Overview

Vaginitis is an inflammation of the vagina. It often is caused by infections, some of which are associated with serious diseases. The most common vaginal infections are

• Bacterial Vaginosis
• Trichomoniasis
• Vaginal Yeast Infection

Some vaginal infections are transmitted through sexual contact, but others, such as yeast infections, probably are not.

Other causes of vaginitis

Although most vaginal infections in women are due to bacterial vaginosis, trichomoniasis, or yeast, there may be other causes as well. These causes include other sexually transmitted infections, allergic reactions, and irritations.

Allergic symptoms can be caused by spermicides, vaginal hygiene products, detergents, and fabric softeners. Inflammation of the cervix (opening to the womb) from these products often is associated with abnormal vaginal discharge, but health care providers can tell them apart from true vaginal infections by doing lab tests.

Bacterial Vaginosis

Overview

According to the Centers for Disease Control and Prevention (CDC), bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. It previously was called nonspecific vaginitis, or Gardnerella-associated vaginitis. Health experts are not sure what role sexual activity plays in developing BV.

Cause

BV is a sign of a change in the growth of vaginal bacteria. The resulting chemical imbalance occurs when different types of bacteria outnumber the normal “good,� or beneficial, ones. Instead of Lactobacillus (a type bacteria that normally lives in the vagina) being most common, increased numbers of bacteria such as Gardnerella vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis inhabit the vaginas of women with BV.

Transmission

Although health experts are not sure what role sexual activity plays in developing BV, a change in sexual partners or having multiple sexual partners may increase a woman’s chances of getting the infection. Using an IUD (intrauterine device) and douching also may increase her risk of getting BV.

Symptoms

The main symptom of BV is an abnormal, foul-smelling vaginal discharge. Some women describe it as a fish-like odor that is most noticeable after having sex.

Other symptoms may include

• Thin vaginal discharge, usually white or gray in color
• Pain during urination
• Itching around the vagina

Some women who have signs of BV, such as increased levels of certain harmful bacteria, have no symptoms. A health care provider who sees these signs during a physical examination can confirm the diagnosis by doing lab tests of vaginal fluid.

Diagnosis

A health care provider can examine a sample of vaginal fluid under a microscope, either stained or in special lighting, to look for bacteria associated with BV. Then, they can diagnose BV based on

• Absence of lactobacilli
• Presence of numerous “clue cellsâ€� (cells from the vaginal lining that are coated with BV germs)
• Fishy odor
• Change from normal vaginal fluid

Treatment

Health care providers use antibiotics such as metronidazole or clindamycin to treat women with BV. Generally, male sex partners will not be treated. For updated information about the treatment for BV and other sexually transmitted infections, read the CDC Sexually Transmitted Diseases Treatment Guidelines.

Complications

In most cases, BV causes no complications. There have been documented risks of BV, however, such as an association between BV and pelvic inflammatory disease (PID). PID is a serious disease in women that can cause infertility and tubal (ectopic) pregnancy.

BV also can cause other problems such as premature delivery and low-birth-weight babies. Therefore, some health experts recommend that all pregnant women who previously have delivered a premature baby be checked for BV, whether or not they have symptoms. A pregnant woman who has not delivered a premature baby should be treated if she has symptoms and laboratory evidence of BV.

BV also is associated with increased chances of getting one or more STIs, including chlamydia, gonorrhea, or HIV infection.

Trichomoniasis

Overview

Trichomoniasis (trick-oh-moe-nye-uh-sis) is one of the most common curable sexually transmitted infections (STIs), especially in young, sexually active women. According to the Centers for Disease Control and Prevention (CDC), an estimated 7.4 million new cases occur in men and women every year in the United States.

Cause

Trichomoniasis is caused by a parasite called Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urogenital tract. The vagina is the most common place for infection in women, and the urethra (urine canal) is the most common place for infection in men.

Transmission

Trichomoniasis is transmitted through sexual intercourse with an infected partner.

