Vaginitis and pathological shifts in the vaginal flora

Contrary to a popular, but faulty theory, not all vaginal inflammation is due to infection, and the cases of vaginal inflammation which are, in fact, due to infection are not necessarily due to yeast. Targeted treatment based on the exact etiological diagnosis is the key to long-term success. It is therefore worthwhile to turn to a specialist in the case of vaginal inflammation. Various potions and over-the counter preparations are frequently actually harmful.

What can cause vaginitis?

There are many possible causes of vaginitis. The problem can be due to mechanical irritation (e.g., due to insufficient lubrication during sexual intercourse or excessive duration of penetration), chemical irritation or allergic reaction (cosmetics, feminine deodorants, lubricants, soaps, vaginal douches, condoms, tampons, sanitary napkins, scented toilet paper, swimming pools, etc.). It is also possible that the cause is an allergic reaction to the partner’s sperm, but this is very rare.

The underlying cause is often a change in the pH of the vagina (shift in the pH to either too basic or too acidic), which can be a consequence of antibiotic treatment or the unnecessary and unjustified use of vaginal douches.

This can often be induced by hormonal changes stemming from age-related factors (menopause), various physiological conditions (pregnancy) or medications (contraceptives, hormone therapies).

The invasion and multiplication of various microbes in the vaginal mucous membrane cause symptoms of varying severity.

Vaginitis may also be the secondary result of infectious inflammation of the cervix, the uterine mucous membrane or the fallopian tubes, via the dripping, high pH, purulent discharge.

Cervical lesions may be either the cause or the result of vaginal inflammation!

Does the presence of pathogens always result in symptoms?

Symptom-free carriers are not rare, since many kinds of microorganisms exist in the vaginal flora. Small amounts of certain microbes cannot be considered pathological (e..g, Gardnerella vaginalis, yeast, Streptococcus B, E. coli), while infection with the same microbes in large numbers will cause illness (bacterial vaginosis, fungal vaginal inflammation, aerobic vaginitis).

What are the symptoms of vaginitis?

In most cases, vaginitis is accompanied by increased vaginal secretions, discharge. The volume, color and smell of the discharge is typical and characteristic for particular pathogens; however, one should strive for an exact etiological diagnosis.

It is a mistake to commence treatment simply on the basis of the patient’s complaints and symptoms, because various conditions will produce identical symptoms, while the treatments are completely different.

Increased discharge can be accompanied by various subjective complaints: burning, stinging, itchiness, pain upon urination or during sexual intercourse. The reddening of the pudendum, discharge, the development of sores on the vaginal entrance, increased sensitivity may accompany vagiitis , especially if there are increased secretions which macerate, irritate and secondarily damage the skin and mucous membrane of the external genitalia.

How is the cause of vaginitis determined?

The patient is examined following a thorough interview. The external genitalia are inspected, the inguinal lymph nodes are palpated, and the vagina is examined using a vaginal speculum. The condition of the mucous membrane and the quality of the secretions are noted. A sample of the secretions is taken from the rear vaginal fornix for laboratory examination.

The first and most important is the microscopic examination of the vaginal secretions. The secretions can be immediately viewed, following use of special stains. The condition of the vaginal flora and the presence of inflammatory (pus) cells can be easily seen, as well as the presence of the pathogen itself in certain cases (large amounts of yeast, Trichomonas or bacteria).

The next step is the examination of the secretion in the laboratory, where a culture is bred, the pathogen is identified and sensitivity tests are done for various antibiotics and antimycotics; in certain cases, a molecular genetic procedure, i.e. PCR, is carried out to identify the pathogen. The latter analyses take longer, the result is usually obtained within one week.

How is vaginitis treated?

Knowledge of the underlying pathogen or other factors causing vaginal inflammation allows for targeted treatment. Vaginal suppositories, creams, orally taken medications are at our disposal, and if the exact causal diagnosis can be established, the treatment will certainly be effective.

It is advisable to carry out control examinations follow cessation of treatment, because the cessation of the symptoms does not necessarily mean that the problem has been effectively resolved.

The examination, treatment and control of the sexual partner is justified in some cases, in the interest of avoiding a “ping-pong” infection.

Characteristics of pathogens causing vaginitis/vaginosis

Diagnosis	Bacterial vaginosis	Trichomoniasis	Gombás hüvelygyulladás	Aerob vaginitis	Cytolytic vaginosis	Atrophic vaginitis
Complaints, symptoms	Unpleasant, grey, “fishy” discharge	Heavy, frothy, greenish-brownish discharge, itchiness, pain upon	Itchiness, sensitivity, reddening, swelling, vaginal pain upon sexual intercourse	Purulent discharge, inflammed vaginal mucous membrane, marked pain upon sexual intercourse	Itchiness, painful coitus and urination, thick and creamy white discharge	Whitish, occasionally unpleasant smelling discharge of varing intensity; Burning, itching and dryness; pain upon coitus, bleeding following coitus; bloody urine, frequently cystitis
pH	>4,5	>4,5	4,0-4,5	>4,5	3,5-4,5	>4,5
Microscopic examination	No normal flora; miscellaneous bacterial flora, clue cells	Protozoans with wavy movement	Filaments, pseudofilaments, proliferative cells blastomycetes	Numerous pus cells, no normalflora, round bacteria	Numerous lactobacilli; epitelial nuclei	Normal flora missing
Stained smear	Same	Numerous pus cells	Filaments, pseudofilaments, blastomycetes, pus cells	Gram positive bacteria. Frequently streptococcus chains, numerous pus, in addition to normal flora cells	Numerous lactobacilli, bald epithelial nuclei	Gram positive coccus, other signs of vaginal infection