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Vaginitis is an inflammation of the vagina characterized by discharge, odor, irritation, and/or itching. The cause of vaginitis may not always be determined adequately solely on the basis of symptoms or a physical examination. For a correct diagnosis, a doctor should perform laboratory tests including microscopic evaluation of vaginal fluid. A variety of effective drugs are available for treating vaginitis.

Vaginitis often is caused by infections, which cause distress and discomfort. Some infections are associated with more serious diseases. The most common vaginal infections are bacterial vaginosis, trichomoniasis, and vaginal yeast infection or candidiasis. Some vaginal infections are transmitted through sexual contact, but others such as yeast infections probably are not, depending on the cause.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. Previously called nonspecific vaginitis or Gardnerella-associated vaginitis, BV is associated with sexual activity. BV reflects a change in the vaginal ecosystem. This imbalance, including pH changes, occurs when different types of bacteria outnumber the normal ones. Instead of Lactobacillus bacteria being the most numerous, increased numbers of organisms such as Gardnerella vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis are found in the vaginas of women with BV. Investigators are studying the role that each of these microbes may play in causing BV, but they do not yet understand the role of sexual activity in developing BV. A change in sexual partners and douching may increase the risk of acquiring bacterial vaginosis.

Symptoms. The primary symptom of BV is an abnormal, odorous vaginal discharge. The fish-like odor is noticeable especially after intercourse. Nearly half of the women with clinical signs of BV, however, report no symptoms. A physician may observe these signs during a physical examination and may confirm the diagnosis by doing tests of vaginal fluid.

Diagnosis. A healthcare worker can examine a sample of vaginal fluid under a microscope, either stained or in special lighting, to detect the presence of the organisms associated with BV. They can make a diagnosis based on the absence of lactobacilli, the presence of numerous "clue cells" (cells from the vaginal lining that are coated with BV organisms), a fishy odor, and decreased acidity or change in pH of vaginal fluid.

Treatment. All women with BV should be informed of their diagnoses, including the possibility of sexual transmission, and offered treatment. They can be treated with antibiotics such as metronidazole or clindamycin. Generally, male sex partners are not treated. Many women with symptoms of BV do not seek medical treatment, and many asymptomatic women decline treatment.

Complications. Researchers have shown an association between BV and pelvic inflammatory disease (PID), which can cause infertility and tubal (ectopic) pregnancy. BV also can cause adverse outcomes of pregnancy such as premature delivery and low-birth-weight infants. Therefore, the U.S. Centers for Disease Control and Prevention (CDC) recommends that doctors check all pregnant women for BV who previously have delivered a premature baby, whether or not the women have symptoms. If these women have BV, they should be treated with oral metronidazole or oral clindamycin. A pregnant woman who has not delivered a premature baby should be treated if she has symptoms and laboratory evidence of BV. BV is also associated with increased risk of gonorrhea and HIV infection (HIV, human immunodeficiency virus, causes AIDS).

Trichomoniasis

Trichomoniasis, sometimes referred to as "trich," is a common STD that affects 2 to 3 million Americans yearly. It is caused by a single-celled protozoan parasite called Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urogenital tract; the urethra is the most common site of infection in man, and the vagina is the most common site of infection in women.

Symptoms. Trichomoniasis, like many other STDs, often occurs without any symptoms. Men almost never have symptoms. When women have symptoms, they usually appear within four to 20 days of exposure. The symptoms in women include a heavy, yellow-green or gray vaginal discharge, discomfort during intercourse, vaginal odor, and painful urination. Irritation and itching of the female genital area, and on rare occasions, lower abdominal pain also can be present. The symptoms in men, if present, include a thin, whitish discharge from the penis and painful or difficult urination.

Treatment. Because men can transmit the disease to their sex partners even when symptoms are not present, it is preferable to treat both partners to eliminate the parasite. Metronidazole is the drug used to treat people with trichomoniasis. It usually is administered in a single dose. People taking this drug should not drink alcohol because mixing the two substances occasionally can cause severe nausea and vomiting.

Complications. Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that trichomoniasis is associated with increased risk of transmission of HIV and may cause a woman to deliver a low-birth-weight or premature infant. Additional research is needed to fully explore these relationships.

Prevention. Use of male condoms may help prevent the spread of trichomoniasis, although careful studies have never been done that focus on how to prevent this infection.