Curing Vaginal Infections: When to see the doctor

When you do visit a gynecologist, the doctor will need to know your “history” in order to make a diagnosis and prescribe treatment. Report all of your symptoms. Try to recall when you first noted them. Be frank about new sexual partners, sexual practices, or suspected infidelity by your partner. Physicians know that this information is personal and sensitive and will keep everything you tell them confidential.

The doctor will examine the skin of your vulva, vagina, and cervix for signs of infection; check the appearance of your vaginal discharge; and note any tenderness in your uterus and ovaries. (In simple vulvovaginitis, there is usually no tenderness.)

Your vaginal discharge can be examined microscopically right in the doctor's office. If cultures are necessary, a medical laboratory can usually perform the necessary tests and return the results to the doctor within 48 hours. Most of these procedures are completely painless; the worst of them is only mildly uncomfortable.

Treating Bacterial Vaginosis

Despite the fact that bacterial vaginosis (known as BV) accounts for 40 percent of all vaginitis-related office visits, this common disorder is still not well understood. Indeed, as researchers have attempted to sort out the causes, it has been renamed several times. Originally called “non-specific vaginitis,” it was later redubbed “Haemophilus vaginalis vaginitis” and then “Gardnerella vaginalis vaginitis.”

For most women, BV is more a nuisance than a significant health threat. However, there is some evidence linking it to an increased risk of pelvic inflammatory disease (a bacterial infection of the uterus, fallopian tubes, and ovaries). In pregnancy, BV appears to markedly increase the risk of premature rupture of the membranes (bag of waters) and premature birth. Most doctors now routinely test and treat pregnant women for this vaginal infection.

The most common symptom of BV is a thin, white/gray vaginal discharge with an unmistakable, offensive “fishy” odor. Because the odor is strongest when the discharge is exposed to an alkaline substance such as soap or semen, it may be most apparent in the shower or after intercourse. Itching and irritation are absent or mild.

BV is so common that many people wrongly believe vaginal odor to be normal in adult women. This misunderstanding has given rise to a host of “put-down” jokes and has inspired the manufacture of many useless “feminine hygiene products.”

One of the major players in BV is the bacteria Gardnerella vaginalis. This organism appears to be present in 30 to 40 percent of all women. But in order to cause infection, it must interact with at least three other bacteria, and the entire group must proliferate sufficiently to wipe out healthy organisms such as the Lactobacillus. Although we do not yet know the cause of this burst of growth, researchers suspect it has something to do with sexual intercourse.

When BV is suspected, your doctor will take your history, examine your pelvic organs, and study a few drops of the your vaginal discharge under the microscope. If the diagnosis is uncertain, or if you are pregnant, a vaginal culture may be necessary.

Treatment involves five to seven days of antibiotics taken orally or inserted in the vagina. Oral metronidazole (Flagyl) is the best known and most effective medication currently prescribed. It is also available in a vaginal gel (Metrogel). If you are allergic to metronidazole or have active liver disease, bleeding or seizure disorders, several other antibiotics work reasonably well.

Most authorities recommend treating a male sexual partner only if the female becomes re-infected after completing her medication and resuming intercourse. Many doctors, however, are now treating couples simultaneously at the outset in order to avoid the need for a second course of antibiotics. There is currently no test available to detect BV in men. Although they may carry the infection, they often show no symptoms. In any case, BV presents no danger to their health. For lesbian couples, a test of the partner is recommended. If she is positive, both women should be treated to avoid reinfection.

Curing Yeast Infections

Although yeast infections are probably the most common type of vulvovaginitis, they rank second in office visits because many women never go to their doctor for this type of infection. Some recover spontaneously, others treat themselves with anti-fungal vaginal creams or suppositories available without prescription.

Classic symptoms of yeast infections include vulvar itching, redness, and irritation. If your urinary opening is inflamed, you may have to urinate somewhat more frequently than usual, and urination may be uncomfortable. If your infection is severe, your vulva may swell and fine breaks, called fissures, may appear. Your vaginal discharge will become thicker, whiter, and curd-like (similar to cottage cheese in texture and appearance). Inflammation of the vulva and vagina, combined with the dryness of your discharge, makes intercourse painful.

Yeast infections are the result of excessive growth of a family of fungi that normally live and thrive in the vagina. The most common of these is Candida albicans. Certain factors such as recent use of oral or vaginal antibiotics, clothing (such as nylon and lycra) that traps heat and moisture, obesity, pregnancy, and diabetes tend to disrupt the normal balance of vaginal organisms, causing the fungi to reproduce rapidly and leading to the uncomfortable symptoms we associate with yeast infections. Other possible causes of these infections include suppression of the immune system during such chronic illnesses as AIDS, the use of oral contraceptives, and eating large amounts of sugars, starch, and yeasts.

Because yeasts also normally inhabit the intestine, it's important always to wipe front to back (vaginal area first; rectal area second) after a bowel movement. During sex you must take care to prevent your vagina from becoming contaminated with organisms from your bowel and rectum.

