Chronic BV Holistic Treatment
Common cause of vaginitis in prepubertal girls. Presents with serous discharge, marked erythema and irritation of the vulvar area, and discomfort on walking and urination. 2. Candida. Can also cause vaginitis but typically causes intense pruritus. Labia may be pale or erythematous with satellite lesions. Vaginal discharge, if present, is usually thick and adherent, with white curds. 3. Other causes. In sexually active adolescents, the most common causes include bacterial vaginosis ( fishy, foul-smelling discharge), candidal vulvovaginitis (white, cottage-cheese'-appearing discharge), and trichomoniasis (malodorous yellow, frothy discharge).
Candida is the second most common diagnosis associated with vaginal symptoms. It is found in 25 of asymptomatic women. Fungal infections account for 33 of all vaginal infections. B. Patients with diabetes mellitus or immunosuppressive conditions such as infection with the human immunodeficiency virus (HIV) are at increased risk for candidal vaginitis. Candidal vaginitis occurs in 25-70 of women after antibiotic therapy.
The cause or causes of bacterial vaginosis are unknown. A marked decrease in vaginal lactobacilli is a constant feature, suggesting that conditions supressing lactobacilli, or promoting other flora, play a causative role. Gardnerella vaginalis, a small, aerotoler-ant bacterium with a Gram-positive type of cell wall, is commonly present in large numbers, as are strictly anaerobic bacteria of the Mobiluncus and Prevotella genera, Mycoplasma sp., and anaerobic streptococci. Pure cultures of these species do not consistently produce bacterial vaginosis when healthy people are voluntarily inoculated, although the discharge from people with the condition can produce the disease. Each of these species of bacteria can occur in vaginal secretions of women without the disease, although in much smaller numbers.
Vaginitis is an inflammation of the lining of the vagina. It is caused by a hormonal imbalance during postmenopause or postpartum by irritations from allergies or irritating substances and chemicals or by bacteria, candidiasis, or yeast infection, and trichomoniasis. The symptoms include itching, pain, and a white discharge. It is recommended sugar and possibly fruit juices be avoided in the diet as yeast thrives in that particular environment. Boric acid and gentian violet have shown to be as effective as prescribed antibiotics. Malaleuca alternifolia controls vaginal infections.
Inspect skin and perineum for evidence of rashes, redness, or irritation. Look for evidence of discharge. Perform pelvic exam in sexually active adolescent girls who present with dysuria and discharge to rule out vaginitis, cervicitis, and pelvic inflammatory disease.
When using graft material to reinforce a rectocele repair, the graft may be sutured to the lateral posterior vaginal sulcus on each side using absorbable or permanent suture. The graft should be trimmed before placement so that it lies as a flat layer between the vaginal mucosa and the newly repaired rectovaginal fascia (Figure 8-5.5). There is no evidence that soaking the graft material in antibiotic solution before placement decreases the incidence of vaginal infection or erosion.
There are no proven preventive measures. Studies on the use of yogurt by mouth or vaginally to restore vaginal lactobacilli have given conflicting results. Treatment of the male sex partners of patients with recurrent disease does not prevent recurrences. Most cases respond promptly to treatment with metronidazole, a medication active against anaerobes. The main features of bacterial vaginosis are summarized in table 25.3. Vulvovaginal candidiasis is the second most common cause ofvagi-nal symptoms after bacterial vaginosis. As with bacterial vaginosis, vulvovaginal candidiasis appears to follow a disruption of normal flora. As the name indicates, the infection often involves not only the vagina, but the woman's vulva, or external genitalia, as well.
The pH level can be determined by placing pH paper on the lateral vaginal wall or immersing the pH paper in the vaginal discharge. A pH level greater than 4.5 often indicates the presence of bacterial vaginosis. It may also indicate the presence of Trichomonas vaginalis.
While adverse reactions are common following the use of abortion-inducing doses of the prostaglandins, most are not serious. Gastrointestinal disturbances include nausea, vomiting, and diarrhea. Transient fever, retained placental fragments, excessive bleeding, decreased diastolic blood pressure, and headache also have been noted. These drugs should be used with caution in patients with asthma, cervicitis, vaginitis, hypertension or hypotension, anemia, jaundice, diabetes, or epilepsy. They should not be used in patients with acute pelvic inflammatory disease, drug hypersensitivity, or an active renal, hepatic, or cardiovascular disorder. Since prostaglandins are potentially carcinogenic, if pregnancy is not effectively terminated following their use, another method should be used. The prostaglandins are not generally used concomitantly with oxytocin because of the possibility of uterine rupture.
