Vaginitis

black and white image of woman with no clothes on, arms crossed covering lower regionVaginitis is an inflammation of the vagina. It often is caused by infections, some of which are associated with serious diseases.

The most common vaginal infections are:

  • Bacterial vaginosis
  • Trichomoniasis
  • Vaginal yeast infection

Some vaginal infections are transmitted through sexual contact, but others,
such as yeast infections, probably are not.

BACTERIAL VAGINOSIS

Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among
women of childbearing age. It previously was called nonspecific vaginitis or
Gardnerella-associated vaginitis. Health experts are not sure what role
sexual activity plays in BV.

BV reflects a change in the growth of vaginal bacteria. This chemical
imbalance occurs when different types of bacteria outnumber the normal, “good”
ones. Instead of Lactobacillus (a type of normal bacteria that can live
naturally in the vagina) being the most numerous, increased numbers of bacteria
such as Gardnerella vaginalis, Bacteroides, Mobiluncus, and
Mycoplasma hominis are found in the vaginas of women with BV.
Researchers are studying the role that each of these germs may play in causing
BV, but they do not yet understand the role of sexual activity in developing BV.
A change in sexual partners, using an IUD (intrauterine device), and douching
may increase a woman’s risk of getting BV.

Symptoms

The main symptom of BV is an abnormal, foul-smelling vaginal discharge. Some
women describe it as a fish-like odor that is most noticeable after having sex.
Nearly half of the women with signs of BV, however, have no symptoms. A health
care provider may see these signs while giving a physical examination and may
confirm the diagnosis by doing lab tests of vaginal fluid.

Other symptoms may include

  • Thin vaginal discharge, usually white or gray in color
  • Pain during urination
  • Itching around the vagina

Diagnosis

A health care provider can examine a sample of vaginal fluid under a
microscope, either stained or in special lighting, to look for bacteria
associated with BV. Then, they can diagnose BV based on

  • Absence of lactobacilli
  • Presence of numerous “clue cells” (cells from the vaginal lining that are
    coated with BV germs)
  • Fishy odor
  • Change from normal vaginal fluid

Treatment

Health care providers use antibiotics such as metronidazole or clindamycin to
treat women with BV. Generally, male sex partners will not be treated.

Complications

In most cases, BV causes no complications. There have been documented risks
of BV, however, such as an association between BV and pelvic inflammatory
disease (PID). PID is a serious disease in women which can cause infertility and
tubal (ectopic) pregnancy.

BV also can cause other problems such as premature delivery and
low-birth-weight babies. Therefore, some health experts recommend that all
pregnant women, whether or not they have symptoms, who previously have delivered
a premature baby be checked for BV. A pregnant woman who has not delivered a
premature baby should be treated if she has symptoms and laboratory evidence of
BV.

BV also is associated with increased chances of getting gonorrhea or HIV
infection. (HIV, human immunodeficiency virus, causes AIDS.)

TRICHOMONIASIS

Trichomoniasis (trick-oh-moe-nye-uh-sis) is one of the most common sexually
transmitted infections (STIs). According to CDC, an estimated 7.4 million new
cases occur in men and women every year in the United States.

Trichomoniasis is caused by a parasite called Trichomonas vaginalis.
Trichomoniasis is primarily an infection of the urogenital tract. The vagina is
the most common place for infection in women, and the urethra is the most common
in men.

Symptoms

Trichomoniasis, like many other STIs, often occurs without any symptoms. Most
infected men do not have symptoms. When women have symptoms, they usually appear
within 5 to 28 days of exposure to the parasite.

Although some infected women have minor or no symptoms, many do have
symptoms. The symptoms in women include

  • Heavy, yellow-green or gray vaginal discharge
  • Discomfort during sex
  • Vaginal odor
  • Painful urination

They may also have irritation and itching of the genital area and, on rare
occasions, lower abdominal pain.

If present, the symptoms in men include a thin, whitish discharge from the
penis and painful or difficult urination and ejaculation.

Diagnosis

A health care provider can diagnose trichomoniasis by performing laboratory
tests on fluid samples from the vagina or penis. When women are infected with
trichomoniasis, a pelvic examination reveals red sores on the cervix or inside
the vagina.