Your chances of catching a yeast infection from a male sexual partner are quite low. The fungus does not fare well on a man's sexual organs, where exposure to the air can dry it out. However, men can develop the disease through frequent sexual contact with an infected female partner. In this case, tiny tender, itchy red bumps appear on the penis. Among lesbian couples, sexual transmission is more common. In all cases, treatment is the same.

To diagnose these infections, the doctor will take a case history, perform a pelvic examination, and examine a few drops of vaginal discharge under the microscope. When the diagnosis is unclear, a vaginal culture may be taken. A good response to an antifungal medication confirms the physician's diagnosis.

If you do have a yeast infection, your doctor will ordinarily treat you with either prescription or nonprescription antifungal vaginal creams and suppositories. These preparations usually provide substantial relief in a few days. You must finish all your medication even if you're feeling better. Otherwise, you run the risk of relapse. If you still have symptoms after you complete your medication, see your doctor. Several other skin conditions can mimic or coexist with yeast infections.

If you have frequent yeast infections (three or more per year), the first line of attack is elimination of any predisposing factors. If the problem persists, the doctor may prescribe preventive doses of antifungal creams or suppositories. For example, inserting a suppository one or more times per menstrual cycle has proven effective for some women.

Recently there has been substantial interest in the anti-yeast activity of boric acid. You can buy boric acid powder in the “eyecare” section of most drugstores. Pack it loosely into size “0” capsules (available at some pharmacies and most health food stores). For a current yeast infection, insert 1 capsule as deeply into your vagina as possible in the morning and again at bedtime for five to seven days. To prevent recurrent infections, use 1 capsule vaginally at bedtime twice weekly beginning one week after menstruation and ending when the next period begins. The capsules cause a very slight watery discharge, but are far less messy than either creams or suppositories. They may also cause mild vaginal irritation. This can be eliminated by not using them for a day or two.

Dealing with Trichomoniasis

Trichomoniasis, or “trich,” is a sexually transmitted vaginitis suffered by at least 2.5 million American women yearly. In men, this infection rarely produces any symptoms; approximately 40 percent of infected women are also asymptomatic. Since they are unaware of their infection, these people unwittingly spread the infection throughout their communities.

Like most organisms responsible for causing sexually transmitted diseases (STDs), the trichomonad is fragile and cannot survive long outside the body of its host or hostess. However, infections have occasionally been traced to the use of shared washcloths or towels. Since the trichomonad dies promptly when exposed to drying, it cannot be caught from toilet seats, saunas, or dry linens.

Chemical purifiers in swimming pools and hot tubs will also kill it.

While infection with trichomoniasis can be intensely uncomfortable, it is not a serious threat to your overall health. Antibiotic treatment cures the infection more than 90 percent of the time.

The most striking symptoms are vulvar and vaginal burning and itching. The burning may be most apparent after intercourse and can affect the skin of the penis as well as that of the vagina. In addition, there may be vulvar swelling and frequent and uncomfortable urination. There is a heavy vaginal discharge, usually yellowish or green, which may or may not have an offensive odor.

The trichomonad is a tiny teardrop-shape, one-cell parasite. It has three tails at its narrow end. By whipping these tails back and forth the organism can swim about in a brisk, if rather jerky, fashion. As it swims, the host's white blood cells follow in hot pursuit. These blood cells, critical to the human immune defense system, can literally surround a trichomonad and digest it. Presumably, symptoms occur only when the body's defense forces cannot keep up with the numbers of rapidly reproducing trichomonads.

Trichomoniasis is usually easily diagnosed by a case history, pelvic examination, and microscopic examination of a sample of vaginal discharge. Your doctor may take a vaginal PAP smear or trichomonas culture if the diagnosis is unclear.

Metronidazole (Flagyl) is the most effective treatment for trichomoniasis. A single 2000 milligram dose (four 500 milligram tablets taken by mouth all at once) usually works well. If not, the treatment is generally extended over 7 days (either 250 milligrams 3 times daily or 500 milligrams twice daily). To prevent re-infection, your sexual partner must be treated as well.

The use of metronidazole in pregnancy is controversial. Many doctors avoid prescribing this medication at least until the second or third trimesters. If you are pregnant and have trichomoniasis, anti-yeast vaginal creams, which also affect trichomonads, will provide significant relief. If you are unsure whether you are pregnant, you should either have a pregnancy test taken at least 2 weeks after your last intercourse or simply delay starting treatment with metronidazole until your menstrual period begins.

This drug interacts with alcohol, causing abdominal cramps, nausea, and vomiting. Therefore, it is important not to drink alcoholic beverages while taking this medication. If you have active liver disease, certain blood disorders, current or past seizures, or a history of metronidazole allergy, you should avoid using this medication.

As with all STDs, the only certain way to avoid infection is to refrain from all sexual activity. Condoms with a spermicide offer excellent protection for those who remain sexually active. Remember that most men and nearly half of all women with trichomoniasis have no symptoms! Even if your partner is the picture of health, use a condom!

Remember, too, that if you find you have one STD, there's a chance you may have others as well. For more information on this and other STDs, turn to the chapter on them later in this section.

Whatever you do, if vulvar irritation or itching fails to go away be sure to check with your doctor. Especially in menopausal women, these symptoms could mean the presence of a precancerous condition or a cancer.

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