A Guide to Vaginitis and its Causes

A Guide to Vaginitis and its Causes

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Vaginitis is a very common infection that affects women across the world. Every day, women visit healthcare providers with vaginitis symptoms. Vaginitis, also known as vulvovaginitis, is actually a term that means inflammation of the vagina. The term vaginitis does not refer to a single type infection, but can develop as a result of several types of infections. This article will provide an introduction to vaginitis and its causes, and explore its prevalence, symptoms, consequences and other valuable information for women.

It is caused by several different types of infections, some of which are sexually transmitted and some of which are not.1 The 3 most common causes of vaginitis are bacterial vaginosis (BV), vaginal candidiasis (also known as a yeast infection) and the sexually transmitted infection (STI) trichomoniasis.1 These 3 types of infection are responsible for 90% of vaginitis incidences.1

In this article, you will learn about the prevalence, symptoms, testing and treatment available for vaginitis and its causes.

Hologic Provides Tools to Fight Vaginitis

Hologic is an innovative medical technology company primarily focused on improving women’s health and well-being through early detection and treatment. The Diagnostic Solutions division at Hologic provides molecular testing for STIs and other infections and conditions that affect women’s and men’s reproductive health. Hologic has a DNA test for trichomoniasis and is currently developing tests for BV and yeast infections. We work closely with laboratories and healthcare providers to help patients find answers about their healthcare so they can live healthier and avoid long-term health consequences.

What are the Symptoms of Vaginitis?

There are some symptoms that are common among vaginitis cases in general. Others are specific to BV, yeast infections and trichomoniasis. General symptoms include:

  • Abnormal discharge from the vagina, including a change in color, smell or amount of discharge2
  • Itching or irritation in or around the vagina2
  • Pain during intercourse or urination2
  • Abnormal vaginal bleeding or spotting between periods2
  • Certain symptoms are specific to the unique cause of each vaginitis case.

BV-Specific Symptoms3

BV infection typically has grayish-white, foul-smelling discharge. Up to 50% of sufferers with BV experience abnormal vaginal discharge or odor.

Yeast-Infection-Specific Symptoms2

Yeast infections have discharge ranging from watery to thick, white discharge. They also cause genital itching or burning during intercourse or urination.

Trichomoniasis-Specific Symptoms

Trichomoniasis often leads to greenish-yellow and/or “frothy” discharge.3

Background and Prevalence of Vaginitis

10 million women each year visit their healthcare providers seeking a cure for vaginitis.4 A third of all women will have symptoms of vaginitis at some point during their lives, most commonly during their reproductive years.5

Vaginitis can develop even if a woman is not sexually active.6 Some types of vaginitis are transferred through sex, while others arise because of an imbalance in the bacteria or fungal makeup of the vagina.6

As mentioned, vaginitis usually occurs as a result of infection with BV, vaginal candidiasis or trichomoniasis.6

Bacterial Vaginosis7

Bacterial vaginosis is a bacterial infection that occurs when the vagina has too much of one type of bacteria. Many types of bacteria exist naturally in the vagina even when it is healthy. BV infection occurs when bacteria become imbalanced.

BV is the most common vaginal infection in women ages 15-44. The infection typically occurs in women who are sexually active, and it rarely occurs in women who have never had sex.

Yeast Infection8

Unlike bacterial vaginosis, a vaginal candidiasis is a fungal infection.8 Yeast infections are caused by Candida yeasts. There are several types of Candida yeast that can cause infection. A species called Candida albicans is most commonly responsible for yeast infection. This yeast normally lives inside the body, in the mouth, gut, throat and vagina.9 A vaginal yeast infection occurs when the environment inside the vagina changes that encourages fungal growth.9

This type of infection occurs more frequently and more severely for women with weakened immune systems.9

Trichomoniasis

Trichomoniasis is an STI caused by a protozoan parasite – a very small, single-celled life form that is invisible to the human eye.10 Trichomoniasis is the third-most common cause of vaginitis.10
Trichomoniasis is the most common curable STI in the US, with more than 3.7 million men and women infected.10 Trichomoniasis detection rates are highest in women age 40 and older.11

Other Causes2

In some cases, vaginitis can also be caused from allergy to certain soaps, detergents, vaginal sprays, douches or other products. These cause “non-infectious” vaginitis, which typically goes away by eliminating the irritant. Additionally, reduced estrogen levels that occur during or after menopause or after surgical removal of ovaries may lead to vaginitis. This is known as atrophic vaginitis, and it is also a non-infectious form of vaginitis.

