Vaginitis

Last updated

Vaginitis
Other namesVulvovaginitis, vaginal infection, vaginal inflammation [1]
Pronunciation
Specialty Gynecology
Symptoms Itching, burning, pain, discharge, bad smell [1]
CausesInfections (bacterial vaginosis, vaginal yeast infection, trichomoniasis), allergic reactions, low estrogen [2]
Diagnostic method Based on examination, measuring the pH, culturing the discharge [3]
Differential diagnosis Inflammation of the cervix, pelvic inflammatory disease, cancer, foreign bodies [3]
TreatmentBased on the cause [1]
Frequency~33% of women (at some point) [4]

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. [4] [5] Symptoms may include itching, burning, pain, discharge, and a bad smell. [1] Certain types of vaginitis may result in complications during pregnancy. [1]

Contents

The three main causes are infections, specifically bacterial vaginosis, vaginal yeast infection, and trichomoniasis. [2] Other causes include allergies to substances such as spermicides or soaps or as a result of low estrogen levels during breast-feeding or after menopause. [2] More than one cause may exist at a time. [2] The common causes vary by age. [3] Prepubescent girls are often at risk for development of vulvovaginitis because of low amounts of estrogen and an underdeveloped labia minora. [6] [7]

Diagnosis generally include examination, measuring the pH, and culturing the discharge. [3] Other causes of symptoms such as inflammation of the cervix, pelvic inflammatory disease, cancer, foreign bodies, and skin conditions should be ruled out. [3]

Treatment depends on the underlying cause. [1] Infections should be treated. [3] Sitz baths may help with symptoms. [3] Soaps and feminine hygiene products such as sprays should not be used. [3] About a third of women have vaginitis at some point in time. [4] Women of reproductive age are most often affected. [4]

Signs and symptoms

A woman may have vaginal irritation, itching, or burning or may notice a foul-smelling or abnormal discharge that could appear green or yellow. [8]

The following signs or symptoms may indicate the presence of infection: [9]

Complications

Vaginal infections left untreated can lead to further complications, especially for the pregnant woman. For bacterial vaginosis, these include "premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease, [as well as] postsurgical complications (after abortion, hysterectomy, caesarian section), increased vulnerability to HIV infection and, possibly, infertility". [11] Studies have also linked trichomoniasis with increased likelihood of acquiring HIV; theories include that "vaginitis increases the number of immune cells at the site of infection, and HIV then infects those immune cells." [9] Other theories suggest that trichomoniasis increases the amount of HIV genital shedding, thereby increasing the risk of transmission to sexual partners. While the exact association between trichomoniasis infection and HIV genital shedding has not been consistently demonstrated, "there is good evidence that TV treatment reduces HIV genital shedding. Five studies were reported in the literature and, of these, four found a decrease in HIV genital shedding after TV treatment." [12]

Further, there are complications which lead to daily discomfort such as:

Causes

Infection

Vaginitis is often caused by an infection or the disruption of the healthy vaginal flora. [2] The vaginal flora consists of those organisms which generally do not cause symptoms and is dominated mainly by Lactobacillus species. [13] Disruption of the normal flora can cause a vaginal yeast infection. Vaginal yeast infection can affect women of all ages and is very common. The yeast Candida albicans is the most common cause of vaginitis. Specific forms of vaginal inflammation include the following types:

Infectious vaginitis accounts for 90% of all cases in reproductive age women:

Other less common infections are caused by gonorrhea, chlamydia, Mycoplasma , herpes, Campylobacter , improper hygiene, and some parasites, notably Trichomonas vaginalis . [16] Rare cases of amebic vaginitis have been reported, primarily in tropical, developing countries. [17] Women who have diabetes develop infectious vaginitis more often than women who do not. [18]

Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infectious vaginitis. Physical factors that have been claimed to contribute to the development of infections include the following: constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast. [19]

Hormonal

Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal women. [20]

Irritation/allergy

Irritant vaginitis can be caused by allergies or reactions to vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. [2] It can also be caused by hot tubs, abrasion, tissue, tampons, or topical medications.