Diagnostic considerations Tarsal follicles are observed typically on the upper and lower eyelids, and pannus will be seen to spread across the limbus of the cornea. As this is an oculogenital infection, it is essential to determine whether the mother has any history of vaginitis, cervicitis, or urethritis if there is clinical suspicion of neonatal infection. Gynecologic or urologic examination is indicated in appropriate cases. Chlamydia may be detected in conjunctival smears, by immunofluorescence, or in tissue cultures. Typical cytologic signs include basophilic cytoplasmic inclusion bodies (Fig. 4.13).
One-third of patients with vaginal symptoms will not have laboratory evidence of bacterial vaginosis, Candida, or Trichomonas. C. Atrophic vaginitis should be considered in postmenopausal patients if the mucosa appears pale and thin and wet-mount findings are negative.
Place a second sample on a slide, apply one drop of 10 potassium hydroxide (KOH) and a coverslip. A pungent, fishy odor upon addition of KOH--a positive whiff test--strongly indicates bacterial vaginosis. A. The most common cause of vaginitis is bacterial vaginosis, followed by Candida albicans. The prevalence of trichomoniasis has declined in recent years. Clinical Manifestations of Vaginitis Candidal Vaginitis Bacterial Vaginosis Atrophic Vaginitis IV. Bacterial Vaginosis A. Bacterial vaginosis develops when a shift in the normal vaginal ecosystem causes replacement of the usually predominant lactobacilli with mixed bacterial flora. Bacterial vaginosis is the most common type of vaginitis. It is found in 10-25 of patients in gynecologic clinics.
Trichomoniasis is a genital infection produced by the protozoan Trichomonas vaginalis. Infections frequently are asymptomatic in the male, whereas in the female vaginitis characterized by a frothy pale yellow discharge is common. Relapses occur if the infected person's sexual partner is not treated simultaneously.
Trichomonas vaginalis is a common sexually transmitted pathogen causing vaginitis, exocervicitis, and ureteritis in women (Fauts and Kraus 1980). Trichomonas vaginalis infections has been suggested to play a role in the pathogenesis of pre-term birth, pre-term rupture of membranes and delivery of low-birth-weight infants (Cotch et al. 1991 Read and Klebanoff 1993). Recently T. vaginalis infections has been implicated as a cofactor in the transmission of HIV (Laga et al. 1993). Trichomonas vaginalis infection are frequently asymptomatic, and early, accurate diagnosis are required for specific treatment. Routine diagnosis of T. vaginalis usually depends on direct microscopic identification of the parasite in wet mount preparations. However, wet mount examinations detects only 60 and the direct immunofluorescense using monoclonal antibodies detect 86 of culture positive cases in women. Although culture is considered the most reliable diagnostic method, with a sensitivity of 90 for...
The reconstituted human vaginal epithelium (RHVE) resembles the multilayer human vaginal mucosa and is commercialized by Skinethic Laboratory (Nice, France). It is based on a cell line which was obtained by culturing transformed human keratinocytes of the cell line A431 derived from a vulval epidermoid carcinoma (Rosdy et al., 1986). The RHVE model was valid for evaluating the phenotype of mutants in the agglutinin-like sequence (ALS) family in C. albicans. The expression of ALSs proteins in the in vitro RHVE was compared with in vivo expression in a murine vaginitis model (Cheng et al., 2005). The RHVE model has been also used to study the epithelial cytokine response induced by C. albicans and the role of the Secreted Aspartyl Proteinases (Saps), important virulence factors of this fungus. Saps cause tissue damage and the different damaging potential of each Sap correlates with an epithelium-induced pro-inflammatory cytokine response, which could be crucial in the control of the...
The normal flora of the genital tract of women is influenced by the action of estrogen hormones on the epithelial cells of the vaginal mucosa. When estrogens are present, glycogen is deposited in these cells. The glycogen is converted to lactic acid by lactobacilli, resulting in an acidic pH that inhibits the growth of many potential pathogens. Lactobacilli may also release hydrogen peroxide, a powerful inhibitor of some anaerobic bacteria, as a by-product of metabolism. Thus, the normal flora and resistance to infection of the female genital tract vary considerably with the person's hormonal status. For example, prepubertal girls, having low estrogen levels, are much more susceptible to vaginal infections with Streptococcus pyogenes and Neisseria gonorrhoeae than women during the child-bearing years. lactobacilli, p. 275
Vulvovaginal thrush is a relatively common problem, representing roughly a quarter of all infectious vaginitis, with a large proportion of women experiencing at least one episode of vaginal thrush during their lifetime (Sobel et al., 1998). Some women experience multiple episodes, commonly called recurrent vulvovaginal candidiasis (RVVC). Symptoms of vulvovaginal candidiasis include itching, burning, soreness, and abnormal vaginal discharge. In women presenting with vulvovaginal candidiasis 60-100 of isolates are identified as C. albicans (Giraldo et al., 2000 Lopes Consolaro et al., 2004 De Vos et al., 2005 Beltrame et al., 2006 Moreira & Paula, 2006 Paulitsch et al., 2006 Pirotta & Garland, 2006).
