Vaginitis
Dr Sherly Suneeth, BHMS

What is vaginitis?
Vaginitis is an inflammation of the vagina characterised by discharge, irritation, and itching. Vaginitis is seldom dangerous. In most women, it is easy to treat.

Causes
The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, vaginal atrophy, allergies and chemical irritation.

Predisposing Factors
Antibiotics (medicines), pregnancy, douching, damp underwear, tight pants, poor diet, vaginal products (sprays, lubricants, birth control devices).

Symptoms
Vaginal discharge, itching, frequent urination and/or irritation. Painful urination and/or intercourse are common.

Bacterial vaginosis
Bacterial vaginosis is the most common cause of vaginitis symptoms among women of childbearing age. BV (previously called nonspecific vaginitis) can be transmitted through sexual activity although the organisms responsible also have been found in young women who are not sexually active. BV is due to a change in the balance among different types of bacteria in the vagina.

Trichomoniasis
Trichomoniasis is a common STD that affects 2 to 3 million Americans yearly. It is caused by a single-celled protozoan parasite called Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urogenital tract; the urethra is the most common site of infection in men, and the vagina is the most common site of infection in women.

Vaginal yeast infection?
Vulvovaginal candidiasis, sometimes referred to as candidal vaginitis, or vaginal yeast infection, is a common cause of vaginal irritation. It has been estimated that approximately 75 percent of all women will experience at least one episode of candidiasis during their lifetime. It is caused by an overabundance or overgrowth of yeast cells (primarily Candida albicans) that normally colonize in the vagina.

Pathophysiology
The normal physiologic vaginal discharge comprises vaginal secretions, exfoliated cells and cervical mucus. The frequency of vaginal discharge varies with age, menstrual cycle, pregnancy and use of oral contraceptives. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. Antibiotics, contraceptives, sexual intercourse, douching, stress and hormones can change the vaginal environment and allow pathogens to grow. Similarly, changes in the vaginal environment, such as an increase in glycogen production in pregnancy or altered estrogen and progesterone levels from the use of oral contraceptives, enhance the adherence of Candidia albicans to vaginal epithelial cells and facilitate the germination of yeast. These changes may transform asymptomatic colonization into symptomatic infection. In patients with trichomoniasis, changes in estrogen and progesterone levels, as well as elevations of vaginal pH and glycogen levels, may enhance the growth and virulence of Tricomonas vaginalis

Treatment
All women with vaginitis should be informed of their diagnosis, including the possibility of sexual transmission, and offer treatment. Bacterial vaginosis can be treated with antibiotics. Both the partners should take the treatment. Metronidazole is the drug used to treat trichomoniasis.

Are all vaginal infections transmitted sexually?
No, some vaginal infections are transmitted through sexual contact, but others such as candidiasis (yeast infections) are not.