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Thursday, 12 May 2016

Vaginal Infections




Vaginitis is a very common problem among ladies from all walks of life and ages regardless of any socioeconomic and ethnic background. Sometimes, this disease can be recurrent and irritating.

What is vaginitis?
Vaginitis means inflammations of the vagina. In most cases, it is due to a fungal, bacterial, trichomoniasis or mixed infections. The patient typically has a discharge, itching, burning, and possibly pain.

How many types of vaginitis are there?
There are several types of vaginitis. The most common are:
  • Atrophic vaginitis occurs when the endothelium, the lining of the vagina, gets thinner when estrogen levels go down during the menopause. This makes the lining more susceptible to irritation and inflammation.
  • Bacterial vaginitis is caused by overgrowth of normal bacteria in the vagina. Patients usually lacking the normal vaginal bacteria called lactobacilli.
  • Trichomoniasis is a sexually transmitted single-celled protozoan parasite Trichonomas vaginalis. It may infect other parts of the urogenital tract, including the urethra (where urine comes out) as well as the vagina.
  • Candidiasis (or thrush) happens when Candida Albicans, a yeast-like fungal organism grows in the vagina.
What are the symptoms of vaginitis?
A symptom is something the patient complaints, while a sign is what doctor detected. For instance, pain is a symptom while a rash is a sign.
The hallmark symptoms of vaginitis include itching, burning and a discharge. Generally, the symptoms are as follows:
  • Irritation at genital area.
  • Genital itching.
  • Inflammation (redness and swelling especially around the labia areas).
  • Foul odor.
  • Vaginal discharge.
  • Discomfort when urinating (burning sensation).
What causes vaginitis?
Infectious vaginitis makes up 90% of all cases in post-pubescent females. These include candidiasis,
bacteria vaginosis and trichmonisasis. Less commonly vaginitis may be caused by gonorrhea, Chlamydia, mycoplasma, herpes, campylobacter, some parasites and poor hygiene.

Young girls, before they reach
puberty, may also develop vaginitis, but the cause is often different from those elder females. While streptococcus spp causes bacterial vaginosis in pre-pubescent girls, for post-pubescent females it is Gardnerella (both are types of bacteria). Improper hygiene in pre-pubescent girls can transfer bacteria and other irritants to the vaginal area from the anal region. Pre-pubescent girls do not usually get yeast infection because their pH balance is different from older women's.

Allergic reaction can cause vaginitis as well. For example, some women may be allergic to condoms, spermicides, certain soaps and perfumes, douches, topical medications, lubricants, and even semen. Irritation from a tampon may cause vaginitis in some women.

How is vaginitis diagnosed?
The doctor, usually a GP will carry out a physical examination and question the patient regarding her medical history. A sample of discharge may be taken to examine the cause of the inflammation.

Vaginitis is diagnosed by checking vaginal fluid appearance, vaginal pH levels, and the presence of volatile amines (the gas that causes a bad smell) and the microscopic detection of specific cells.

What is the treatment for vaginitis?
The type of treatment recommended depends on the cause of the infection.
1. Oral antibiotics and antifungals. Metronidazole may be prescribed by GP for Trichomonas  or Fluconazole/intraconazole for Candida or Ciprofloxacin for bacteria. Please consult your doctor to get the suitable prescriptions only medications.

2. Vaginal pessary – there are many types of pessary available to treat vaginitis. The most common one are Clotrimazole 1’s, 3’s, 6’s vaginal pessary, Nystatin 14’s vaginal pessary, dequalinium 6’s pessary. Recently, there is a good drug choice – Neo-Penotran Vaginal Pessary 14’s (Metronidazole 500mg+Miconazole 100mg) with 3-in-1 actions i.e. antibacterial, antitrichomonal and antifungal. I personally prefer this as it is broad spectrum, an immediate treatment with no test required and with lesser side effects. Furthermore, it is safe in pregnant women after 1st trimester.

3. Combination of antifungal and steroids cream is usually prescribed for local applications when required if irritation symptoms are severe.

4. An antihistamine will be prescribed if inflammation has been caused by an allergic reaction.

5. If the vaginitis was caused by low estrogen levels (especially in those menopause women), a topical estrogen cream may be recommended.

6. Urine alkalizer might be given to neutralize the acidity of the vaginal if it is due to PH imbalance.
                                              
7. Probiotics is recommended to restore vaginal flora balance especially after the antibiotics course which may have been altered after treatment for an infection. Vaginal flora refers to a balance of good bacteria in the vagina that has significant implications for a woman's overall health.

8. Cranberries juice is recommended for mild UTIs. Recent research has shown that the unusual nature of their proanthocyanidins (PACs) can help prevent UTIs. The special structure of these PACs (involving A-type linkages between their components) acts as a barrier to bacteria that might latch on to the urinary tract lining.

How can vaginitis be prevented?
  • Good hygiene - keep vaginal area clean. Use a mild soap without irritants.
  • Avoid douching and irritating agents - many are present in hygiene sprays, soaps, and other feminine products.
  • Avoid wiping from your bottom to vagina (wipe it the other way round).
  • Wear loose clothing.
  • Practice safe sex.

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