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Vaginitis

Vaginitis

Description

Vaginal discharge and the associated vulvar itching are the most common reasons for a woman to seek gynecological care.

Vaginitis, a common gynecological complaint, refers to an infection of the female genital tract. It is characterized by a distressing, sometimes whitish, nonbloody discharge. The abnormal discharge is not a disease in itself, but a symptom of some disorder in the genital tract.

The current term, bacterial vaginosis, rather than vaginitis, indicates lack of an inflammatory reaction (absence of WBCs in the discharge) and is much more reflective of the true polymicrobial nature of this condition.

Bacterial vaginosis (BV), candidiasis, and trichomoniasis account for more than 90% of vaginal infections. BV typically is associated with a decrease in commensal, protective lactobacilli and a proliferation of other flora.

BV is the commonest of vaginal infections found in reproductive age women (12%-25%). It also can be found in children without any sexual exposure.

Bacterial Vaginosis

BV is a polymicrobial, primarily anaerobic, infection associated with sometimes fishy-smelling increased vaginal discharge but not accompanied by leukorrhea, vulvar burning, or pruritis. Infection with BV can have significant sequelae, however. It has been associated with an increased risk of septic abortion, premature rupture of amniotic membranes, preterm labor, preterm delivery, post-Cesarean endomyometritis and post-hysterectomy pelvic cellulitis.

Another entity, inflammatory vaginitis, features a vaginal pH above 4.2, large numbers of leukocytes, and some parabasal and basal vaginal cells, with a paucity of superficial squamous cells. Clinicians often find that patients are infected with group A or group B streptococcus. Treatments are the same as for bacterial vaginosis.

Candida
Candida, a commensal organism, is found in small population densities in the vaginal ecosystems of nearly one third of healthy women. Symptomatic infection arises, however, when proliferation causes a shift from colonization to frank adherence and infection.

While the most common offender is Candida albicans, Candida tropicalis and Candida glabrata have become increasingly prevalent, currently representing one third of isolates.

Trichomonas vaginalis
The trichomonad parasite is a flagellated protozoan that causes up to 25% of vaginitis cases. While trichomonas infection is asymptomatic up to 50% of the time, when clinical signs are present they include irritation and soreness of the vulva, perineum, and thighs, with dyspareunia and dysuria. Unlike bacterial vaginosis, it seems that trichomonas is primarily a sexually transmitted infection.

Causes

Vaginitis is usually diagnosed within one of three categories: infectious, hormonal or irritant.

The most common causes of VAGINITIS are Infections :

As much as 90% of vulvovaginitis will be associated with one of three organisms: Trichomonas, Gardnerella or Candida.

While BV was originally described by Curtis in 1911, it gained notoriety only in 1955 after Gardner and Dukes described the offending organism as Haemophilus vaginalis; the organism has since been renamed Gardnerella vaginalis in honor of its discoverer. G vaginalis is found in nearly 100% of women with symptomatic BV.

Presence of 3 of 4 criteria indicates BV (bacterial vaginitis):
· a homogenous noninflammatory discharge (not many WBCs);
· pH 4.5 or above (therefoere pH testing provides useful information in evaluating the patient with a vaginal discharge);
· clue cells (bacteria attached to borders of 20 % of epithelial cells); and
· a positive whiff test.

Trichomonas vaginalis

Trichomonas vaginalis causes up to 25% of vaginitis cases. Typically, the trichomonas infection is accompanied by a copious, foul, greenish-yellow frothy discharge. Unlike bacterial vaginosis, it seems that trichomonas is primarily sexually transmitted.

A general list of Infections would be:

Candida albicans
Chlamydia
Gonorrhea
Haemophilus vaginalis (Renamed: Gardnerella Vaginalis)
Herpes simplex
Protozoans
Trichomoniasis


The normal flora is affected by intercourse, especially with multiple partners and frequent douching.


Vaginal tissue and mucous changes with hormonal levels subject to influence by:

        Diet
        Estrogen stimulation or deficiency
        Use of oral contraceptives

Atrophic vaginitis is a common problem in menopausal women, in whom there is epithelial thinning.

Related physical problems, or irritants, may include:

        Chemicals
        Fistulae
        Foreign bodies within the vaginal tract
        Radiation
        Trauma
        Tumors
        Vulvitis

Chemicals may derive from feminine hygiene products.
Trauma includes sexual intercourse.

Vaginal candidiasis occurs more commonly after antibiotic treatment and among women taking oral contraceptives.

The alkaline nature of menstrual fluid combines with the acidic vaginal environment, balancing the chemistry (pH) of the vagina with normal, healthy flora. This balance may be disturbed by the use of tampons, for example, which may also cause injury to the vaginal walls, inviting infection e.g. HPV.

