Written by Chen Mei Fei, AA Pharmacist.

Vaginitis, the inflammation of vaginal, is often caused by infections be it bacterial or yeast infection.

Vaginitis is most frequently affecting women during the reproductive years.

Three common types of vaginal infection are bacterial vaginosis (BV), vaginal candidiasis (VC) and trichomoniasis. BV happens when there is too much of certain bacteria which changes the normal balance of bacteria in the vagina. VC is related to infections with Candida yeasts. Trichomoniasis is a very common sexually transmitted disease (STD) that caused by infection with a protozoan parasite called Trichomonas vaginalis1.

Bacterial Vaginosis Vaginal Candidiasis Trichomoniasis
Risk Factors1,2
  • Black ethnicity
  • Douching
  • Smoking
  • Multiple sex partners
  • Not using condoms
  • Sex with women
  • Immunosuppression
  • Antibiotics
  • Pregnancy
  • Hormone replacement therapy (HRT)
  • Oral contraceptive pill
  • Sexual behaviour:
    • Increased frequency of intercourse
    • Receptive oral sex
  • Multiple sex partners
  • Not using condoms
Sign and Symptoms 3,4,5 Thin white or gray vaginal discharge Thick white or gray vaginal discharge Foamy yellow discharge
A strong fish-like odor Non-offensive odor Offensive odor
Discharge coating the vagina Painful sexual intercourse. Painful urination and lower abdominal pain
No vulval inflammation Pain, itching, or burning in the vagina Itching in the vagina
More than pH 4.5 Less than or equal to pH 4.5 More than pH 4.5
Pharmacological Interventions Metronidazole or clindamycin orally or intra-vaginally Clotrimazole, miconazole, or fluconazole orally or intra-vaginally Metronidazole orally

 

Prevention 6,7

  • Use a hypoallergenic liquid wash with pH 4.2 to 5.6
  • Avoid contact with irritants
  • Avoid bar soaps and bubble baths, which are abrasive and have a more alkaline pH.
  • Use lactic acid–based liquids which help in vaginal infections
  • Not recommended for vaginal douching
  • Wear loose-fitting cotton underwear
  • Change underwear frequently
  • Avoid using talcum powder
  • Change tampons and sanitary pads frequently
  • Cleanse the vulva from front to back before and after intercourse
  • Avoid cleansing the vulva vigorously or irrigating the vagina
  • Use a safe method of pubic hair removal
  • Maintain cleanliness and dryness over any sutures after birth
  • Wash hands prior to children’s genital care and use separate towels

Reference:

  1. Workowski KA, Bolan GA. Centers for Disease Control and Prevention, Sexually transmitted diseases treatment guidelines. MMWR 2015; 64(RR-03): 69-78.
  2. Chen, Y., Bruning, E., Rubino, J., & Eder, S. E. Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Womens Health 2017, 13(3), 58-67. doi:10.1177/1745505717731011
  3. Martin Lopez, J. E. 2015. Candidiasis (vulvovaginal). BMJ Clinical Evidence, 2015, 0815.
  4. Brocklebank, A., & Maraj, H. Vulvovaginal candidiasis. InnovAiT: Education and Inspiration for General Practice 2013, 6(10), 643-651. doi:10.1177/1755738013479944
  5. Reproductive Healthcare, & British Association of Sexual Health. FSRH/BASHH vaginal discharge in non-genitourinary medicine guideline. Retrieved from https://www.guidelinesfornurses.co.uk/womens-health/fsrh/bashh-vaginal-discharge-in-non-genitourinary-medicine-guideline/436055.article.
  6. Arab H Almadani L, Tahlak M, et al. The middle east and central Asia guidelines on female genital hygine. BMJ Middle East 2011, 19: 99-106.
  7. Royal College of Obstetricians and Gynaecologists. The management of vulval skin disorders. Green–top Guideline No. 58 2011, 1-23. https://bssvd.org/education-and-training/guidelines…/RCOG-Vulval-Guidelines.pdf.
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