Foreign body vaginitis (most common foreign bodies are retained tampons or condoms) may cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.

Diagnosis

Diagnosis is typically suspected based on a women's symptoms. [9] Diagnosis is made with microscopy (mostly by vaginal wet mount) and culture of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. Determining the agent is especially important because women may have more than one infection, or have symptoms that overlap those of another infection, which dictates different treatment processes to cure the infection. [9] For example, women often self-diagnose for yeast infections but due to the 89% misdiagnosis rate, self-diagnoses of vaginal infections are highly discouraged. [21]

Another type of vaginitis, called desquamative inflammatory vaginitis (DIV) also exists. The cause behind this type is still poorly understood. [22] DIV corresponds to the severe forms of aerobic vaginitis. About 5 to 10% of women are affected by aerobic vaginitis. [23]

The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:

ConditionDescriptionpH
Candida vaginitis (B37.3)Commonly referred to as a yeast infection, Candidiasis is a fungal infection that usually causes a watery, white, cottage cheese-like vaginal discharges. The discharge is irritating to the vagina and the surrounding skin.low (4.0–4.5)
Atrophic vaginitis [24] [25] (N95.2)Usually causes scant vaginal discharge with no odor, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause. Current term is Genitourinary syndrome of menopause.alkaline
Bacterial vaginitis (B96.3). Gardnerella usually causes a discharge with a fish-like odor. It is associated with itching and irritation, but not pain during intercourse.elevated
Trichomonas vaginalis (A59.0)Can cause a profuse discharge with a fish-like odor, pain upon urination, painful intercourse, and inflammation of the external genitals.elevated (5.0–6.0)
Aerobic vaginitis Burning, stinging and dyspareunia. Non-malodorous yellowish discharge. Symptoms can last for several years. The condition can also be asymptomatic. Thinned reddish vaginal mucosa, sometimes with erosions or ulcerations and abundant yellowish dischargeIncreased

Prevention

Prevention of candidiasis, the most common type of vaginitis, includes using loose cotton underwear. The vaginal area should be washed with water. Perfumed soaps, shower gels, and vaginal deodorants should be avoided. [26] Douching is not recommended. The practice upsets the normal balance of yeast in the vagina and does more harm than good. [27]

Prevention of bacterial vaginosis includes healthy diets and behaviors as well as minimizing stress as all these factors can affect the pH balance of the vagina. [11]

Prevention of trichomoniasis revolves around avoiding other people's wet towels and hot tubs, and safe-sex procedures, such as condom use. [9]

Some women consume good bacteria[ clarification needed ] in food with live culture, such as yogurt, sauerkraut and kimchi, or in probiotic supplements either to try to prevent candidiasis, or to reduce the likelihood of developing bacterial vaginitis following antibiotic treatment. There is no firm evidence to suggest that eating live yogurt or taking probiotic supplements will prevent candidiasis. [26]

Studies have suggested a possible clinical role for the use of standardized oral or vaginal probiotics in the treatment of bacterial vaginosis, either in addition to [28] or in place of [29] the typical antibiotic regimens. However, recent articles [30] [31] question their efficacy in preventing recurrence compared with other means, or conclude that there is insufficient evidence for or against recommending probiotics for the treatment of bacterial vaginosis.

Treatment

The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.

The following are typical treatments for trichomoniasis, bacterial vaginosis, and yeast infections:

Aerobic vaginitis

Treatment can include topical steroids to diminish the inflammation. Antibiotics to diminish the proportion of aerobic bacteria is still a matter of debate. The use of local antibiotics, preferably local non-absorbed and broad spectrum, covering enteric gram-positive and gram-negative aerobes, can be an option. In some cases, systemic antibiotics can be helpful, such as amoxicillin/clavulanate or moxifloxacin. [34] Vaginal rinsing with povidone iodine can provide relief of symptoms but does not provide long-term reduction of bacterial loads. [35] Dequalinium chloride can also be an option for treatment. [36]

