Our expert is Christine Isaacs, M.D., Associate Professor of Obstetrics and Gynecology at Virginia Commonwealth University in Richmond, Virginia. She is the Division Head of General Ob/Gyn and the Director of Midwifery Services. Her clinical specialties include Natural Childbirth, Group Obstetric care, and the full scope of women’s gynecologic procedures and counseling.
Dr. Isaacs is a featured speaker at Women’s Health 2016: The 24th Annual Congress.
MOST WOMEN WILL AT SOME TIME EXPERIENCE VAGINITIS
At some point in their lives, most women will experience vaginitis. It’s one of the most common gynecologic condition encountered in the office, and it typically comes about when the yeast or bacteria that are naturally present in the vagina are not kept in balance by other yeasts or bacteria in the vagina. When the vagina’s ecosystem is out of balance, certain yeasts and bacteria overpopulate. The result is that a patient will experience symptoms such as itching, burning, abnormal discharge, or foul odor which prompt her to seek care. She may also experience light vaginal bleeding or spotting and pain during intercourse. Vaginitis can also be caused by decreased postmenopausal estrogen levels, a topic that will be addressed in future issues of the MP Post Blog.
DISRUPTIONS TO THE VAGINA’S NATURAL ECOSYSTEM
Several factors can disrupt the ecosystem that normally keeps problematic yeasts and bacteria in check. Antibiotics can disrupt the system’s balance. For example, if antibiotics reduce the population of lactobacillus bacteria, the acids which they produce may no longer be enough to prevent the excessive growth of naturally present yeasts such as Candida albicans. This may result in a classic “yeast infection.” Other factors make patients susceptible to an increase in harmful yeasts or bacteria include uncontrolled diabetes, an impaired immune system, and excessive douching.
FREQUENTLY VAGINITIS CAN BE TREATED AT HOME
When over-the-counter (OTC) medications work, they work very well, and they are especially convenient, since the woman won’t have to disrupt her normal life activities or miss work for a visit to her health care provider. However, if she experiences recurrent symptoms after self-treatment, this should warrant an office visit to assure a correct diagnosis and to create a treatment plan.
DETERMINE WHETHER THE VAGINITIS IS BACTERIAL OR FROM YEAST, OR OF OTHER ETIOLOGY
A yeast infection’s symptoms typically include: itching; redness; pain during urination or intercourse; and a heavy discharge. The discharge may be white and clumpy, resembling cottage cheese. Usually a yeast infection is odorless. A bacterial infection, in contrast may have less irritation but there’s a classic foul odor. The discharge is typically gray or milky white. During a physical exam, the vaginal pH is measured >4.5 and a classic “fishy odor” is noted after applying potassium hydroxide to a sample of the discharge.
Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the US. Symptoms can range from nothing, to diffuse, malodorous yellow-green discharge with or without vulvar irritation. Diagnosis can be made with microscopy (a method with poor sensitivity), culture or by molecular detection methods. Concurrent treatment of all sex partners is critical for symptomatic relief, and to prevent transmission and reinfection from repeated exposure. Expedited Partner Treatment laws vary by state and can be accessed through the CDC website.
Most women who experience a yeast or bacterial infection will not experience frequent recurrences. However, some women, typically less than 5%, will experience a recurrence more than four times in the course of a year, and these are classified as recurrent infections. The impact on a woman’s life can range from minor inconvenience to symptoms that seriously interfere with her daily activities. Vaginitis can also be a problem for her intimate relationship, when sex becomes uncomfortable.
TREATING RECURRENT VAGINITIS MAY REQUIRE TREATING AN UNDERLYING CONDITION
Recurrent vaginitis may be a symptom of other health problems. Your patient comes to you because she wants her yeast infection cleared up, but antifungals aren’t going to fix her problem permanently if the underlying cause is the effect of her uncontrolled diabetes on her body immunity and chemistry. For her, this can be a teachable moment because she can see her vaginitis as a warning sign that things are out of balance. Let her know that she needs to get her weight or her diabetes under control or she’s likely to have continued flares of vaginitis.
THE 2015 STD GUIDELINES IS A USEFUL DOWNLOADABLE APP
The 2015 STD Guidelines is a free app created by the CDC and available for downloading. It’s an easy-to-use reference that combines information from the CDC’s STD Treatment Guidelines as well as MMWR updates. It features a streamlined interface so providers can access treatment and diagnostic information. You can download the app for your Apple or Android device by clicking here: Apple and Android.