Treatment

Because men can transmit the disease to their sex partners even when they
don’t have symptoms, health experts recommend that both partners be treated to
get rid of the parasite. Health care providers usually use metronidazole in a
single dose to treat people infected with trichomoniasis. A person can get
trichomoniasis again after being treated successfully, however.

Prevention

The surest way to avoid getting STIs is to abstain from sexual contact, or to
be in a long-term mutually monogamous relationship with a partner who has been
tested and is known to be uninfected. Using a latex male condom consistently and
correctly during sex may help prevent the spread of trichomoniasis.

Complications

Research has shown a link between trichomoniasis and two serious
complications. Scientific studies suggest that trichomoniasis is associated with
at least a 3- to 5-fold increased risk of HIV transmission and may cause a woman
to deliver a low-birth-weight or premature infant. Scientists need to do
additional research to fully explore these relationships.

VAGINAL YEAST INFECTION

Vaginal yeast infection, or vulvovaginal candidiasis, is a common cause of
vaginal irritation. This common fungal infection occurs when there is an
imbalance of the fungus called Candida albicans. Although this
infection is not considered an STI, 12 to 15 percent of men develop symptoms
after sexual contact with an infected partner.

Yeast are always present in the vagina in small numbers, and symptoms only
appear with overgrowth. Health experts estimate that approximately 75 percent of
all women will have at least one yeast infection with symptoms during their
lifetimes.

Several factors are associated with increased yeast infection in women,
including

  • Being pregnant
  • Having uncontrolled diabetes mellitus
  • Using oral contraceptives or antibiotics

Other factors that may increase the incidence of yeast infection include
using

  • Douches
  • Perfumed feminine hygiene sprays
  • Topical antibiotics and steroid medicines

Wearing tight, poorly ventilated clothing and underwear also can contribute
to vaginitis. Women should work with their health care providers to find out
possible underlying causes of their chronic yeast infections.

Health experts do not know whether yeast can be transmitted sexually. Because
almost all women have the fungus in their vaginas, it has been difficult for
researchers to study this aspect.

Symptoms

The most frequent symptoms of yeast infection in women a

Psoriasis Q&A

woman doctor in office

Questions and Answers about Psoriasis

What Is Psoriasis?

Psoriasis is a chronic (long-lasting) skin disease of
scaling and inflammation that affects 2 to 2.6 percent of the United
States population, or between 5.8 and 7.5 million people. Although the
disease occurs in all age groups, it primarily affects adults. It
appears about equally in males and females. Psoriasis occurs when skin
cells quickly rise from their origin below the surface of the skin and
pile up on the surface before they have a chance to mature. Usually this
movement (also called turnover) takes about a month, but in psoriasis
it may occur in only a few days. In its typical form, psoriasis results
in patches of thick, red (inflamed) skin covered with silvery scales.
These patches, which are sometimes referred to as plaques, usually itch
or feel sore. They most often occur on the elbows, knees, other parts of
the legs, scalp, lower back, face, palms, and soles of the feet, but
they can occur on skin anywhere on the body.

The disease may also affect the fingernails, the
toenails, and the soft tissues of the genitals and inside the mouth.
While it is not unusual for the skin around affected joints to crack,
approximately 1 million people with psoriasis experience joint
inflammation that produces symptoms of arthritis. This condition is
called psoriatic arthritis.

– How Does Psoriasis Affect Quality of Life?
– What Causes Psoriasis?
– How Is Psoriasis Diagnosed?
– How Is Psoriasis Treated?
– What Are Some Promising Areas of Psoriasis Research?
– Where Can People Find More Information About Psoriasis?

How Does Psoriasis Affect Quality of Life?

Individuals with psoriasis may experience
significant physical discomfort and some disability. Itching and pain
can interfere with basic functions, such as self-care, walking, and
sleep. Plaques on hands and feet can prevent individuals from working at
certain occupations, playing some sports, and caring for family members
or a home. The frequency of medical care is costly and can interfere
with an employment or school schedule. People with moderate to severe
psoriasis may feel self-conscious about their appearance and have a poor
self-image that stems from fear of public rejection and psychosexual
concerns. Psychological distress can lead to significant depression and
social isolation.