Symptoms

Although some infected women have minor or no symptoms, many do have symptoms, which usually appear within 5 to 28 days after they come in contact with the parasite. The symptoms in women include

• Heavy, yellow-green or gray vaginal discharge
• Discomfort during sex
• Vaginal odor
• Painful urination

Women also may have irritation and itching of the genital area and, on rare occasions, lower abdominal pain.

Most infected men do not have symptoms. If they do, the symptoms include a thin, whitish discharge from the penis and painful or difficult urination and ejaculation.

Diagnosis

A health care provider can diagnose trichomoniasis by performing laboratory tests on fluid samples from the vagina or penis.

When women are infected with trichomoniasis, a pelvic examination reveals red sores on the cervix (opening to the womb) or inside the vagina.

Treatment

Because men can transmit the disease to their sex partners even when they don’t have symptoms, health experts recommend that both partners be treated to get rid of the parasite. Health care providers usually prescribe a medication called metronidazole in a single dose to treat people infected with trichomoniasis.

It is important to avoid having sex until both both you and your sex partner complete treatment. You can get trichomoniasis again after being treated successfully, however.

Prevention

The surest way to avoid getting trichomoniasis is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected. Using a latex male condom consistently and correctly during sex may help prevent the spread of trichomoniasis.

Complications

Research has shown a link between trichomoniasis and two serious complications.

• Scientific studies suggest that trichomoniasis is associated with at least a 3- to 5-fold increased risk of HIV transmission.
• Trichomoniasis may cause a woman to deliver a premature or low-birth-weight baby.

Vaginal Yeast Infection

Overview

Vaginal yeast infection, or vulvovaginal candidiasis, is a common cause of vaginal irritation. In addition, 12 to 15 percent of men develop symptoms after sexual contact with an infected partner.

Cause

This infection is caused by an overgrowth of a fungus called Candida albicans in the vagina. Candida is yeast, which is a type of fungus.

Yeast are always present in the vagina in small numbers, and symptoms only appear with overgrowth. Health experts estimate that approximately 75 percent of women will have at least one yeast infection with symptoms during their lifetimes; 40 to 45 percent will experience two or more episodes.

Transmission

Several factors are associated with increased yeast infection in women, including

• Pregnancy
• Uncontrolled diabetes mellitus
• Oral contraceptives or antibiotics
• Douches
• Perfumed feminine hygiene sprays
• Topical antibiotics and steroid medicines
• Weakened or compromised immune systems

Wearing tight, poorly ventilated clothing and underwear also can contribute to vaginitis. Women with chronic (recurring) yeast infections should work with their health care providers to find out possible underlying causes.

Health experts do not know whether yeast can be transmitted sexually. Because almost all women have the fungus in their vaginas, it has been difficult for researchers to study this.

Symptoms

The most frequent symptoms of yeast infection in women are itching, burning, and irritation of the vagina. Painful urination and painful intercourse also are common.

Vaginal discharge is not always present and may only be present in small amounts. The thick, whitish-gray discharge is typically described as cottage-cheese-like, although it can vary from watery to thick.

Most male partners of women with yeast infections do not have any symptoms of the infection. Some men, however, have reported temporary rashes and burning sensations of the penis after intercourse if they did not use condoms.

Diagnosis

Because few specific signs and symptoms of yeast infections are usually present, health care providers cannot diagnose this condition by a person’s medical history and physical examination. They usually diagnose yeast infection by examining vaginal secretions under a microscope for evidence of yeast.

Treatment

Various antifungal vaginal medicines are available to treat yeast infections. Women can buy antifungal creams to be applied directly to the area, tablets to be taken orally, or suppositories (butoconazole, miconazole, clotrimazole, and tioconazole) for use in the vagina.

Because bacterial vaginosis, trichomoniasis, and yeast infections are difficult to tell apart on the basis of symptoms alone, a woman with vaginal symptoms should see her health care provider for an accurate diagnosis before using these products.

Women who have chronic or recurring yeast infections may need to be treated with vaginal creams or oral medicines for long periods of time. HIV-infected women can develop severe yeast infections that often do not respond to treatment.