What are the methods of diagnosing vaginitis or vaginal infections in women?
Diagnosis of Vaginitis
Vaginitis includes a spectrum of conditions causing burning, itching, odour and vaginal discharge. Vulvo vaginitis is one of the commonest gynaecological conditions encountered in out patient clinics in UAE. Vaginitis can be caused by infections, allergy, hormone (Oestrogen) deficiency. The most common infectious causes of vaginitis are bacterial vaginosis, vulvo- vaginal candidiasis and trichomoniasis. Health care providers traditionally diagnose vaginitis using a combination of clinical symptoms, examination findings, pH of vaginal discharge, microscopy and special tests like ‘Whiff’ or ‘sniff’ test.
Diagnosis starts from the review of the medical history of vaginal or sexually transmitted diseases, next is to perform a pelvic examination and using a speculum to look into the vagina and collect a sample for lab testing and for wet mount and pH testing. An elevated pH is an indication of BV or TV. But pH alone is not reliable.
Bacterial vaginosis (BV) is caused by gardnerella vaginalis is the most prevalent cause of vaginal discharge. Bacterial vaginosis (BV) presents with malodorous, clear white or greyish discharge with a ‘fishy’ odour. Even when asymptomatic BV infection is having associated with pelvic inflammatory disease.
In our clinical practice, BV is diagnosed by the presence of 3 out of 4 Amsel criteria.
- Thin homogenous vaginal discharge.
- Vaginal pH greater than 4.5.
- Positive whiff test (fishy odour or adding 10% potassium hydroxide solution to the vaginal discharge)
- Atleast 20% of ‘clue cells’ (vaginal epithelial cells with borders observed by bacteria as wet mount preparation on a special stain named Gram’s stain’
In Trichomonias which is caused by protozoan presents with greenish yellow frothy discharge.
In vulvo-vaginal candidiasis caused by an yeast infection, presents with curdy white or cottage cheese like discharge and it can present with itchy, excoriations and swelling of the genital area.
Trichomoniasis – is diagnosed by microscope on wet mount preparation.
Candidiasis too is diagnosed by microscopic examination and one can visualize budding yeast in the wet smear of vaginal discharge.
What are the factors that increase the incidents of vaginitis in women?
- Sexual activity
- Hormonal changes like taking birth control pills, menopause and pregnancy
- Taking medication like antibiotics and steroids
- Uncontrolled diabetes
- Vaginal douching
- Wearing damp or tight under clothings
- Using intrauterine contraceptive device for birth control
What are the complications of vaginitis in women?
Women with TV or BV are at a greater risk of acquiring sexually transmitted infections. In pregnant woman, symptomatic BV and TV have been associated with premature birth and low birth weight babies even though there are conflicting studies about the same.
Bacterial vaginosis in pregnant women can predispose them to a slightly increased risk of preterm birth.
What are the ways to treat vaginitis?
Prevention and treatment:
Good personal hygiene is the cornerstone for the prevention of vaginitis.
Avoiding hot tubs and whirlpool spas etc. can help in preventing recurrent vaginitis especially in those who are prone for such infections.
Avoiding irritants like scented tampons, pads, douches and scented soaps and deodorants, etc. can be beneficial in prevention of these infections.
The basic practice of wiping from front to back after using toilet, avoid spreading of fecal bacteria to your vagina.
Other useful tips are to use cotton under wears.
BV is treated by anti bacterial medication which can be taken by mouth or vaginal gel. Yeast infections can be treated by anti-fungal creams and pessary and oral anti-fungal medications.
Trichomoniasis too can be treated by anti bacterial medication. Vaginal atrophy can be seen in menopause can be treated by oestrogen cream.
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