Vaginitis

Vaginitis, also known as vulvovaginitis, is an inflammation of the vagina and vulva. It is a common condition in women, especially those of reproductive age, and is characterised by symptoms such as itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis can also result in complications during pregnancy.

Causes

Vaginitis is primarily caused by infections, including bacterial vaginosis, vaginal yeast infections, and trichomoniasis. Other causes include allergic reactions to substances such as spermicides or soaps, and hormonal changes, particularly low oestrogen levels during breastfeeding or after menopause. The risk factors and common causes can vary by age, with prepubescent girls being more susceptible due to low oestrogen levels and an underdeveloped labia minora.

Signs and Symptoms

A woman with vaginitis may experience vaginal irritation, itching, burning, or notice a foul-smelling or abnormal discharge that could appear green or yellow. Specific symptoms indicating infection include:

• Irritation or itching of the genital area
• Inflammation of the labia majora, labia minora, or perineal area
• Vaginal discharge
• Foul vaginal odour
• Pain or irritation during sexual intercourse

Complications

Untreated vaginal infections can lead to significant complications, particularly during pregnancy. These complications can include premature delivery, postpartum infections, pelvic inflammatory disease, and increased susceptibility to HIV infection. Other complications include persistent discomfort, superficial skin infections from scratching, and complications related to the causative condition such as gonorrhoea and candida infection.

Diagnosis

Diagnosis of vaginitis typically involves a combination of physical examination, measuring the vaginal pH, and culturing the discharge. The colour, consistency, and acidity of the discharge can help predict the causative agent. It is very important to determine the specific cause as women may have more than one infection, or symptoms that overlap with other conditions. Self-diagnosis is not recommended due to a high rate of misdiagnosis.

Treatment

The treatment of vaginitis depends on its underlying cause. Infections are generally treated with appropriate medications, such as oral or topical antibiotics and antifungal creams. For allergic reactions, antihistamines may be prescribed, and topical oestrogen creams may be used for postmenopausal women experiencing low oestrogen levels. Specific treatments for common types of vaginitis include:

• Trichomoniasis: Oral treatment with metronidazole or tinidazole, with simultaneous treatment of sexual partners.
• Bacterial vaginosis: Common treatments include metronidazole (pill or gel form) and clindamycin (pill or cream form).
• Yeast infections: Local azole treatments in the form of ovula and cream, which are available over the counter.

Aerobic Vaginitis

Aerobic vaginitis is treated with topical steroids to reduce inflammation and, in some cases, antibiotics. However, the use of antibiotics is still a matter of debate. Vaginal rinsing with povidone iodine can provide symptom relief but does not reduce bacterial loads long-term.

Mixed Infectious Vaginitis

Mixed infectious vaginitis involves multiple pathogens and leads to significant alterations in the vaginal environment. An effective treatment option is a combination of clotrimazole and metronidazole.

Prevention

Preventative measures for candidiasis include wearing loose cotton underwear and avoiding perfumed soaps, shower gels, and vaginal deodorants. For bacterial vaginosis, maintaining a healthy diet and minimising stress can help maintain the vaginal pH balance. For trichomoniasis, avoiding shared wet towels, hot tubs, and practising safe sex are effective preventive strategies.

Some women consume foods with live cultures, such as yoghurt, or take probiotic supplements to prevent candidiasis or bacterial vaginitis. However, the efficacy of these measures is not firmly established, and studies suggest mixed results.

In Children

Vulvovaginitis in children can be nonspecific, resulting from irritation, or infectious, caused by pathogens like Streptococcus or Haemophilus influenzae. Treatment varies depending on the cause and may include topical steroids or antibiotics.

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Self-assessment MCQs (single best answer)

What is another name for vaginitis?

Which of the following is a common symptom of vaginitis?

Which of the following is not a common cause of vaginitis?

What is a possible complication of untreated vaginal infections during pregnancy?

Which treatment is commonly prescribed for trichomoniasis?

What is a typical diagnostic method for vaginitis?

Which type of vaginitis is treated with topical steroids and possibly antibiotics?

What preventative measure is recommended for avoiding candidiasis?

Which pathogen is associated with a vaginal discharge that has a fish-like odour?

What is a common treatment for bacterial vaginosis?