Vaginitis is referred to as an infection or inflammation of the vagina causing vaginal discharge, odor and skin irritation. Associated symptoms may include pain with intercourse and irregular vaginal spotting.
There is a complex balance maintained at the vagina of the skin and normal flora (noninfectious bacteria normally found at the vagina). The pH maintained at the vagina inhibits infection but can be disrupted by many factors causing negative symptoms.
The most common causes of vaginitis are:
Additional causes are not due to infection but may cause the same symptoms, including the following:
Diagnosis of most conditions is based on history and physical exam. Vaginal discharge is tested for pH levels and examined in a slide under the microscope. Vaginal cultures may be done to rule out other STIs. Vaginal skin biopsy may aid in the diagnosis if infection has been ruled out and symptoms are persistent.
The most common causes of vaginitis are treated with antifungal or antibiotic oral or vaginal medications. Candida is treated equally well with oral or vaginal treatments. Oral fluconazole is a convenient single dose method while vaginal treatments may offer fewer side effects.
Bacterial vaginosis is treated with metronidazole or clindamycin. They are administered in the form of oral tablets or a cream or gel vaginal suppository. Asymptomatic women do not require treatment of either Candida or BV. Diagnosed Trichomoniasis always requires treatment most commonly with a single dose of metronidazole or tinidazole. Partners must be treated for all diagnosed STIs and should refrain from sexual activity 1-2 weeks after treatment.
Recurrent vaginitis is not uncommon and may require special cultures to test for resistant strains of infection. In cases of ongoing recurrence, long-term suppressive therapy may be useful in vaginitis prevention. Behavioral and hygienic practices are also very important including the use of gentle soaps, detergents and lotions. Vaginal douching is discouraged. Women with female partners tend to have higher incidence of vaginitis and both partners should take precautions.
Noninfectious causes of vaginitis are often treated by a specialist. A variety of topical medications such as anti-inflammatory, hormonal or analgesic agents are used depending on the diagnosed condition.
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