How Do You Get Vaginitis?

While there are several infections responsible for vaginitis, there are some common things that may increase a woman’s chance of developing this inflammation. They include3:

  • The use of antibiotics
  • A weakened immune system
  • Pregnancy
  • Tight or damp underwear or pants
  • Poor diet
  • Douching
  • Sexual intercourse
  • The use of other vaginal products, such as perfumes or soaps

Having sexual intercourse, especially without protection, can increase your risk of developing vaginitis.2 However, it is important to keep in mind that vaginitis can develop even if a woman is not sexually active.2

The Consequences of Vaginitis

While a woman can have vaginitis without symptoms, the underlying causes of vaginitis can become problematic without treatment.

Untreated trichomoniasis can lead to

  • Prolonged HPV infection12
  • Concurrent infection with chlamydia, gonorrhea or genital herpes13
  • Increased risk of HIV transmission10
  • Preterm delivery in pregnant women10

Untreated BV can lead to

  • Increased risk for STIs like herpes, chlamydia, gonorrhea and HIV.14
  • Pelvic inflammatory disease (PID), caused when BV bacteria infect the uterus or fallopian tubes. PID can cause infertility and increase a woman’s risk of pregnancy outside of the womb.14

Untreated yeast infections can lead to

  • Increased severity of symptoms like discharge, itching and swelling.7 Itching due to irritation can cause sores in the vaginal area, which can become infected with bacteria.7

Diagnosing Vaginitis and its Causes

Healthcare providers test women with vaginitis symptoms to determine what the underlying cause of inflammation is. To diagnose the cause of vaginitis, providers will evaluate symptoms and provide testing, including5,15:

  • A visual examination inside the vagina for inflammation or discharge
  • A gram stain (in which vaginal fluid is placed on a slide, stained and examined under a microscope)
  • A pH test of vaginal fluid
  • A “whiff” test, in which potassium hydroxide is added to a vaginal sample to determine if a strong fishy odor presents, which is commonly a sign of bacterial vaginosis
  • A “Wet mount” test in which sample cells are placed on a slide and examined with a microscope
  • A molecular test of the sample

Determining the root cause of vaginitis is important in order to treat the underlying infection that causes it. The CDC recommends different testing methods for different infections. When trichomoniasis is suspected, the CDC recommends a highly sensitive, specific test, such as a molecular test, instead of a wet mount, which has poor sensitivity.16

Treating Vaginitis

Bacterial vaginosis is typically treated with antibiotics as well. There are oral and cream prescriptions available.5

For vaginitis caused by yeast infection, antifungal medication is provided. You can get treatment over- the-counter at local drugstores or from a healthcare provider. Antifungal treatments come in oral medication (pill form), vaginal cream and suppository forms.8

For vaginitis caused by trichomoniasis, oral antibiotics are prescribed.10 There are single-dose options and multiple-day regimens available.10

Once your provider has identified the cause of vaginitis, he or she will speak with you about what treatment option and dosage makes the most sense for you.

Reducing Risk for Developing Vaginitis

Some women are more prone to develop vaginitis than others. Yeast infections and bacterial vaginosis are both infections known to recur frequently. In many cases, women who have these infections often practice certain methods to help reduce their frequency.

There are a few ways that you can help reduce your risk of developing vaginitis and the infections that cause it.

