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.

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Overview

Syphilis is a sexually transmitted bacterial infection (STI) that initially causes genital ulcers (sores). If untreated, these ulcers can then lead to more serious symptoms of infection.

An ancient disease, syphilis is still of major importance today. Although syphilis rates in the United States declined by almost 90 percent from 1990 to 2000, the number of cases rose from 5,979 in 2000 to 7,980 in 2004. In a single year, from 2003 to 2004, the number of syphilis cases jumped 8 percent.

There also was a dramatic change in whom the disease affects. Between 2002 and 2003, the number of cases in men increased 13.5 percent, reflecting an increase in syphilis in men who have sex with men. During the same time the number of cases in women declined by 27.3 percent.

Syphilis also disproportionately affects African Americans, who represent 41 percent of all cases reported to the Centers for Disease Control and Prevention (CDC).

HIV infection and syphilis are linked. Syphilis increases the risk of transmitting as well as getting infected with HIV.Cause

Syphilis is caused by a bacterium called Treponema pallidum.

Transmission

The most common way to get syphilis is by having sexual contact with an infected person. If you get infected, you can pass the bacteria from infected skin or mucous membranes (linings), usually your genital area, lips, mouth, or anus, to the mucous membranes or skin of your sexual partner.

Syphilis can be passed from mother to infant during pregnancy, causing a disease called congenital syphilis.

The bacteria are fragile; you can’t get them from eating utensils or through using spas, pools, or toilets.

Symptoms

Syphilis is sometimes called “the great imitator” because it has so many possible symptoms, and its symptoms are similar to those of many other diseases. Having HIV infection at the same time can change the symptoms and course of syphilis. Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.

Primary Syphilis

The first symptom of primary syphilis is often a small, round, firm ulcer called a chancre (”shanker”) at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres also can develop on the cervix, tongue, lips, or other parts of the body. Usually there is only one chancre, but sometimes there are many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout the body.) The chancre usually appears about 3 weeks after you’re infected with the bacteria, but it can occur any time from 9 to 90 days after exposure.

Because a chancre is usually painless and can appear inside your body, you might not notice it. The chancre disappears in about 3 to 6 weeks whether or not you are treated. Therefore, you can have primary syphilis without symptoms or with only brief symptoms that could be overlooked. If primary syphilis is not treated, however, the infection moves to the secondary stage.

Secondary syphilis

Most people with secondary syphilis have a non-itchy skin rash. Although the rash is usually on the palms of your hands and soles of your feet, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include

• Sore throat
• Tiredness
• Headache
• Swollen lymph glands

Less frequent symptoms include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area.

Your symptoms may be mild. The sores of secondary syphilis contain many bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will disappear even without treatment. Without treatment, however, the infection will move to the next stages.

You may have recurrences of secondary syphilis..

Latent syphilis

The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over.

In early latent syphilis, you might notice signs and symptoms, but the infection remains in your body. When you are in this stage, you can still infect a sexual partner.

In late latent syphilis, the infection is quiet and the risk of infecting a sexual partner is low or absent. If you don’t get treated for latent syphilis, you will progress to tertiary syphilis, the most serious stage of the disease.

Tertiary syphilis

Even without treatment, only a small number of infected people develop the dreaded complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage.

Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurological problems, heart disease, and death. Late neurosyphilis (brain or spinal cord damage) is one of the most severe signs of this stage.

Diagnosis

It can be very difficult for your health care provider to diagnose syphilis based on symptoms. This is because symptoms and signs of the disease might be absent, go away without treatment, or be confused with those of other diseases. Because syphilis can be hard to diagnose, you should

• Visit your health care provider if you have a lesion (sore) in your genital area or a widespread rash
• Get tested periodically for syphilis if your sexual behaviors put you at risk for STIs
• Get tested to be sure you do not also have syphilis if you have been treated for another STI such as gonorrhea or HIV infection

Your health care provider can diagnose early syphilis by seeing a chancre or rash and then confirming the diagnosis with laboratory tests. Because latent syphilis has no symptoms, it is diagnosed only by laboratory tests.

There are two laboratory methods for making the diagnosis.

• Identifying the bacteria under a microscope in a sample taken from a lesion
• Performing a blood test for syphilis

If your doctor thinks you might have neurosyphilis, your spinal fluid will be tested as well.

Treatment

Syphilis is easy to cure in its early stages. Penicillin, an antibiotic, injected into the muscle is the best treatment for syphilis. If you are allergic to penicillin, your health care provider may give you another antibiotic to take by mouth.

If you have neurosyphilis, you may need to receive daily doses of penicillin intravenously (in the vein) and may need to be treated in the hospital.

If you have late syphilis, damage done to your body organs cannot be reversed.

While you are being treated, you should abstain from sex until your sores are completely healed. You should also notify your sex partners so they can be tested for syphilis and treated if necessary.

Prevention

To prevent getting syphilis, you must avoid contact with infected tissue (a group of cells) and body fluids of an infected person. Usually syphilis is transmitted from people who have no visible sores or rashes and who do not know they are infected, however.

If you are not infected with syphilis and are sexually active, having mutually monogamous sex with only one uninfected partner is the best way to prevent syphilis. Using condoms properly and consistently during sexual intercourse reduces the risk of getting syphilis.

Washing or douching after sex will not prevent syphilis. Even if you have been treated for syphilis and cured, you can be re-infected by having sex with an infected partner.

The risk of a mother transmitting syphilis to her unborn baby during pregnancy declines with time but persists during latent syphilis. To prevent passing congenital syphilis to her unborn baby, all pregnant women should be tested for syphilis.

Complications

Pregnancy

Untreated syphilis results in a high-risk pregnancy. There are an estimated 8,000 pregnant women with syphilis in the United States. Untreated early syphilis results in death of the unborn baby in up to 40 percent of cases. Studies show that if a woman contracts syphilis during the 4 years before her pregnancy, untreated early syphilis may lead to infection of her unborn baby in more than 70 percent of cases. Therefore, if you are pregnant, you should be tested for syphilis.

Syphilis can cause miscarriages, premature births, stillbirths, or death of newborn babies. Some infants with congenital syphilis have symptoms at birth, but most develop symptoms later.

Untreated babies with congenital syphilis can have deformities, delays in development, or seizures along with many other problems such as rash, fever, swollen liver and spleen, anemia, and jaundice. Sores on infected babies are infectious. Rarely, the symptoms of syphilis go unseen in infants so that they later develop the symptoms of late-stage syphilis, including damage to their bones, teeth, eyes, ears, and brains.

HIV infection

There is an estimated two- to five-fold increased risk of getting infected with HIV when syphilis is present. Substantial biological evidence shows the increased likelihood that getting and transmitting HIV is linked to the presence of sexually transmitted infections (STIs). You should discuss this and other STIs with your health care provider.

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