomonas vaginalis.
Trichomoniasis is primarily an infection of the urogenital tract;
the urethra is the most common site of infection in man, and the vagina
is the most common site of infection in women.
Symptoms. Trichomoniasis, like many other STDs, often
occurs without any symptoms. Men almost never have symptoms. When
women have symptoms, they usually appear within four to 20 days of
exposure. The symptoms in women include a heavy, yellow-green or gray
vaginal discharge, discomfort during intercourse, vaginal odor, and
painful urination. Irritation and itching of the female genital area,
and on rare occasions, lower abdominal pain also can be present. The
symptoms in men, if present, include a thin, whitish discharge from
the penis and painful or difficult urination.
Treatment. Because men can transmit the disease to
their sex partners even when symptoms are not present, it is preferable
to treat both partners to eliminate the parasite. Metronidazole is
the drug used to treat people with trichomoniasis. It usually is administered
in a single dose. People taking this drug should not drink alcohol
because mixing the two substances occasionally can cause severe nausea
Complications. Research has shown a link between trichomoniasis
and two serious sequelae. Data suggest that trichomoniasis is associated
with increased risk of transmission of HIV and may cause a woman to
deliver a low-birth-weight or premature infant. Additional research
is needed to fully explore these relationships.
Prevention. Use of male condoms may help prevent the
spread of trichomoniasis, although careful studies have never been
done that focus on how to prevent this infection.
Vaginal Yeast Infection
Vaginal yeast infection or vulvovaginal candidiasis is a common cause
of vaginal irritation. Doctors estimate that approximately 75 percent
of all women will experience at least one symptomatic yeast infection
during their lifetimes. Yeast are always present in the vagina in
small numbers, and symptoms only appear with overgrowth. Several factors
are associated with increased symptomatic infection in women, including
pregnancy, uncontrolled diabetes mellitus, and the use of oral contraceptives
or antibiotics. Other factors that may increase the incidence of yeast
infection include using douches, perfumed feminine hygiene sprays,
and topical antimicrobial agents, and wearing tight, poorly ventilated
clothing and underwear. Whether or not yeast can be transmitted sexually
is unknown. Because almost all women have the organism in the vagina,
it has been difficult for researchers to study this aspect of the
Symptoms. The most frequent symptoms of yeast infection
in women are itching, burning, and irritation of the vagina. Painful
urination and/or intercourse are common. Vaginal discharge is not
always present and may be minimal. The thick, whitish-gray discharge
is typically described as cottage-cheese-like in nature, although
it can vary from watery to thick in consistency. Most male partners
of women with yeast infection do not experience any symptoms of the
infection. A transient rash and burning sensation of the penis, however,
have been reported after intercourse if condoms were not used. These
symptoms are usually self-limiting.
Diagnosis. Because few specific signs and symptoms
are usually present, this condition cannot be diagnosed by the patient's
history and physical examination. The doctor usually diagnoses yeast
infection through microscopic examination of vaginal secretions for
evidence of yeast forms.
Scientists funded by the National Institute of Allergy and Infectious
Diseases (NIAID) have developed a rapid simple test for yeast infection,
which will soon be available for use in doctors offices. If
such a test were available for home screening, it would help them
to appropriately use yeast medication.
Treatment. Various antifungal vaginal medications are
available to treat yeast infection. Women can buy some antifungal
creams, tablets, or suppositories (butoconazole, miconazole, clotrimazole,
and tioconazole) over the counter for use in the vagina. But because
BV, trichomoniasis, and yeast infection are difficult to distinguish
on the basis of symptoms alone, a woman with vaginal symptoms should
see her physician for an accurate diagnosis before using these products.
Other products available over the counter contain antihistamines
or topical anesthetics that only mask the symptoms and do not treat
the underlying problem. Women who have chronic or recurring yeast
infections may need to be treated with vaginal creams for extended
periods of time. Recently, effective oral medications have become
available. Women should work with their physicians to determine possible
underlying causes of their chronic yeast infections. HIV-infected
women may have severe yeast infections that are often unresponsive
Other Causes of Vaginitis
Although most vaginal infections in women are due to bacterial vaginosis,
trichomoniasis, or yeast, there may be other causes as well. These
causes may include allergic and irritative factors or other STDs.
Noninfectious allergic symptoms can be caused by spermicides, vaginal
hygiene products, detergents, and fabric softeners. Cervical inflammation
from these products often is associated with abnormal vaginal discharge,
but can be distinguished from true vaginal infections by appropriate
In an effort to control vaginitis, research is under way to determine
the factors that promote the growth and disease-causing potential
of vaginal microbes. No longer considered merely a benign annoyance,
vaginitis is the object of serious investigation as scientists attempt
to clarify its role in such conditions as pelvic inflammatory disease
and pregnancy-related complications.
NIAID is a component of the National Institutes of Health
(NIH), which is an agency of the Department of Health and Human Services.
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treat infectious and immune-mediated illnesses, including HIV/AIDS
and other sexually transmitted diseases, illness from potential agents
of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma
News releases, fact sheets and other NIAID-related
materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
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Last Updated November 21, 2003 (alt)