Mixed infectious vaginitis

Mixed infectious vaginitis is a condition caused by multiple pathogens, leading to significant alterations in the vaginal environment, including a decrease in lactic acid bacteria, an increase in vaginal pH, and a reduction in local defenses. The term "mixed" refers to the involvement of multiple pathogens in causing the condition. The female vagina hosts a diverse array of over 50 different microorganisms that interact and coexist in a complex microecological environment. When the balance among these microorganisms is disrupted, it can lead to mixed infectious vaginitis, with the specific pathogens involved varying based on individual cases and environmental factors. This condition often results in distressing symptoms like vulvar itching, burning pain, and urethral irritation, and can be complicated by increasing drug resistance and recurrence rates, particularly in patients with ineffective treatment, long-term contraceptive use, or compromised sexual hygiene. [37] Mixed infectious vaginitis is a condition characterized by the simultaneous infection of two or more types of pathogens, which may include Chlamydia, Mycoplasma, anaerobic bacteria, and aerobic bacteria. [38] Additionally, this mixed infection can also involve yeast, further contributing to the complexity of the condition. [39]

An effective treatment option for mixed infectious vaginitis is a combination of clotrimazole and metronidazole. [37]

In children

Vulvovaginitis in children may be "nonspecific", or caused by irritation with no known infectious cause, or infectious, caused by a pathogenic organism. Nonspecific vulvovaginitis may be triggered by fecal contamination, sexual abuse, chronic diseases, foreign bodies, nonestrogenized epithelium, chemical irritants, eczema, seborrhea, or immunodeficiency. It is treated with topical steroids; antibiotics may be given in cases where itching has resulted in a secondary infection. [40]

Infectious vulvovaginitis can be caused by group A beta-hemolytic Streptococcus (7-20% of cases), Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Shigella, Yersinia , or common STI organisms ( Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis , herpes simplex virus, and human papillomavirus). Symptoms and treatment of infectious vulvovaginitis vary depending on the organism causing it. Shigella infections of the reproductive tract usually coexist with infectious of the gastrointestinal tract and cause mucous, purulent discharge. They are treated with trimethoprim-sulfamethoxazole. Streptococcus infections cause similar symptoms to nonspecific vulvovaginitis and are treated with amoxicillin. STI-associated vulvovaginitis may be caused by sexual abuse or vertical transmission, and are treated and diagnosed like adult infections. [40]

See also

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<span class="mw-page-title-main">Candidiasis</span> Fungal infection due to any type of Candida

Candidiasis is a fungal infection due to any species of the genus Candida. When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth and throat. Other symptoms may include soreness and problems swallowing. When it affects the vagina, it may be referred to as a yeast infection or thrush. Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina. Yeast infections of the penis are less common and typically present with an itchy rash. Very rarely, yeast infections may become invasive, spreading to other parts of the body. This may result in fevers, among other symptoms.

<span class="mw-page-title-main">Trichomoniasis</span> Medical condition

Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of human females

The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The human female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo, which develops into the fetus. The uterus also produces secretions, which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Vaginal flora</span> Microorganisms present in the vagina

Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type of bacteria present have significant implications for an individual's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus, such as L. crispatus, and the lactic acid they produce is thought to protect against infection by pathogenic species.

A vaginal disease is a pathological condition that affects part or all of the vagina.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

<span class="mw-page-title-main">Vaginal yeast infection</span> Medical condition

Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burning with urination, a thick, white vaginal discharge that typically does not smell bad, pain during sex, and redness around the vagina. Symptoms often worsen just before a woman's period.

<span class="mw-page-title-main">Vaginal wet mount</span> Gynecologic test

A vaginal wet mount is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution. It is used to find the cause of vaginitis and vulvitis.

<span class="mw-page-title-main">Atrophic vaginitis</span> Medical condition

Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to not enough estrogen. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does not resolve without ongoing treatment. Complications may include urinary tract infections.

The vaginal flora in pregnancy, or vaginal microbiota in pregnancy, is different from the vaginal flora before sexual maturity, during reproductive years, and after menopause. A description of the vaginal flora of pregnant women who are immunocompromised is not covered in this article. The composition of the vaginal flora significantly differs in pregnancy. Bacteria or viruses that are infectious most often have no symptoms.

