Vaginitis is infection of vagina, mostly by parasites such as trichomonas, yeasts such as candida or certain bacteria and sometimes by other organisms and result in swelling and/or discomfort. Sometimes vaginitis may be sexually transmitted. Vaginitis frequently cause discomfort in adult women. Vaginitis is less frequently seen in extremes of ages (before puberty and after menopause).
What are the symptoms of vaginitis?
Common symptoms of vaginitis include discharge from vagina (commonly yellowish-white in color), irritation and itching in vagina and sometimes pain. The character of vaginal discharge may vary according to the causative organism, e.g. bacterial infection of vagina cause fishy smelling and thin discharge. Yeast, candida or other fungal infections result in thick and white (curd like) vaginal discharge which may stick to the vagina. Infection by trichomonas vaginalis cause purulent yellow or grey color vaginal discharge with characteristic odor, itching in valva, pain during urination and pain/discomfort during intercourse.
How vaginitis is diagnosed?
Symptoms may guide the diagnosis, but can not be completely relied upon. For accurate diagnosis of the cause of vaginitis, microscopic examination or culture of vaginal samples may be required for isolation of causative microorganisms.
Microscopy of candidal vaginitis shows epithelial cells, white blood cells in the vaginal discharge.
Microscopy of discharge due to trichomonas vaginalis, the organisms (trichomonas vaginalis) can be positive in 80-90% of symptomatic cases of vaginitis due to trichomonas vaginalis.
In bacterial vaginitis there are huge numbers of mixed flora, Gardnerella vaginalis (most of the times) etc. can be seen by Gram’s stain.
What is the treatment of vaginitis?
The treatment of vaginitis depends on the offending microorganisms. After correct diagnosis appropriate antibiotics need to be given according to the sensitiveness of the microorganisms.
If vaginitis is due to trichomonas vaginalis, metronidazole is the antibiotic of choice, which can completely eliminate the trichomonas vaginalis infection. The dose of metronidazole is 2 gram orally as single dose or 500 mg twice a day for 7 days. Tinidazole can also be used as 2 gram single dose. Strict avoidance of alcohol is required while taking metronidazole, as it may react with alcohol and lead to serious disulfiram like reaction.
If vaginitis is by candida the treatment of choice are fluconazole 150 mg single dose or azole antifungals as cream or suppository (miconazole 100-mg vaginal suppository) or vaginal tablet (clotrimazole 100-mg vaginal tablet, once daily for 7 days).
Bacterial vaginitis is treated by metronidazole 500 mg twice a day for 7 days or clindamycin, 2% cream applied locally to vagina with applicator for 7 nights.
Male partner of the patient also should be treated with the same antibiotic, even if the male partner is asymptomatic; otherwise there is always risk of recurrence of vaginitis.
Can vaginitis be prevented and if yes, how?
To prevent spread of vaginitis by sexual route, use of condoms, diaphragm etc. may be helpful, especially infection of trichomonas vaginalis. Use of spermicidal jelly (which kills sperms and used as contraceptive) is not effective in prevention of vaginitis and excess use of spermicidal jelly may result in chemical inflammation of vagina. Good control of blood sugar is essential to prevent infection, as diabetics are prone to infection by yeast. Personal hygiene should be maintained.