Causes, symptoms and treatment of various types of vaginal infections

Read this in Hindi. The endless itching is causing you constant discomfort and embarrassment, and you have a sneaking feeling that something is not right with your vagina! You guessed it right. It is most probably a vaginal infection. Vaginal infections afflict females as young as 11 years old and it could keep bugging you post menopause too. Vaginal infection /inflammation is medically termed vaginitis. There are different types of vaginitis, the most common being –

• Yeast infection
• Bacterial vaginosis
• Viral vaginitis
• Trichomoniasis
• Genital herpes
• Chlamydia

Vaginal inflammation can also occur because of allergies. This type of inflammation is non-infectious though. Each one of these requires a different treatment, and sometimes more than one vaginal infection can occur at the same time. Get the infection treated as early as possible because untreated or incomplete cure and recurring UTI can lead to a shift from a predominance of lactobacilli to disease causing bacteria. [1] Lactobacilli are the dominant bacteria in the vagina. They have antimicrobial properties and help maintain an acidic pH in the vagina. These microbes are the ones that keep your vagina and urinary tract safe and free of infection. An imbalance will cause an infection. Here’s a cheat sheet on the various vaginal infections. Candidiasis or yeast infection The most common kind of vaginal infection is the candida or yeast infection or thrush. Almost 75 percent of women get this infection at some point in their lifetime. Although infection can occur after sexual intimacy, it is not a sexually transmitted infection. If you have more than four episodes, then it is called recurrent candidiasis. Read to know Expert tips to keep your vagina safe from infections Yeast infection is common during pregnancy. But normally, the infection does not harm the baby. Uncontrolled diabetes or HIV infection can cause, what is called, a complicated yeast infection. Symptoms include

• Genital itching
• Burning sensation, especially during urination or sexual intercourse
• Swelling and redness of vulva
• Vaginal rash
• Cottage cheese-like vaginal discharge
• Nipple pain in the breastfeeding woman

Causes The infection occurs when there is an overgrowth of the fungus Candida. It is normal to have a small population of Candida, but when the pH of the vagina changes or there is hormonal imbalance, the fungus multiplies and you get the infection. Other factors that can cause or worsen the infection are –

• Stress. Psychosocial factors, especially stress, is the primary cause of vaginal yeast infection, say researchers from University of Bamberg, Germany. [2]
•  High sugar and caffeine diet can worsen the infection. In a case study at Fontana Medical Center, California, the patient reported that her symptoms reduced after she reduced the intake of processed sugars and dairy products, and started consuming more of yogurt and probiotics. [3]
•  Overuse of antibiotics can cause antimicrobial resistance, so the infection can worsen.
•  Weather changes, using birth control pills, and even frequent douching can aggravate the condition.

Treatment Treatment can include a single dose therapy, a short course therapy, or over the counter treatment. Your doctor will prescribe the treatment best suited for you. Generally, antifungal creams or tablets are quite effective in stopping the overgrowth of the yeast. According to Mayoclinic, common antifungals used are butoconazole, clotrimazole, miconazole, and terconazole. A study found that clotrimazole (imidazoles) are more effective than nystatin and hydrargaphen. They found that a 7-day course was more effective than 4-day course. [4] Here's Baking soda — a natural way to keep your vagina bacteria and odour free Fluconazole injection is used to treat serious or complicated yeast infections. Your doctor will decide the dosage depending on how fast your condition improves. Then he will switch you to oral medication. It is important that you tell your doctor about any OTC medicine or herbal products /supplements or prescription drugs you are taking. [5] Fluconazole is not suitable for pregnant woman as it may harm the baby. You should not use the drug if you have cardiovascular problems, liver disease, or kidney disease. It may be right to point out here that traditional antifungal treatment influences only the symptoms of the illness, not its causes. To be really effective a complete re-orientation is required concerning the causes of vaginal mycosis. [2] Know more Coconut oil to ease vaginal dryness Bacterial vaginosis As the name suggests this type of vaginal infection is caused by bacteria. Here, the lactobacilli is replaced with bacteria such as E. coli, Gardnerella vaginalis, Mycoplasma species. In most cases, it does not cause any other health problems but sometimes it may lead to complications such as preterm birth or miscarriage in a pregnant woman, continuous vaginal discharge, fishy smell, and HIV risk. Symptoms Sometimes you may not experience any symptoms, but if you do these might include -

• Cloudy, grey, or yellowish watery discharge
• Pain or burning sensation in the vagina
• Abnormal vaginal odour

Causes Although doctors are not exactly sure why this happens, but it seems to occur more commonly in women who –

• Have multiple partners, new sex partner
• Smoke
• Douche their vagina using scented soaps
• Use contraceptives such as spermicides

