Vaginitis

Vaginal infections are among the most common reasons that women seek gynecological care. There are a variety of organisms that are frequently associated with vaginal infection. Some of these include Trichomonas vaginalis, Candida albicans, and Gardnerella vaginalis (formerly Haemophilas vaginalis), in association with other organisms, primarily anaerobes. G. vaginalis, with other organisms, causes a bacterial vaginosis (also referred to as nonspecific vaginitis). Chlamydia trachomatis, and Mycoplasma hominis may also be associated with vaginitis.

While some vaginal infections are simple and require minimal care, others have a more serious side and warrant careful evaluation and appropriate therapy that is specific for the specific site and type of infection. For example, vaginal trichomoniasis and bacterial vaginosis early in pregnancy may be predictors of premature onset of labor. Bacterial vaginosis may also be a risk factor in developing upper genital tract infection. Vaginitis also may be an early sign of toxic shock syndrome. Vaginal discharge may be the presenting symptom of genital herpes, or may occasionally reflect cervicitis or pelvic inflammatory disease (PID) caused by chlamydial or gonococcal infections. All of these are reasons why it is important to have any type of vaginal infection checked out early.

It is important to remember that there are several reasons not related to infection that a woman might have a vaginal discharge. A normal vaginal discharge is generally nonodorous, white, highly viscous, and acidic. Discharges may become heavier at mid-cycle because of increased cervical mucous or increased vaginal cells. Other conditions resulting in excessive vaginal discharges include retention of foreign bodies (e.g., tampons), allergic reactions to vaginal spermicidal agents or products used for douching, or the presence of cervicitis.

Bacterial vaginosis is the most common cause of vulvovaginal symptoms in most clinical settings; it is closely followed in frequency by vulvovaginal candidiasis.(2) Trichomoniasis is a sexually transmitted disease (STD) that is much less common in most settings in developed countries.

Factors that may lead to the development of bacterial vaginosis are not established, but it may be linked to sexual activity. The syndrome is associated with STD factors, such as multiple sex partners or recent intercourse with a new partner; however, no single sexually transmitted pathogen has been identified as the cause. One difference routinely found is that the hydrogen peroxide-producing Lactobacillus sp., which constitutes most of the bacterial flora of healthy women, is usually absent in women with bacterial vaginosis. This situation may be at least partly responsible for the overgrowth of anaerobic bacteria.

Women of all ages are susceptible to vaginal candidiasis. Some of the factors that lead to candidiasis may include pregnancy and diabetes mellitus, thought to be due in part to elevated glucose levels in urine. The use of broad-spectrum antibiotics, cytotoxic drugs, or corticosteroids are thought to alter the normal bacterial flora, allowing yeast overgrowth. Finally, dietary intake (e.g., high calorie or high carbohydrate diets) may influence the incidence of candidiasis.

Atrophic vaginitis is most commonly associated with postmenopausal women and is due, at least in part, to the lessening of tissues which were formerly dependent upon high estrogen concentrations. Large numbers of estrogen receptors are located in the vagina, vulva, urethra, and trigone of the bladder. The vulva undergoes shrinkage, and there is also shrinkage of the labia minora. A decrease in the subcutaneous fat and elasticity of the tissue causes the labia majora to flatten. Sometimes changes of the vulva (Kraurosis vulvae) lead to pruritis and pain. Additionally, the vaginal cell wall becomes thin and pale, leading to reduced secretion and diminished elasticity; the tissue becomes easily traumatized and may bleed. The normal premenopausal pH of 4.5 to 5 rises to an alkaline 6 to 8, creating a favorable environment for growth of pathogens.

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