Non-infective BV

Not all vaginal discharges result from infection. Atrophic vaginitis, physiologic leukorrhea, and local irritants cause a number of cases. Of the infective etiologies, bacterial vaginosis (BV) and yeast (candida) are by far the most common. Add the occasional case of trichomoniasis, and the list covers more than 90% of the cases of vaginal infections. Not infrequently, multiple etiologies exist.

In the search for a noninfective cause of the vaginosis, the woman may have changed detergents/fabric softeners or used scented hygiene products or douches.

Signs & Symptoms

Classically, there will be a vaginal discharge, usually malodorous with itching possibly extening to the surrounding tissues.

Discharge irregularities of any sort including:

        Watery cervical discharge of variable color and without appreciable mucus

        Abnormal yellow, green, white, or clear discharge (this occurs without urinary tract infections and is caused by an increase in polymorphonuclear leukocytes)

        Moderately increased malodorous white or gray discharge

        Unusually thick, white, cheesy, itchy discharge (Candida)

        Fishy odor - due to volatile amines - (Candida)        

        Increased discharge volume

        Thin, watery, slightly bloody discharge

        Honey-colored pus-like vaginal discharge characteristic of either group B         streptococcus or Staphylococcus aureus.

        Foul, greenish-yellow frothy discharge (Trichomonas)

        Profuse clear or white discharge (Haemophilus or Gardnerella)

Vulvar itching

Vulvar bleeding

Vulvar irritation


Nutritional Supplements

Structure & Function: Women's Health

---------------------------------
General Supplements
---------------------------------

Adult
Acidophilus (douche) 2 - 3 tsp
Beta carotene*
Biotin 200 - 600 mcg
Chlorophyll*
Garlic*
Lysine*
Olive Oil 3 tsp
Vitamin C2000 - 4000 mg
Vitamin E*
Wheatgrass*
Zinc (Sulfate) 20 - 30 mg



* Please refer to the respective topic for specific nutrient amounts.

Discussion:

Plant sources may also be used in a douche e.g. chlorophyll, or wheat grass juice. Garlic is also recommended and may be used both as a food and an ingredient in a vaginal suppository.

In cases of "thrush", yeast infection, or urinary tract infections, it may be advisable to include caprylic acid in order to remove some of the yeast overgrowth. The purpose of the acidophilus, of course, is to repopulate the beneficial microflora.


Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

Treatment for vaginitis varies according to the underlying cause. Vaginitis with a microbial cause should be nutritionally managed, as with any other infection. An Anti-Candida Diet is prescribed to help in tissue repair and antibody production.

Chlamydia, Herpes and Trichomonas may be helped by supplements of zinc sulfate.

Douches and swabs may be helpful, also.

For herpes, certain arginine rich foods need to be avoided and replaced with foods rich in lysine, or by taking a lysine supplement.

Foods to make note of include:

FoodArginineLysine
Almonds2,730mg 580
Brazil nuts2,250 470
Chocolate4,5002,000
Tuna1,5302,530
Turkey1,7002,450



N.B. Amounts are expressed in milligrams per 100g servings (3.5 oz).

Homeopathic Remedy

1. Aconitum Napellus tinct. - 30C
2. Cantharis- 30C
3. Sepia - 30C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Calendula
Garlic
Goldenseal
Tea tree oil

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Boric acid has shown to be more effective against yeast than Nystatin (lactic acid).

Calendula may be useful as a solution applied with a swab.

Garlic has fungicidal and fungistatic properties.

Goldenseal has anti-bacterial properties as well as soothing inflamed mucous membranes in douching solution. The active ingredient is berberine.

Tea tree oil has demonstrated germicidala ction against a number of common vaginal pathogens (Trichomonas vaginalis and Candida albicans). It may be used as a douche as well as saturated tampons.

References:

Buck, DS et al., Comparison of two topical preparations for the treatmen tof onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 1994, 38:601-605.

Pena, EF: Melaleuca alternifolia. Obstet. Gynecol. 1962, 19:793-795.

Aromatherapy - Essential Oils

Palma Rosa Essence.

Cystitis:

Cajeput Essence,Eucalyptus Essence,
Juniper Essence,Lavender Essence,
Niaouli Essence,Pine Essence,
Sandalwood Essence.


Related Health Conditions

BleedingCervicitis
GonorrheaHerpes simplex
InfectionItching
TumorVulvitis



Abstracts

References

Anonymous: Vaginitis Patient information on the causes, symptoms, diagnosis, treatment, complications and prevention of vaginitis. Provided by the U.S. Department of Health and Human Services.

Anonymous: Patient information on the causes, symptoms and treatment of vaginitis. Provided by Planned Parenthood.