Treatment A number of antimicrobial agents such as ampicillin, penicillin, and metronidazole are used in the treatment of bacterial vaginosis. But metronidazole administered either orally or locally is the preferred drug. The use of antimicrobial tinidazole is also on the rise. Clindamycin is another drug used commonly. Studies have shown that intravaginal deliveries of clindamycin and metronidazole improved symptoms within 21–30 days of the starting of the treatment. However, there was no lactobacilli recolonization within that period.  [6] Read more 5 expert tips to keep vaginal problems away Vaginal gels such as policarbophil-carbopol gels and chitosan-based lactic acid delivery gels have been found to be safe. The lactobacilli, present in curd and different milk products, are categorized under probiotics, and are no doubt one of the best treatments for bacterial vaginosis. Not only do they have the property of lactic acid, they also maintain the acidic pH of vagina (pH 3.5–4.5) thus not allowing the pathogenic bacteria to grow.  Probiotics can be either taken orally, or as a vaginal application. Viral vaginitis Viruses that cause viral vaginitis spread mostly through sexual contact. Basically two types of viruses cause this condition -

• HSV or herpes simplex  virus which has symptoms that include pain in the genital area, lesions and sores visible on the vagina and sometimes inside the vagina found only during a pelvic examination. The lesions are painful and may take 3-4 weeks to resolve. Stress and emotional factors are known to trigger genital herpes.
• HPV or human papillomavirus which differs from HSV in that painful warts are associated with the former. Sometimes the warts are not visible, so you may require a Pap test.

There is no cure for HSV and HPV infections. But these can be controlled with medications. You can prevent these infections, though not hundred percent, if you use barrier contraceptives such as condom. Management of genital herpes in pregnancy can be complicated. Check with your ob-gyn. If the infection is in the birth canal, vaginal delivery may not be possible for you. [7] Also like to read 4 natural vaginal washes to keep your vagina clean and infection-free Other common sexual transmitted infections Trichomoniasis, chlamydia, and gonorrhoea are other sexually transmitted infections causing vaginitis. Trichomoniasis: Symptoms include -

• Greenish-yellow discharge that can sometimes be frothy
• Burning during urination
• Soreness and itching of the vagina
• Abdominal pain

Chlamydia: The disease generally affects 18 to 35 year-old women. Most women do not experience any symptoms. If you do, the symptoms could include -

• Light bleeding especially after intercourse
• Pain in the lower abdomen and pelvis

Gonorrhoea: Here too you may not notice any symptoms, or the symptoms may appear after two weeks or months, or sometimes not until it spreads to other parts of the body.  Symptoms include -

• Watery, yellow or green discharge
• Pain on urination
• Lower abdominal pain
• Bleeding between periods (rarely)

Although sexually transmitted infections can be treated with antibiotics, the best treatment is prevention. Atrophic vaginitis Atrophic vaginitis occur in up to 40 percent of menopausal women. The infection occurs because oestrogen levels decrease increasing the pH of the vagina and urinary tract, thereby predisposing them to infection. In addition to general symptoms of vaginal infection, you may also have symptoms such as frequent urination, not being able to urinate, or not being able to control the urge to urinate. As treatment for atrophic vaginitis, your doctor may suggest oestrogen replacement therapy (ERT). however, ERT is contraindicated in breast cancer survivors. [8] Lifestyle modifications may help to certain extent, but cannot significantly improve symptoms. References

1. Minardi D, d’ Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: etiology and treatment options. International Journal of General Medicine. 2011;4:333-343. doi:10.2147/IJGM.S11767.

2. Meyer, H., Goettlicher, S. and Mendling, W. (2006), Stress as a cause of chronic recurrent vulvovaginal candidosis and the effectiveness of the conventional antimycotic therapy. Mycoses. 2006. 49: 202–209. doi: 10.1111/j.1439-0507.2006.01235.x

3. Hanna L, Cruz SA. Candida Mastitis: A Case Report. The Permanente Journal. 2011;15(1):62-64.

4. Young G, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000225. DOI: 10.1002/14651858.CD000225.

5. Fluconazole (By Injection) - National Library Of Medicine - Pubmed Health. PubMed Health. N.p., 2016. Web.

6. Kumar N, Behera B, Sagiri SS, Pal K, Ray SS, Roy S. Bacterial vaginosis: Etiology and modalities of treatment—A brief note. Journal of Pharmacy & Bioallied Sciences. 2011;3(4):496-503. doi:10.4103/0975-7406.90102.

7. Hill LV, Embil JA. Vaginitis: current microbiologic and clinical concepts.CMAJ: Canadian Medical Association Journal. 1986;134(4):321-331.
8. Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue. Armer J, ed. Journal of Personalized Medicine. 2015;5(2):50-66. doi:10.3390/jpm5020050.

Image source: Shutterstock (Image for representational purpose only)

---