Infections of the Vagina and Vulva

Infection of the vulva and vagina are very common conditions nowadays and affect one-third of women and girls during their reproductive period. It is also known as vulvovaginitis. It is the inflammation or infection of the vulva(vulvitis) and vagina(vaginitis).

There are three main types of vaginal and vulval infections-

  • Candidiasis
  • Bacterial vaginosis
  • Trichomoniasis

Candidiasis

Candidiasis is a type of fungal infection and the most common cause of vulvitis, vaginitis and vaginal discharge. The fungal parasite responsible for this infection is Candida Albicans. It is more commonly found in the mouth, digestive system and vagina.

Candida species are normally present in women during reproductive years and remain asymptomatic but under certain conditions, it overgrows, increases and causes symptoms.

Predisposing factors that change their balance and convert them into a parasitic ones include

  • Taking antibiotics for some infections in the body.
  • Physiological changes during pregnancy(change in hormonal levels)
  • Iron deficiency disorders
  • Local changes to the vaginal flora
  • Immunosuppressant diseases or treatment(chemotherapy and AIDS)
  • Endocrine diseases such as diabetes

Symptoms

  • Vulval itching
  • Vulval area becomes sore, red and swollen
  • Thick, white curdy discharge and sometimes watery and odorless.
  • Burning sensation during urination
  • Pain during sexual intercourse
  • Small cuts can occur on the vulva due to intense itching
  • On examination, vulva, vagina and cervix looks erythematous and swollen.

Treatment

Vaginal culture is done to detect the candida cells so that appropriate treatment can be given accordingly. Candidiasis is treated with antifungal pessaries or cream inserted high into the vagina at night. It include clotrimazole, nystatin or oral Fluconazole.

Some other measures include

  • Maintain general and genital hygiene
  • Avoid vaginal douches or irritants
  • Washing and wiping of genital area from front to back after each act of urination
  • Discourage wearing of tight fitting synthetic clothing.
  • Wearing of loose, comfortable and cotton underwear to prevent infection and irritation.

Bacterial vaginosis (BV)

Bacterial vaginosis is a bacterial infection and the most common cause of vaginal discharge in women of childbearing age. In this condition, the normal bacteria which lives in the vaginal flora are replaced with a number of aerobic and anaerobic bacteria. It is caused due to the combination of several bacteria. When there is a change in the pH balance occur, these bacteria overgrow and cause symptoms.

Bacterial vaginosis is termed vaginosis instead of vaginitis because it occurs due to the alteration in the vaginal flora rather than due to any infection.

It is more common in women with intrauterine contraceptive devices, those who smoke and those with pelvic inflammatory diseases.

Symptoms

Bacterial vaginosis is not a sexually transmitted disease and a majority of women complains of vaginal discharge without itching.

  • White and milky discharge
  • Fishy smell of the vaginal discharge
  • After having intercourse, the smell becomes more noticeable
  • Minimal vulval irritation might occur.

An affected woman may not experience any redness or itching until any infection occurs.

Treatment

It can be diagnosed by wet smear and culture which reveals few inflammatory cells and other organisms but very little normal bacteria.

Treatment includes use of antibiotics for 7 days is adequate enough to treat the bacterial infection. Some antibiotics include metronidazole(500mg twice daily), ampicillin(500mg) or cephalosporin(500mg), tetracycline(500mg), clindamycin(300mg) and doxycycline(100mg) are found effective.

Local application of clindamycin cream 2% is also found effective in 85% of cases. Vaginal tablet (ornidazole 500mg) and lacteal gel(neutralizes the vaginal pH)are too effective. General cleanliness of the vulval area is necessary to prevent any infection.

Trichomoniasis

Trichomoniasis is a protozoan infection and is most common amongst women who complain of vaginal and vulval itching. It is a sexually transmitted disease and most common in women and girls of childbearing age.

Trichomonas vaginalis is transmitted by sexual contact with an infected partner or contact with infected materials. It also can be acquired by inadequate hygiene and the use of an infected person’s towel or clothes.

Symptoms

Symptoms include-

  • A typical vaginal discharge which is profuse, irritating, frothy, thin, creamy or slight green in colour
  • Discharge is foul smelling
  • Presence of itching and soreness of the vulva and vagina
  • Pain and burning sensation during urination
  • When the infection reaches the pelvic area, it causes abdominal pain, back pain and pain during sexual intercourse.

Treatment

It can be diagnosed by pap smear which shows the presence of organism in the vaginal smear.

Treatment includes the use of antibiotics such as metronidazole should be prescribed for both partners for 7 days.

Partners are advised to abstain from sexual contact or use a condom during treatment and avoid the use of materials of an infected person.

Conclusion

In the above post, we discussed three types of vulval and vaginal infection, their symptoms and treatment.

Thank you all!!! Hope you find this useful.


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