<span class="mw-page-title-main">Aerobic vaginitis</span> Medical condition

Aerobic vaginitis (AV) is a form of vaginitis first described by Donders et al. in 2002. It is characterized by a more or less severe disruption of the lactobacillary flora, along with inflammation, atrophy, and the presence of a predominantly aerobic microflora, composed of enteric commensals or pathogens.

<span class="mw-page-title-main">Vaginal epithelium</span> Inner lining of the vagina

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers of cells. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

LACTIN-V, also known as CTV-05 or as Lactobacillus crispatus CTV-05, is a live biopharmaceutical medication containing a strain of Lactobacillus crispatus (L. crispatus) which is under development for the treatment of urinary tract infections (UTIs) and bacterial vaginosis (BV). It is administered intravaginally and is described as the first vaginal microbiome (VMB)-based live biotherapeutic product (LBP). Depletion of hydrogen peroxide (H2O2)-producing Lactobacillus strains such as Lactobacillus crispatus in the vagina has been strongly associated with BV and UTIs. Most commercially available probiotic Lactobacillus strains are not vaginal strains and do not appear to improve vaginal or urinary health outcomes. The Centers for Disease Control and Prevention (CDC)'s Sexually Transmitted Infections Treatment Guidelines (2021) noted that intravaginal LACTIN-V produced a considerably lower recurrence of BV following initial antibiotic treatment with metronidazole in a randomized controlled trial. However, the guidelines also noted that LACTIN-V is not yet Food and Drug Administration (FDA)-approved or commercially available. As of December 2021, LACTIN-V is in phase 2/3 clinical trials for the treatment of UTIs and is in phase 2 trials for the treatment of BV. It was originated by GyneLogix and is under development by Osel Inc., the National Institute of Allergy and Infectious Diseases, and other organizations.

<span class="mw-page-title-main">TOL-463</span> Combination drug

TOL-463 is an anti-infective medication which is under development for the treatment of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). It is a boric acid-based vaginal anti-infective enhanced with ethylenediaminetetraacetic acid (EDTA) which was designed to have improved activity against vaginal bacterial and fungal biofilms while sparing protective lactobacilli. EDTA enhances the antimicrobial activity of boric acid and improves its efficacy against relevant biofilms. In a small phase 2 randomized controlled trial, TOL-463 as an insert or gel achieved clinical cure rates of 50–59% against BV and 81–92% against VVC in women who had one or both conditions. It was effective and safe in the study, though it was without indication of superiority over other antifungal medications for VVC. The cure rates against BV with TOL-463 were said to be comparable to those with recently approved antibiotic treatments like single-dose oral secnidazole (58%) and single-dose metronidazole vaginal gel (41%). As of May 2019, TOL-463 is in phase 2 clinical trials for the treatment of BV and VVC. It was originated by Toltec Pharmaceuticals and is under development by Toltec Pharmaceuticals and the National Institute of Allergy and Infectious Diseases.

