Which Infection Is It? Identifying Different Vaginal Infections
By definition, "vaginitis" simply means "inflammation of the vagina." Sometimes vaginitis is caused by an infection, and sometimes it is not. Regardless of the cause, it can be accompanied by a number of other symptoms. Some of the most common symptoms include:
- Abnormal vaginal discharge (most common sign)
- A change in color of vaginal discharge
- A bad or "fishy" odor
- Itching
- Irritation or swelling of the vulva
- Painful intercourse (dyspareunia)
- Burning or painful urination (dysuria)
Please note that even while these can occur with a vaginal infection, they may also arise when the source is not an infection at all. Your body's reaction to a chemical or irritant such as bath soaps or detergents can also produce some of these symptoms.
Is this an infection and if so, what kind?
It is important for women to consult with their Ob/Gyn if they experience these symptoms to determine if they have an infection and if so what kind. In cases when it is, indeed, an infection, there are three types of infections that are the most common:
- Bacterial Vaginosis (BV) accounts for 40 to 50 % of cases
- Vulvovaginal Candidiasis (yeast infection) (VVC) accounts for 20 to 25 % of cases
- Trichomoniasis (Trich) accounts for 5 to 20 % of cases
I will discuss each in sequential order.
Bacterial Vaginosis ("BV")
The bacteria that cause bacterial vaginosis occur naturally in the vagina; however usually there aren't too many of them. BV occurs when these bacteria overgrow.
The main symptom of BV is an increase in discharge that has a strong fishy odor, and might be thin and gray or greenish in color. The odor may be stronger or more noticeable during menstruation or after sex.
Itching is not common in BV, but might be present if there is a lot of discharge. Your doctor can use several tests to detect BV, including a wet mount, a vaginal pH measurement, or a "whiff test." (See the Tools and Tests section below for additional information on these tests.)
BV is not a sexually transmitted disease ("STD"). However, having BV may make you more vulnerable to STDs. The treatment requires antibiotics that can be taken orally or vaginally. If you are experiencing itch or irritation while waiting for the antibiotic to kick in, consider an over-the-counter topical analgesic such as Vagisil® Anti-Itch Crème or Wipes, which can relieve the discomfort until the infection is cleared.
Remember… BV requires a doctor's visit. Over-the-counter treatments will not cure BV.
Vulvovaginal Candidiasis (VVC)
This is commonly called a "yeast" infection.
It is usually caused by Candidia albicans which is a fungus normally found in small amounts in the vagina. However, an overgrowth of yeast results in a yeast infection. For example, an alteration in the normal vaginal environment, such as normal bacteria being eradicated by antibiotics, may result in the yeast overgrowing and causing symptoms.
The most common symptoms of a yeast infection are itching and burning of the vulva, which sometimes results in redness and swelling of this area, making sex and urination painful. Vaginal discharge from yeast is sometimes described as "cottage cheese-like" because of its white and lumpy texture. There may be a "yeasty" odor.
Conditions that might put women at risk for yeast infections are diabetes, pregnancy, antibiotic use and sexual intercourse. To diagnose a yeast infection, your doctor will check vaginal discharge for the presence of yeast hyphae under a microscope. Your doctor may also test for BV.
The first time a woman thinks she has a yeast infection, she should see a doctor. While antifungal medications are available over-the-counter to treat yeast infections today, women should be cautious in "self-treating," especially the first time a yeast infection is suspected.
The treatments available include a prescription oral medication, vaginal suppositories and vaginal creams. While you are treating your yeast infection with an antifungal, the itch can be relieved with an over-the-counter product, such as Vagisil® Anti-Itch Creme, which contains the topical analgesic benzocaine, as well as skin-soothing vitamins E, A and D and aloe. A more portable, discreet option is the use of new flushable Maximum Strength Vagisil® Anti-Itch Medicated Wipes, which can be carried easily in a purse or gym bag.
Trichomoniasis ("Trich")
Trichomonas infection is a condition caused by a parasite called trichomonas vaginalis. It is sexually transmitted, so if you are diagnosed with it, your partner/s will also need diagnosis and treatment by a doctor.
A common sign of trich is a gray-greenish vaginal discharge. It might or might not have a bad odor. There might be burning, irritation, redness, swelling and itching of the vulva. Sometimes there is pain with intercourse and urination.
The diagnosis can be made with a "wet mount" microscope slide, in which the live trichomonads are seen swimming about under the microscope. There are also some cultures suitable to detect trich. Sometimes a Pap smear will show them on the slide and the pathologist will make a note of it on the report.
Trichomonas infection must be treated with an oral antibiotic, usually metronidazole (both partners). Once again, if you are experiencing itch or irritation while waiting for the antibiotic to kick in, consider an over-the-counter topical analgesic such as Vagisil® Anti-Itch Crème or Wipes, which can relieve the discomfort until the infection is cleared.
Other Types of Vaginitis
Other types of vaginitis which are not from infectious agents include:
- Atrophic vaginitis - thinning of the vaginal lining usually from low estrogen
- Chemical or allergic vaginitis which can result from deodorants, spermicides, foreign bodies, perfumes, etc.
- Vaginal or vulvar neoplasia (cancer)
Tools and Testing
Here are some additional notes on the tools and tests used to diagnose vaginitis:
- Wet Mount: Wet mount microscopy can be performed by mixing vaginal fluid with normal saline and placing a drop of the mixture on a slide. The slide is examined under the microscope for white blood cells, motile trichomonads, and clue cells, which are only present with BV.
- Vaginal pH Testing: The vaginal walls are tested with pH paper to determine the acid or alkaline level of the vagina. Normal vaginal pH is between 3.5 and 4.5. When abnormal bacteria overgrow or trichomonas become established, pH rises to the abnormal range of 5.0-7.5.
- Whiff Test: Potassium Hydroxide (KOH) Preparation is a microscope slide of vaginal fluids mixed with a drop of KOH. In a Visual examination of the slide under a microscope, the physician looks for the "Hyphae" form of yeast. Also, KOH mixed with vaginal fluid will give off a bad odor if there is BV. This is called the "whiff test."
Top Tips Regarding Vaginitis:
- The symptoms of vaginitis are non-specific
- Women should always consult their doctors and not self-treat if they are uncertain of the cause of their symptoms
- BV is the most common cause of infectious vaginitis
- Most forms of vaginitis are treatable
- While waiting for a medication to clear up the infection, the burning and itching associated with infections can be relieved with an over-the-counter anti-itch medication such as Vagisil® Anti-Itch Creme or Vagisil ®Anti-Itch Medicated Wipes