What Causes Psoriasis?

Psoriasis is a skin disorder driven by the immune
system, especially involving a type of white blood cell called a T cell.
Normally, T cells help protect the body against infection and disease.
In the case of psoriasis, T cells are put into action by mistake and
become so active that they trigger other immune responses, which lead to
inflammation and to rapid turnover of skin cells. In about one-third of
the cases, there is a family history of psoriasis. Researchers have
studied a large number of families affected by psoriasis and identified
genes linked to the disease. (Genes govern every bodily function and
determine the inherited traits passed from parent to child.) People with
psoriasis may notice that there are times when their skin worsens, then
improves. Conditions that may cause flareups include infections,
stress, and changes in climate that dry the skin. Also, certain
medicines, including lithium and betablockers, which are prescribed for
high blood pressure, may trigger an outbreak or worsen the disease.

How Is Psoriasis Diagnosed?

Occasionally, doctors may find it difficult to diagnose
psoriasis, because it often looks like other skin diseases. It may be
necessary to confirm a diagnosis by examining a small skin sample under a
microscope. There are several forms of psoriasis. Some of these
include:

– Plaque psoriasis–Skin lesions are red at the base and covered by silvery scales.

Guttate psoriasis–Small, drop-shaped lesions appear on the trunk,
limbs, and scalp. Guttate psoriasis is most often triggered by upper
respiratory infections (for example, a sore throat caused by
streptococcal bacteria).
– Pustular psoriasis–Blisters of
noninfectious pus appear on the skin. Attacks of pustular psoriasis may
be triggered by medications, infections, stress, or exposure to certain
chemicals.
– Inverse psoriasis–Smooth, red patches occur in the
folds of the skin near the genitals, under the breasts, or in the
armpits. The symptoms may be worsened by friction and sweating.

Erythrodermic psoriasis–Widespread reddening and scaling of the skin
may be a reaction to severe sunburn or to taking corticosteroids
(cortisone) or other medications. It can also be caused by a prolonged
period of increased activity of psoriasis that is poorly controlled.
– Psoriatic arthritis–Joint inflammation that produces symptoms of arthritis in patients who have or will develop psoriasis.

How is Psoriasis Treated?

Doctors generally treat psoriasis in steps based on the
severity of the disease, size of the areas involved, type of psoriasis,
and the patient’s response to initial treatments. This is sometimes
called the “1-2-3” approach. In step 1, medicines are applied to the
skin (topical treatment). Step 2 uses light treatments (phototherapy).
Step 3 involves taking medicines by mouth or injection that treat the
whole immune system (called systemic therapy).

Over time, affected skin can become resistant to
treatment, especially when topical corticosteroids are used. Also, a
treatment that works very well in one person may have little effect in
another. Thus, doctors often use a trial-and-error approach to find a
treatment that works, and they may switch treatments periodically (for
example, every 12 to 24 months) if a treatment does not work or if
adverse reactions occur.

Topical Treatment

Treatments applied directly to the skin may improve its
condition. Doctors find that some patients respond well to ointment or
cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or
anthralin. Bath solutions and moisturizers may be soothing, but they are
seldom strong enough to improve the condition of the skin. Therefore,
they usually are combined with stronger remedies.

– Corticosteroids–These drugs reduce inflammation and
the turnover of skin cells, and they suppress the immune system.
Available in different strengths, topical corticosteroids (cortisone)
are usually applied to the skin twice a day. Short-term treatment is
often effective in improving, but not completely eliminating, psoriasis.
Long-term use or overuse of highly potent (strong) corticosteroids can
cause thinning of the skin, internal side effects, and resistance to the
treatment’s benefits. If less than 10 percent of the skin is involved,
some doctors will prescribe a high-potency corticosteroid ointment.
High-potency corticosteroids may also be prescribed for plaques that
don’t improve with other treatment, particularly those on the hands or
feet. In situations where the objective of treatment is comfort,
medium-potency corticosteroids may be prescribed for the broader skin
areas of the torso or limbs. Low-potency preparations are used on
delicate skin areas. (Note: Brand names for the different strengths of
corticosteroids are too numerous to list in this booklet.)
– Calcipotriene–This drug