Vaginal Infections Treatment

What are vaginal infections?

Vaginal infections are typically due to bacterial, fungal, or parasitic infection of the vagina.  These infectious organisms often include Gardnerella vaginalis, Gonorrhea, Chlamydia, Candida, and Trichomonas.  Patients usually develop symptoms such as vaginal itching, burning, discharge, malodor, redness, spotting, and occasionally pelvic pain.  Some may experience pain during intercourse (dyspareunia). 

Vaginal infections often occur in women with risk factors such as a history of sexually transmitted infections, sexual promiscuity, obesity, diabetes, and use of certain medications (eg, antibiotics, corticosteroids).  Due to the importance of this condition, it is essential that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions

  • What causes vaginal infections?
  • How common are vaginal infections?
  • What are the symptoms and signs of vaginal infections?
  • How are vaginal infections diagnosed?
  • How are vaginal infections treated?

What causes vaginal infections?

Vaginal infections are caused by infectious organisms such as bacteria, fungi, or parasites.  These microorganisms often include:

  • Gardnerella vaginalis – bacteria responsible for bacterial vaginosis
  • Gonorrhea & Chlamydia – these frequently coexist and cause cervicitis and pelvic inflammatory disease
  • Candida – causes female genital yeast infection
  • Trichomonas

Bacterial vaginosis is the most frequent cause of vaginitis in women of reproductive age.  Patients with vaginal infection usually develop vaginal irritation and inflammation resulting in itching, burning, discharge, malodor, and occasionally pelvic pain. 

Risk factors for vaginal infection include:

  • Multiple sexual partners
  • History of sexually transmitted infection
  • Lack of use of barrier protection such as condoms
  • Obesity
  • Diabetes mellitus
  • HIV/AIDS
  • Medications - antibiotics, corticosteroids

How common are vaginal infections?

Vaginal infections are exceedingly common in the United States and responsible for frequent primary care visits.  The most common cause is in women of childbearing age is bacterial vaginosis.  Advances cases may require referral to a gynecology specialist, especially if first-line treatment was unsuccessful. 

About 55%-83% of women with vaginal infection symptoms see their physician - in most cases, patients use over-the-counter medications to treat their symptoms whether or not they saw a healthcare provider.

What are the symptoms and signs of vaginal infections?

Symptoms of vaginal infections often include:

  • Vaginal itching (pruritus)
  • Burning
  • Irritation
  • Discharge
  • Malodor
  • Spotting
  • Redness

Some may experience pain during intercourse (dyspareunia).  These symptoms occur due to inflammation of the vaginal mucosa.

Patients with yeast infection (vulvovaginal candidiasis) typically have a curdy white discharge that appears like cottage cheese.  Bacterial vaginosis is associated with a fishy amine odorTrichomonas classically produces a frothy greenish-yellow purulent discharge.

Patients with pelvic inflammatory disease often have fever, severe pelvic or abdominal pain, and systemic symptoms.  Pelvic examination may demonstrate cervical discharge (cervicitis).  Individuals tend to have exquisite pain when the doctor manipulates the cervix - chandelier sign. 

How are vaginal infections diagnosed?

The diagnosis of vaginal infection is suggested based on symptoms, patient history, and physical examination.  Your doctor will typically begin by obtaining a detailed gynecologic, obstetric, and sexual history.  This will normally include your last menstrual period and if you are using contraceptives or barrier devices (condoms) during sexual intercourse.

The diagnosis of vaginal infection is typically confirmed with a vaginosis screen.  Your doctor will usually obtain vaginal discharge specimens during speculum examination and send them to the laboratory for pH measurement.

Wet mount microscopy of vaginal secretions is also typically performed.  Your doctor will look for yeast buds or hyphae – these suggest Candida infection.  Motile trichomonads may be also be visualized in Trichomonas infection.  Epithelial cells studded with coccobacilli (clue cells) are suggestive of bacterial vaginosis.

Vaginal discharge is also usually sent for PCR testing – you doctor can evaluate for gonorrhea, chlamydia, candida, and trichomonas.  Under certain circumstances, your doctor may also send samples for culture.

How are vaginal infections treated?

Vaginal infections are treated based on the causative organism.  Bacterial vaginosis and Trichomonas infection are both typically treated with Flagyl (metronidazole).  This antibiotic is generally effective against anaerobic organisms.

Vaginal candida infection (yeast infection) is typically treated with topical or oral antifungal agents.  Your doctor may prescribe a single dose of Diflucan (fluconazole).  Patients with recurrent vulvovaginal candidiasis may benefit from chronic suppressive therapy.  Pregnant women may receive topical imidazole creams such as Monistat (miconazole) or Canestan (clotrimazole).

Gonorrhea and chlamydia infections frequently coexist and cause cervicitis or pelvic inflammatory disease.  These bacteria are treated simultaneously with intramuscular Rocephin (ceftriaxone) and oral Zithromax (azithromycin).  Pelvic inflammatory disease is a very severe condition that typically requires hospitalization with intravenous antibiotics.

Vaginal Infections Summary:

  • Symptoms of vaginal infections often include vaginal itching, burning, discharge, and malodor.
  • Patients with yeast infection typically have a curdy white discharge that appears like cottage cheese. Bacterial vaginosis is associated with a fishy amine odorTrichomonas classically produces a frothy greenish-yellow purulent discharge.
  • Patients with pelvic inflammatory disease often have fever, severe pelvic or abdominal pain, and systemic symptoms. Pelvic examination may demonstrate cervical discharge (cervicitis). 
  • The diagnosis of vaginal infections is suggested based on symptoms and physical examination, but typically confirmed with a vaginosis screen.
  • Your doctor will obtain specimens of vaginal discharge during speculum examination and send them to the laboratory for pH measurement.
  • Wet mount microscopy of vaginal secretions is also performed to look for yeast buds or hyphae – these suggest Candida infection. Motile trichomonads may be visualized in Trichomonas infection.  Epithelial cells studded with coccobacilli (clue cells) are suggestive of bacterial vaginosis.
  • Vaginal discharge is also usually sent for PCR testing and occasionally culture.
  • Bacterial vaginosis and Trichomonas infection are both typically treated with Flagyl (metronidazole).
  • Vaginal candida infection (yeast infection) is usually treated a single dose of Diflucan (fluconazole). Pregnant women may receive topical imidazole creams such as Monistat (miconazole) or Canestan (clotrimazole).
  • Gonorrhea and chlamydia infections frequently coexist and cause cervicitis or pelvic inflammatory disease. These bacteria are treated simultaneously with intramuscular Rocephin (ceftriaxone) and oral Zithromax (azithromycin)

Pelvic inflammatory disease is a very severe condition that typically requires hospitalization with intravenous antibiotics.

References:

  1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.
  2. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.

Popular Vaginal Infections Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.