References

  1. 1 2 3 4 5 6 7 "Vaginitis". NICHD. 2016. Retrieved October 14, 2018.
  2. 1 2 3 4 5 6 "What causes vaginitis?". NICHD. 2016. Retrieved October 14, 2018.
  3. 1 2 3 4 5 6 7 8 "Overview of Vaginitis". Merck Manuals Professional Edition. May 2018. Retrieved October 14, 2018.
  4. 1 2 3 4 "Vaginitis". ACOG. September 2017. Retrieved October 14, 2018.
  5. ↑ Ferri FF (2016). Ferri's Clinical Advisor 2017 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1333. ISBN   9780323448383.
  6. ↑ Beyitler İ, Kavukcu S (April 2017). "Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature". World Journal of Pediatrics. 13 (2): 101–105. doi:10.1007/s12519-016-0078-y. PMID   28083751. S2CID   23511706.
  7. ↑ Romano ME (September 2020). "Prepubertal Vulvovaginitis". Clinical Obstetrics and Gynecology. 63 (3): 479–485. doi:10.1097/GRF.0000000000000536. PMID   32282354. S2CID   215758924.
  8. 1 2 Paladine HL, Desai UA (March 1, 2018). "Vaginitis: Diagnosis and Treatment". American Family Physician. 97 (5): 321–329. PMID   29671516.
  9. 1 2 3 4 5 "Trichomoniasis." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011.
  10. ↑ Rose L (April 20, 2020). "Postpartum Vaginal Odor - Treating Feminine Odor After a Baby".
  11. 1 2 3 "Bacterial Vaginosis." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011.
  12. ↑ Kissinger P, Adamski, A (September 2013). "Trichomoniasis and HIV interactions: a review". Sexually Transmitted Infections. 89 (6): 426–33. doi:10.1136/sextrans-2012-051005. PMC   3748151 . PMID   23605851.
  13. 1 2 Petrova MI, Lievens E, Malik S, Imholz N, Lebeer S (2015). "Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health". Frontiers in Physiology. 6: 81. doi: 10.3389/fphys.2015.00081 . ISSN   1664-042X. PMC   4373506 . PMID   25859220.
  14. ↑ Mastromarino P, Vitali B, Mosca L (2013). "Bacterial vaginosis: a review on clinical trials with probiotics" (PDF). New Microbiologica. 36 (3): 229–238. PMID   23912864.
  15. ↑ Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B (January 2002). "Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis". BJOG. 109 (1): 34–43. doi:10.1111/j.1471-0528.2002.00432.x. hdl: 10067/1033820151162165141 . PMID   11845812. S2CID   8304009.
  16. ↑ Hudson T (2007). Women's Encyclopedia of Natural Medicine. New York: McGraw-Hill. ISBN   978-0-07-146473-4.
  17. ↑ Musthyala NB, Indulkar S, Palwai VR, Babaiah M, Ali MA, Marriapam P (April 2019). "Amebic infection of the female genital tract: a report of three cases". Journal of Mid-Life Health. 10 (2): 96–98. doi: 10.4103/jmh.JMH_152_18 . PMC   6643709 . PMID   31391760.
  18. ↑ "Yeast Infections With Diabetes – Diabetes and Yeast Infections". Archived from the original on February 2, 2009. Retrieved January 26, 2009.
  19. ↑ Northrup C (2010). Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing. New York: Bantam. pp. 297–9.
  20. ↑ Choices NH (2018). "What causes a woman to bleed after sex? - Health questions - NHS Choices" . Retrieved February 7, 2018.
  21. 1 2 "Yeast Infections." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011.
  22. ↑ Sobel JD, Reichman O, Misra D, Yoo W (April 2011). "Prognosis and treatment of desquamative inflammatory vaginitis". Obstet Gynecol. 117 (4): 850–5. doi:10.1097/AOG.0b013e3182117c9e. PMID   21422855. S2CID   205473642.
  23. ↑ Tansarli GS, Kostaras EK, Athanasiou S, Falagas ME (2013). "Prevalence and treatment of aerobic vaginitis among non-pregnant women: evaluation of the evidence for an underestimated clinical entity". European Journal of Clinical Microbiology & Infectious Diseases. 32 (8): 977–84. doi:10.1007/s10096-013-1846-4. PMID   23443475. S2CID   14514975.