Ant, M.: Diabetic vulvovaginitis treated with vitamin E suppositories. Am. J. Ob. Gyn. 1954,67: 407-410.

Berkow, R. 1977. The Merck Manual. Merck Sharp and Dohme Research Laboratories Pub., Rahway, New Jersey. 2165 pp.

Bernstein JA et al., Prevalence of human seminal plasma hypersensitivity among symptomatic women. Ann Allergy Asthma Immunol, 1997 Jan, 78:1, 54-8.

Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.

Cathcart, R.F. Vitamin C in the Treatment of Aids. Med Hypoth, 14. 1984.

Dworetzky, M.: Allergic Vaginitis. American Journal of Obstetrics and Gynecology, December 1989;161(6):Part I:1752-1753 (Also a letter to the editor.)

Fidel PL Jr et al., Vaginal-associated immunity in women with recurrent vulvovaginal candidiasis: evidence for vaginal Th1-type responses following intravaginal challenge with Candida antigen. J Infect Dis, 1997 Sep, 176:3, 728-39.

Foxman, B.: The Epidemiology of Vulvovaginal Candidiasis: Risk Factors. The American Journal of Public Health, March 1990;8(3):329-331.

Gardner, W.A. & B.D. Bennett. In Vitro Susceptibility to Trichomonas Vaginalis to Zinc. Prostate, 2. 1981.

Gilliland, S.E. & M.L. Speck. Antagonistic Action of Lactobacillus Toward Intestinal Pathogens. Journal Of Food Prot., 40. 1977.

Griffith, R. et al: A multicentered study of lysine therapy in Herpes simplex infection. Dermatologia, 1978, 156: 257-267.

Guiraud P, Steiman R, et al. Comparison of the antibacterial and antifungal activities of lapachol and beta-lapachone. Planta Med 1994;60:373—4.

Heidrich, F. et al: Clothing factors and vaginitis. J. Fam. Pract. 1984, 19: 491-494.

Heinerman, John. 1982. Herbal Dynamics. Root of Life, Inc.: Publ. Kunz, J.R.M. 1982. The American Medical Association Family Medical Guide. Random House Pub, New York. 832 pp.

Hughes BG, Lawson LD. Antimicrobial effects of Allium sativum L. (garlic), Allium ampeloprasum L. (elephant garlic) and Allium cepa L. (onion), garlic compounds and commercial garlic supplement products. Phytother Res 1991;5:154—8.

Jackson DJ et al., Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management. J Infect Dis, 1997 Apr, 175:4, 833-8.

Jovanovic R, et al. Antifungal agents vs. boric acid for treating chronic mycotic vulvovaginitis. J Reprod Med 1977;36(8):593-597.

Kaufman RH: Common causes of vaginitis. Hosp Med 22:23-44, 1986.

Keller Van Slyke, K.: Treatment of vulvovaginal candidiasis with boric acid powder. Am. J. Ob. Gyn. 1981, 141: 145-148.

Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.

Krieger, J. & Rein, M.: Zinc sensitivity of Trichomonas vaginalis: in vitro studies and clinical implications. J. Inf. Dis. 1982, 146: 341-345.

Murray, M.T., & J.E. Pizzorno. 1991. Encyclopedia of Natural Medicine. Rocklin, Ca; Prima Publishing.

Neri, A. et al: Bacterial Vaginosis in Pregnancy Treated With Yogurt. Acta Obstet. Gynecol. Scand, 1993;72:17-19.

Netto, N.R. et al: The importance of vaginal infection on recurrent cystitis in women. Int. Surg. 1979, 64: 79-82.

Nyirjesy P et al., Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol, 1997 Jul, 90:1, 50-3.

Pena, E.F.: Maleluca alternafolia oil: its use for trichomonal vaginitis and other vaginal infections. Ob. Gyn. 1962, 19: 793-795.

Petersdorf, R.G. & R.D. Adams. 1983. Harrison's Principles Of Internal Medicine. 10th ed. McGraw Hill Pub Co., New York. 2212 pp.

Plourd DM: Practical Guide to Diagnosing and Treating Vaginitis. Medscape. [Internet]

Rigg, D., et al Recurrent Allergic Vulvovaginitis: Treatment With Candida Albicans Allergen Immunotherapy. American Journal of Obstetrics and Gynecology, February, 1990;162(2):332-6.

Sabir, M. & Bhide, M.: Study of some pharmacological actions of berberine. Ind. J. Phys. Pharm. 1971, 15: 111-132.

Sobel JD & Chaim W: Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy. Clin Infect Dis, 1997 Apr, 24:4, 649-52.

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Swate, T. & Weed, J.: Boric acid treatment of vulvovaginal candidiasis. Ob. Gyn. 1974, 43: 894-895.