Vaginitis - Symptom & Treatment of Bacterial, Atrophic Vaginitis
What is Vaginitis?
Inflammation and infection of the vagina are common gynecologic problems, resulting from a variety of pathogens, allergic reactions to vaginal contraceptives or other products, or the friction of coitus. The normal vaginal pH is 4.5 or less, and Lactobacillus is the predominant organism. At the time of the midcycle estrogen surge, clear, elastic, mucoid secretions from the cervical os are often profuse. In the luteal phase and during pregnancy, vaginal secretions are thicker, white, and sometimes adherent to the vaginal walls. These normal secretions can be confused with vaginitis by concerned women.
Vaginitis can be described as an inflammation of the vagina and vulva. It is a fairly common problem with women. Bacterial and Atrophic Vaginitis can be avoided by taking proper treatment in the initial stages itself.
Normal healthy women do not suffer from the sensations of the itching, burning, pain or irritation due to Vaginitis.
There is increase in the frequency or discharge of urine which is accompanied with an unpleasant order.
Symptom of Vaginitis
When the patient complains of vaginal irritation, pain, or unusual discharge, a careful history should be taken, noting the onset of the LMP; recent sexual activity; use of contraceptives, tampons, or douches; and the presence of vaginal burning, pain, pruritus, or unusually profuse or malodorous discharge. The physical examination should include careful inspection of the vulva and speculum examination of the vagina and cervix. The cervix is cultured for gonococcus or chlamydia if applicable. A specimen of vaginal discharge is examined under the microscope in a drop of 0.9% saline solution to look for trichomonads or clue cells and in a drop of 10% potassium hydroxide to search for candida. The vaginal pH should be tested; it is frequently greater than 4.5 in infections due to trichomonads and bacterial vaginosis. A bimanual examination to look for evidence of pelvic infection should follow. The symptoms of vaginitis are
- feeling of heat and fullness in the vagina
- a dragging feeling in the groin
- increased urinary frequency
- vaginal discharge
No woman can predict what symptoms she will experience, or how severely. Therefore, the management of Vaginitis needs to be as personalized as the symptoms themselves.
Causes of Vaginitis
The most rare causes of vaginitis are:
- irritation of vagina by external factors like cuts, abrasions in this region
- constant wearing of tight-fitting clothes
- wearing unclean clothes
- infected water and lack of hygiene.
Trichomonas vaginalis Vaginitis
This protozoal flagellate infects the vagina, Skene's ducts, and lower urinary tract in women and the lower genitourinary tract in men. It is transmitted through coitus. Pruritus and a malodorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema and red macular lesions on the cervix in severe cases. Motile organisms with flagella are seen by microscopic examination of a wet mount with saline solution
Treatment of Vaginitis
Vulvovaginal Candidiasis
A variety of regimens are available to treat vulvovaginal candidiasis. Women with uncomplicated vulvovaginal candidiasis will usually respond to a 1- to 3-day regimen of a topical azole. Women with complicated infection (including four or more episodes in 1 year, severe signs and symptoms, non-albicans species, uncontrolled diabetes, HIV infection, corticosteroid treatment, or pregnancy) should receive 7–14 days of a topical regimen or two doses of fluconazole 3 days apart. (Pregnant women should use only topical azoles.)
Single-dose regimens
Clotrimazole (500-mg vaginal tablet) or tioconazole ointment (6.5%, 5 g). Fluconazole, 150 mg orally is also effective.
Three-day regimens
Butoconazole (2% cream, 5 g), clotrimazole (two 100-mg vaginal tablets), terconazole (0.8% cream, 5 g, or 80-mg suppository), or miconazole (200-mg vaginal suppository) once daily.
Seven-day regimens
Clotrimazole (1% cream or 100-mg vaginal tablet), miconazole (2% cream, 5 g, or 100-mg vaginal suppository), or terconazole (0.4% cream, 5 g) once daily.
Fourteen-day regimens
Nystatin (100,000-unit vaginal tablet once daily), boric acid capsules (600 mg gelatin capsule inserted vaginally, daily).
Recurrent vulvovaginitis (maintenance therapy)
Ketoconazole (100 mg orally) once daily for up to 6 months, clotrimazole (500-mg vaginal suppository) once weekly, fluconazole (100–150 mg orally) once weekly, or itraconazole (400 mg orally) once monthly or 100 mg orally once daily.
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