Vaginal Infections (Women, Girls) – Causes, Symptoms, Treatment

Vaginal infections may be caused by bacteria, fungus, and other microorganisms. The most common vaginal infections that are seen include bacterial vaginosis, vaginal fungal infection, and trichomoniasis.

Excessive and/or abnormal vaginal discharge is the typical symptom of a vaginal infection, although not all vaginal discharges are due to infection. There may be a change in the odor or color of the discharge, which is likely to be accompanied by itching, redness, and swelling of the vagina. Read more in itchy vagina and swollen vulva.

Certain conditions may increase the risk of a vaginal infection and exacerbate an existing infection. This includes :

• Poor personal hygiene.
• Wearing tight, non-absorbent underwear.
• Causes of decreased the vaginal acidity, such as menstrual discharge, male ejaculate, and infected cervical mucus.
• Frequent douching.
• Diabetes mellitus (sugar diabetes).
• Lack of endogenous estrogen – before puberty and after menopause.
• Foreign bodies in the vagina such as a forgotten tampon or retained condom.

Bacterial Vaginosis

Causes

Bacterial vaginosis is a bacterial infection of the vagina caused by Gardnerella vaginalis. There are many types of bacteria present in a normal healthy vagina, of which lactobacilli is important in helping to maintain the normal acidic environment of the vagina, thus discouraging growth of harmful bacteria.

Under certain circumstances, there is a decrease in the number of lactobacilli, resulting in an overgrowth of other types of bacteria normally present in the vagina, such as Gardnerella vaginalis.

Symptoms

Bacterial vaginosis is the most common type of vaginal infection and while some women may be asymptomatic, the typical symptoms associated with this type of infection includes :

• Excessive vaginal discharge, which is usually thin, white or grey in color.
• Typical fishy odor of the discharge, stronger after sexual intercourse and during periods.
• Vaginal itching in some women.

Risk Factors

Bacterial vaginosis is not usually sexually transmitted but it is seen to be more common in women suffering from a sexually transmitted disease (STD). Additional risk factors for developing this type of infection may be :

• Multiple sex partners.
• Use of intrauterine device (IUD).
• Pregnancy.
• Frequent douching.

Complications

Bacterial vaginosis may lead to complications such as :

• Pelvic inflammatory disease (PID).
• Infection of the membranes around the fetus (chorioamnionitis). Read more on infected placenta.
• Premature rupture of membranes.
• Preterm labor and delivery.
• Infection of the uterus after childbirth or miscarriage.

Treatment

Bacterial vaginosis usually resolves in a few days with the appropriate treatment. This includes metronidazole or clindamycin vaginal gel or cream, or metronidazole or tinidazole orally. Recurrence is common, however, and may need long-term treatment.

Vaginal Fungal or Yeast Infection (Candidiasis)

Causes

Vaginal yeast infection or candidiasis is caused by the fungus Candida albicans which is normally found on the skin or in the intestine, from where it can spread to the vagina. It is most common in women of childbearing age and is relatively less common after menopause, except in those women who are on hormone replacement therapy.
Candidiasis is not transmitted sexually.

Symptoms

• Thick white discharge.
• Odorless discharge in most cases.
• Intense itching of the vulva and vagina, especially during intercourse.
• Swelling and redness of the vagina.

Risk Factors

• Pregnancy.
• Diabetes.
• Obesity.
• Oral contraceptives.
• Weakened immune system – may be caused by HIV/AIDS, corticosteroids, or chemotherapy.
• Antibiotic use.
• Wearing tight, non-absorbent undergarments.

Treatment

Antifungal drugs may be used in the form of creams, vaginal suppositories, or oral tablets. This includes clotrimazole, fluconazole, miconazole, tioconazole, butoconazole, nystatin, and itraconazole. Recurrence is common and may need repeated treatment.

Trichomonas Vaginitis

Causes

Trichomonas vaginitis or trichomoniasis is a vaginal infection caused by the protozoa Trichomonas vaginalis, which is usually sexually transmitted. Other STDs may also be present. Trichomoniasis, when seen in children, may point to sexual abuse.

Symptoms

Symptoms may occur immediately after infection or the protozoa can remain in the vagina or cervix for a long time (several weeks or months) without leading to any symptoms. This makes it difficult to determine when the infection was acquired and from whom.

The symptoms may include :

• Excessive vaginal discharge.
• The discharge may be frothy, with a greenish or yellowish color.
• Unpleasant or fishy odor.
• Vaginal itching.
• Vagina may be red and painful to touch.
• Pain during sexual intercourse and/or pain or burning sensation while passing urine.

Complications

• PID.
• Preterm labor and delivery.

Treatment

Use of condoms during sexual intercourse can prevent transmission of infection.

Condoms should be used during treatment till the infection resolves completely. A single dose of metronidazole or tinidazole taken orally is effective in most cases. Simultaneous treatment of partners is advocated so as to prevent re-infection.