Trichomoniasis is the most common non-viral sexually transmitted disease world-wide. It has been estimated that more than 180 million people are infected with Trichomonas vaginalis (Brown 1972). However, according to the National Disease and Therapeutic Index survey, numbers of physician visits for trichomonal vaginitis in the US declined from a high of 1.3 million in 1974 to less than 600000 in 1987 (Kent 1991). According to a study from Denmark, trichomoniasis has become a rare infection in that country. That is, in 1967, 19 and in 1997, 2 of specimens analysed in the Statens Serum Institut, Copenhagen, were positive for T. vaginalis (Dragsted et al. 2001). Also in Sweden and Norway, trichomoniasis is an unusual diagnosis (A. Hallen and B. Stray-Pedersen, personal communications). By contrast, in Estonia (the only Baltic country with available data) trichomoniasis was reported among approximately 6000 individuals out of 1 500 000 inhabitants (1 250) in 1994 (Lazdane and Bukovskis...
Vaginitis, the DNA test had a sensitivity of 90 and a specificity of 99.8 . In fact, polymerase chain reaction (PCR) analysis is sensitive enough to be used on introital specimens. Witkin et al. (1996) compared introital specimens with specimens from the endocervix and from the posterior vaginal vault in 219 pregnant women. Introital testing had a sensitivity of 95.5 and a specificity of 100 . Screening for T. vaginalis based on PCR of urine specimens only, might have a sensitivity problem. That is, among 51 women positive by vaginal wet prep or culture, 65 of urine specimens were PCR-positive (Lawing et al. 2000). By contrast, van Der Schee et al. (1999), identified trichomoniasis by PCR on vaginal swab of 10 and on urine specimen of 11 of 200 Dutch women.
Stress incontinence.5 Complications from pessary use are uncommon and include vaginal abrasions, ulcerations, urinary tract infections, and vaginal infection. These problems are rare if the pessary is cared for properly, removed and cleaned at least every 3 months, and if the patients concomitantly use estrogen locally in the vagina. We have not found any particular type of pessary to be superior in treating stress urinary incontinence. If the Smith-Hodge remains in place, it has theoretical advantages in providing bladder neck support.
Withdrawal of estradiol during menopause results in thinning of the mucosal layer. The vaginal and urethral mucosa appear pale, dry, and flattened. These changes are associated with vaginal dryness, dyspareunia, atrophic vaginitis, urethritis, and urinary incontinence. Use of systemic estrogen replacement or local estrogen creams and urethral suppositories can reverse these changes.
Ligneous conjunctivitis (chronic pseudomembranous conjunctivitis) is a rare bilateral disease, mainly occurring in young girls. It presents as a subacute inflammation of the tarsal conjunctiva, often accompanied by nasopharyngitis and vaginitis. The disease seems to be due to a defective fibrinolysin system. Microscopically, granulation tissue is present, covered with plaques of fibrinous material, later forming a hyalinised mass. After removal of the plaque, recurrence is common. It can be complicated by corneal involvement and perforation with loss of the eye may occur 15, 17, 99 .
Therapy is directed at specific cause. 1. Bacterial vaginitis (group A streptococci). Treatment consists of topical antibiotic ointment (mupirocin). 2. Candidal vaginitis. Topical antifungal (miconazole, butocona-zole, or clotrimazole) for 3-7 days. Alternative treatment for older adolescent 150-mg single oral dose of fluconazole. 3. Bacterial vaginosis or trichomonal vaginitis. Metronidazole, 2 g as a single dose, is effective. 4. Atrophic vaginitis or labial adhesions. Topical Premarin cream is effective. It should be applied daily for 1 week, then 2-3 times per week thereafter.
A marked derangement of the normal vaginal flora characterizes bacterial vaginosis, the most prevalent vaginal disease of women in the child-bearing years. Vulvovaginal candidiasis often occurs as a result of antibacterial therapy suppressing normal vaginal flora, but many other cases arise for unknown reasons. Toxic shock syndrome is caused by certain strains of Staphylococcus aureus whose exotoxins are absorbed into the bloodstream, causing the massive release of cytokines responsible for shock.
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Bacterial Vaginosis Facts
This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.