Evaluation and management of vaginitis

Abstract

V aginitis is a common medical problem in women that is associated with substantial discomfort and frequent medical visits. Roughly 5 to 10 million office visits per year are attributed to vaginitis. 1 Research in recent years has increased our understanding of the disease process and its potential sequelae and resulted in improved diagnostic and treatment modalities. 2-6 Nevertheless, adequate diagnosis and treatment of vaginitis in the office setting often is problematic for practitioners. 2,5,7-9 Moreover, the availability of over-the-counter medications for fungal vaginitis has increased the likelihood that women will come to medical attention with partially or inadequately treated infections. 10 We will focus on the common infectious causes of vaginal discharge-yeast infection, bacterial vaginosis, and trichomonas infection, emphasizing new developments in diagnosis, associated complications, and treatment of these infections.The initial evaluation of vaginal discharge requires an understanding of physiologic vaginal discharge and what differentiates it from abnormal, pathologic discharge. Substances from the vulvar, sebaceous, sweat, Bartholin's and Skene's glands, as well as exfoliated cells, cervical mucus, and secretions of the endometrial cavity and fallopian tubes constitute the normal physiologic secretions of the vagina. These secretions pool in the posterior fornix and do not adhere to the vaginal walls. 11 The pH of normal vaginal secretions in women of childbearing age is between 3.8 and 4.5. The presence of sperm, blood, amniotic fluid, or cervical mucus raises the vaginal pH. 11 The amount and fluidity of the discharge can vary over the menstrual cycle. Cervical mucus becomes more fluid around ovulation, and women frequently mistake this change in consistency for an abnormal discharge. Stress increases the rate of vaginal desquamation and thus the amount of discharge, which patients can also mistake for a pathologic discharge. 12 Women generally do not have other symptoms if their discharge is physiologic.In contrast, a pathologic discharge adheres to the vaginal walls and is often accompanied by irritation, pruritus, odor, or urinary symptoms such as dysuria or frequency. 6 The discharge can be thick to watery and frothy, and white to yellow, gray, or green. 11 Causes of an abnormal discharge include infectious causes of vaginitis such as yeast infection, bacterial vaginosis, and trichomonas infection, as well as cervicitis and sexually transmitted diseases such as gonorrhea and chlamydia infection. Noninfectious etiologies include chemical irritants such

Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

“…History of previous infection was the second most common risk factor for vaginitis. This re-occurrence might be the outcome of either improper medication or previously unrecognized complication or may be due to repetitive use of contaminated cloth pad [2]. Other risk factors that we observed with vaginosis were pregnancy, use of contraceptive, recently antibiotics/steroid use, sexually transmitted disease, diabetes, and hygienic issues.…”

“…In our study, highly prescribed drug (75%) was topical antibacterialantifungal agents (Drug composition contains clotrimazole, metronidazole, lactic acid bacillus often in mixed form). Use of topical therapies in the treatment of bacteria vaginosis are known to be effective and associated with fewer side effects than systematic medication [2]. Combination of clotrimazole, metronidazole and lactic acid bacillus in single dosage form was prescribed for both symptomatic and asymptomatic vaginitis and plays in effective role in eradication of bacterial, fungal or mixed infection vaginitis.…”

“…Approximately 5-10 million offices visits per year are attributed to vaginitis [1,2]. The most common diseases associated with vaginal infection involve bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, which may often also infect in combination [3].…”

“…Various studies have revealed that frequent etiology of vaginitis involves imbalances in the normal flora or pH of the vagina, unhygienic practices, improper care during menstruation, pregnancy, diabetes, broadspectrum antibiotic use, immunodeficiency, frequent douching, diaphragm use, oral contraceptives pill use and occasionally, hormonal and allergic factors [1,3,7,8]. Many studies suggest that oral and topical antibiotics such as metronidazole, tinidazole, clindamycin as the stronghold available therapy for the treatment of bacterial vaginosis and trichomoniasis and antifungals such as fluconazole, clotrimazole, itraconazole are effective in vaginal candidiasis or combined therapy in mixed infection cases [2,4,5]. In Nepal, studies related to infectious genital diseases and their risk factors in females are still lacking.…”

Screening for lower genital tract infections in women of reproductive age group attending a tertiary care hospital

“…The differences in the figures in our study with comparison to other studies is due to lesser sample size, hospital based study while all the comparative study groups are community based studies. 13,14 Bacterial vaginosis, as such is a clinical term diagnosed by Amsel criteria. The sensitivity and specificity of Amsel criteria is 37% and 99% respectively (Sha BE et al 14 We have estimated 6.97% of BV cases by the gold standard laboratory diagnostic method i.e., Nugent scoring.…”