Let’s demystify three types of vaginitis

The vagina hosts an abundance of bacterial flora, more than 90% of which are lactobacilli. These bacteria are beneficial, as the lactic acid they produce maintains the vagina’s acidic pH and prevents infection by other undesirable bacteria. Problems arise when this balance is upset, and the lactobacilli no longer protect against the pathogenic microbes that can cause infection. Vaginitis is infectious in 70-90% of cases, but can be non-infectious 10-30% of the time [2].

• Bacterial vaginosis: 40 to 50% of cases
• Yeast vaginitis (candidiasis): 20 to 25% of cases
• Parasitic vaginitis (trichomoniasis): 15 to 20% of cases

• Irritant vaginitis: Can be caused by antibiotics, a foreign body (tampon or condom), soaps or other vaginal hygiene products, poor personal hygiene, dermatosis, systemic inflammatory diseases such as rheumatoid arthritis or lupus, etc.
• Atrophic vaginitis: Occurs in post-menopausal women or those with low estrogen levels. Low estrogen levels lead to dryness and thinning of the vaginal wall, which becomes more easily irritated.

Vaginosis, which is sometimes asymptomatic, is a change in the composition of the vaginal flora, with a decrease in lactobacilli and an increase in other types of bacteria. Although bacterial vaginosis is not considered an STBBI, it shares the same risk factors (see “Parasitic vaginosis” below). However, this infection also occurs in women who have never had sexual intercourse with vaginal penetration.

Characterized by the proliferation of the fungus Candida albicans, candidiasis often occurs for no apparent reason. However, it occurs more frequently in the following women:

• Pregnant (higher estrogen levels)
• Diabetic
• Immunosuppressed
• Treated with antibiotics

Antibiotics tend to upset the balance of vaginal flora and vaginal pH, encouraging yeast to multiply. As a result, a third to a quarter of women develop candidiasis during or after taking antibiotics.

Caused by the parasite trichomonas vaginalis, trichomoniasis is considered a non-viral STBBI. Therefore, its risk factors are the same as for other common STBBIs:

• Multiple sex partners
• History of STBBIs
• One or more previous episodes of trichomoniasis
• Unprotected sex

Vaginitis can also be caused by a sexually transmitted and blood-borne infection (STBBI), such as gonorrhea or chlamydia.

Treatment of vaginitis depends on the cause of the infection [3].

Oral or topical antibiotic treatment is preferred in non-pregnant women. In pregnant women, oral treatment is recommended to avoid complications. Screening for vaginosis during pregnancy can be carried out for certain at-risk women, but is not immediately recommended. However, bacterial vaginosis with symptoms during pregnancy should be treated to avoid pregnancy complications.

Depending on the situation, the medications recommended are metronidazole 500 mg orally for five to seven days, metronidazole gel or clindamycin intravaginal cream. A single oral dose of metronidazole is also possible, but the cure rate is 85%, with a higher recurrence rate of 30-50% at one month.

Simple yeast vaginitis is treated with antifungal agents such as oral fluconazole and topical clotrimazole. In pregnant women, topical treatment with clotrimazole is recommended, but a doctor should confirm the diagnosis before treatment.

If you suffer from yeast vaginitis, you can obtain clotrimazole over the counter in pharmacies or consult a pharmacist, who can prescribe fluconazole. Symptoms generally improve within two to three days after starting treatment.

Trichomoniasis requires an effective oral antibiotic to eliminate the parasite. Treatment may take the form of a single massive dose of 2 g of metronidazole, or lower doses of metronidazole for seven days. As with any antibiotic, metronidazole must be taken until the end of the prescribed period.

To avoid recurrence, it is important that all sexual partners of the infected person be treated at the same time. These people should also discontinue sexual relations until symptoms have completely disappeared and the treatment is finished.

Bacterial vaginosis increases the risk of contracting or spreading a concomitant STBBI. Adverse effects occur mainly during pregnancy, with an increased risk of amniotic fluid infection, premature labour and delivery, and post-delivery or post-abortion infections.

Complications of yeast vaginitis are rare. Recurrence of the infection and its unpleasant symptoms is the most common. Pregnant patients can also infect the fetus, which can lead to systemic infections in the newborn, particularly if it is premature or has low birth weight [4].

In addition to being contagious, trichomoniasis increases the risk of contracting other STBBIs, including HIV. It can also lead to the development of pelvic inflammatory disease (infection of the uterus and fallopian tubes) or infertility. Pregnant women are more likely to give birth prematurely and have a low-birth-weight baby [5].

• Avoid douches and other vaginal hygiene products, such as sprays, scented soaps and deodorant pads and tampons.
• When using the toilet, always wipe from front to back (vagina to anus).
• Wear cotton or cotton-covered underwear.
• Change tampons or sanitary pads frequently.
• Protect yourself during sexual relations (condom or dental dam) and limit the number of partners.

• Limit the use of vaginal hygiene products such as scented soaps, gels, creams, etc.
• Identify, with the help of your pharmacist, any treatments that may increase the risk of candidiasis (antibiotics, cortisone, certain oral contraceptives, chemotherapy).
• Avoid wearing wet bathing suits or tight-fitting, synthetic clothing for too long. Choose loose-fitting cotton clothing.
• Use a personal lubricant, avoiding overly scented and irritant products.
• Control diabetes and avoid a high-sugar diet.
• Avoid stress and other conditions that weaken the immune system.

As trichomoniasis is an STBBI, precautions are the same as for other STBBIs. These include avoiding or limiting sexual relations and protecting yourself. Here are a few ways of protecting yourself and your partner against trichomonas vaginalis infection:

• Use a condom during vaginal or anal intercourse.
• Use a polyurethane condom or dental dam.
• Avoid sharing sex toys or cover them with a new condom before use.