  • Keep your vagina clean and dry. This means avoiding perfumed tampons, body wash, bubble bath, vaginal sprays and wipes, which can cause irritation.14
  • Change tampons and/or pads during menstruation every 4-8 hours.17
  • Carefully wash your vagina and anus daily with water and mild soap.17
  • Do not douche.14
  • Limit your number of sex partners and wear condoms.14,17
  • Wear cotton or cotton-lined underpants.14
  • Don’t wear tight-fitting clothes like tight pants or pantyhose, especially in hot weather.14

Even by following these precautions, some women still experience repeated vaginitis infection. If you do experience recurrent vaginitis, your healthcare provider can work with you to help reduce the frequency of these infections.

Taking the Next Step

If you have symptoms of vaginitis, you should visit your healthcare provider as soon as possible to discuss your testing options. By addressing any symptoms and infections early, you can get tested and treated fast and avoid long-term consequences.

For more information about vaginitis, talk to your healthcare provider or visit the American College of Obstetricians and Gynecologists website. Hologic is a leader in women’s health and sexually transmitted infection testing. For more information on Hologic, visit our website.

1. Sobel JD, et al. Vaginal Infections in adult women. Med Clin North Am. 1990;74(6):1573-602. 2. Cleveland Clinic. Vaginitis. https://my.clevelandclinic.org/health/articles/vaginitis. Reviewed January 16, 2016. Accessed August 24, 2017. 3. Mayo Clinic. Vaginitis Symptoms and Causes. http://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/dxc-20258675. Accessed August 24, 2017. 4. Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165(Part 2): 1168-76. 5. American College of Obstetricians and Gynecologists. Vaginitis. https://www.acog.org/Patients/FAQs/Vaginitis. Published August 2011. Accessed August 28, 2017. 6. National Institutes of Health. What Causes Vaginitis? https://www.nichd.nih.gov/health/topics/vaginitis/conditioninfo/Pages/causes.aspx. Accessed July 20, 2017. 7. CDC. Bacterial Vaginosis – CDC Fact Sheet. https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm. 8. CDC. Vaginal Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html. Updated August 4, 2017. Accessed August 21, 2017. 9. CDC. Fungal Diseases: Vaginal Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html. Updated August 4, 2017. Accessed August 21, 2017. 10. CDC. Trichomoniasis – CDC Fact Sheet. https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm. Updated July 14, 2017. Accessed August 21, 2017. 11. Johns Hopkins Medicine. Sexually Transmitted Parasite Trichomonas Vaginalis Twice as Prevalent in Women Over 40, Survey Shows. http://www.hopkinsmedicine.org/news/media/releases/sexually_transmitted_parasite_trichomonas_vaginalis_twice_as_preva lent_in_women_over_40_survey_shows. Published July 12, 2011. Accessed August 21 2017. 12. Shew ML, et al. Association of Condom Use, Sexual Behaviors, and Sexually Transmitted Infections with the Duration of Genital Human Papillomavirus Infection Among Adolescent. Arch Pediatr Adolesc Med. 2006;160(2):151-156. doi:10.1001/archpedi.160.2.151. 13. Allsworth JE, et al. Trichomoniasis and other sexually transmitted infections: results from the 2001-2004 National Health and Nutrition Examination Surveys. Sex Transm Dis. 2009;36(12):738-44. doi:10.1097/OLQ.0b013e3181b38a4b. 14. The New York Times. Vulvovaginitis – Overview. http://www.nytimes.com/health/guides/disease/vulvovaginitis/overview.html?mcubz=0. Reviewed June 13, 2014. Accessed August 21 2017. 15. AACC Lab Tests Online. Vaginitis and Vaginosis. https://labtestsonline.org/understanding/conditions/vaginitis/start/2. Updated December 30, 2015. Accessed August 21, 2017. 16. CDC. 2015 Sexually Transmitted Treatment Guidelines: Trichomoniasis. https://www.cdc.gov/std/tg2015/trichomoniasis.htm. Updated August 12, 2016. Accessed August 21, 2017. 17. Planned Parenthood. How do I prevent vaginitis? https://www.plannedparenthood.org/learn/health-and-wellness/vaginitis/how-do-i- prevent-vaginitis. Accessed August 21, 2017.