  24. ↑ Vulvovaginal atrophy and atrophic vaginitis have been the preferred terms for this condition and cluster of symptoms until recently. These terms are now regarded as inaccurate in describing changes to the whole genitourinary system occurring after menopause. The term atrophic vaginitis suggests that the vaginal is inflamed or infected. Though this may be true, inflammation and infection are not the major components of postmenopausal changes to the vagina after menopause. The former terms do not describe the negative effects on the lower urinary tract which can be the most troubling symptoms of menopause for women.
  25. ↑ Portman D, Gass M (2014). "Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society". Maturitas. 79 (3): 349–354. doi:10.1016/j.maturitas.2014.07.013. PMID   25179577.
  26. 1 2 NHS Choices, United Kingdom National Health Service -Preventing vaginal thrush, reviewed 2012-02-17, retrieved June 10, 2013
  27. ↑ Vaginal Health Organization How to avoid getting a Vaginal Yeast Infection July 10, 2010
  28. ↑ Anukam K, Osazuwa E, Ahonkhai I, Ngwu M, Osemene G, Bruce AW, Reid G (May 2006). "Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial". Microbes Infect. 8 (6): 1450–4. doi:10.1016/j.micinf.2006.01.003. PMID   16697231.
  29. ↑ Vujic G, Jajac Knez A, Despot Stefanovic V, Kuzmic Vrbanovic V (May 2013). "Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study". Eur J Obstet Gynecol Reprod Biol. 168 (1): 75–9. doi:10.1016/j.ejogrb.2012.12.031. PMID   23395559.
  30. ↑ Bradshaw CS, Pirotta M, De Guingand D, Hocking JS, Morton AN, Garland SM, Fehler G, Morrow A, Walker S. (April 2012). "Efficacy of oral metronidazole with vaginal clindamycin or vaginal probiotic for bacterial vaginosis: randomised placebo-controlled double-blind trial". PLOS ONE. 7 (4): e34540. Bibcode:2012PLoSO...734540B. doi: 10.1371/journal.pone.0034540 . PMC   3317998 . PMID   22509319.
  31. ↑ Senok AC, Verstraelen H, Temmerman M, Botta GA (October 2009). "Probiotics for the treatment of bacterial vaginosis". Cochrane Database Syst Rev (4): CD006289. doi:10.1002/14651858.CD006289.pub2. PMID   19821358.
  32. ↑ Sherrard J, Ison, C, Moody, J, Wainwright, E, Wilson, J, Sullivan, A (March 10, 2014). "United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014". International Journal of STD & AIDS. 25 (8): 541–549. doi:10.1177/0956462414525947. PMID   24616117. S2CID   7181478.
  33. ↑ Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD (December 16, 2015). "Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 62 (4): e1–50. doi:10.1093/cid/civ933. PMC   4725385 . PMID   26679628.
  34. ↑ Wang C, Han C, Geng N, Fan A, Wang Y, Yue Y, Zhang H, Xue F (2016). "Efficacy of oral moxifloxacin for aerobic vaginitis". European Journal of Clinical Microbiology & Infectious Diseases. 35 (1): 95–101. doi:10.1007/s10096-015-2513-8. PMID   26526787. S2CID   15238909.
  35. ↑ Donders GG, Ruban K, Bellen G (2015). "Selecting Anti-Microbial Treatment of Aerobic Vaginitis". Current Infectious Disease Reports. 17 (5): 477. doi:10.1007/s11908-015-0477-6. PMID   25896749. S2CID   34979527.
  36. ↑ Mendling W, Weissenbacher ER, Gerber S, Prasauskas V, Grob P (2016). "Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review". Archives of Gynecology and Obstetrics. 293 (3): 469–84. doi:10.1007/s00404-015-3914-8. PMC   4757629 . PMID   26506926.
  37. 1 2 Huang Y, Shen C, Shen Y, Cui H (January 2024). "Assessing the Efficacy of Clotrimazole and Metronidazole Combined Treatment in Vaginitis: A Meta-Analysis". Altern Ther Health Med. 30 (1): 186–191. PMID   37773671.
  38. ↑ Wu YQ, Tong T (2023). "Curcumae Rhizoma: A botanical drug against infectious diseases". Frontiers in Pharmacology. 13. doi: 10.3389/fphar.2022.1015098 . PMC   9871392 . PMID   36703758.
  39. ↑ Benyas D, Sobel JD (2022). "Mixed Vaginitis Due to Bacterial Vaginosis and Candidiasis". Journal of Lower Genital Tract Disease. 26 (1): 68–70. doi:10.1097/LGT.0000000000000641. PMID   34840242. S2CID   244713847.
  40. 1 2 Hoffman B, Schorge J, Bradshaw K, Halvorson L, Schaffer J, Corton MM (April 22, 2016). Williams Gynecology, Third Edition. McGraw Hill Professional. ISBN   9780071849098.


This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.