By Dr. Allen Douma
Q: I have been struggling with vaginitis for years. My doctor says it is caused by bacteria and needs to be treated with antibiotics. But it comes back within a few months, and sometimes the antibiotic treatment doesn’t work.
What can I do?
— Buffalo, N.Y.
A: Inflammation of the lining of the vagina is called vaginitis. It’s one of the more common problems faced by women of all ages.
The primary symptom of vaginitis is abnormal vaginal discharge. Vaginal discharge is considered abnormal if it occurs in large amounts, has an offensive odor, or is accompanied by vaginal itch or pain. The characteristics of the discharge depend on the cause of the vaginitis.
Inflammation of the vaginal lining can be caused by many agents and conditions. They include infections, physical irritation, allergic reactions, tumors, drugs, radiation, hormonal changes and the friction of sexual intercourse.
Vaginal infections can be due to bacteria, fungi, protozoa and viruses. Poor personal hygiene can contribute to the growth of bacteria and fungi, but in most cases it’s not known why some women have a greater problem than others.
The most common vaginal infection is due to the fungus called candida. It typically causes a white, curd-like discharge with little to no odor. Diagnosis is often made by the woman herself and treated at home. But resistant cases need to be examined and the discharge looked at under a microscope.
Vaginitis caused by bacteria is also called vaginosis. It typically produces a grayish, frothy or cloudy discharge with a fishy odor. The odor may become stronger after intercourse or washing with soap, both of which reduce vaginal acidity and encourage bacterial growth.
It’s important to confirm the suspicion of bacterial infection by looking at the discharge under a microscope and testing the acidity of the fluid to see if it is more acid than normal.
Although the most common culprit is a bacterium called Gardnerella, many different bacteria can cause vaginosis. Often more than one can be responsible at the same time. In most cases the lactobacillus bacteria that normally inhabit the vagina, without causing problems, are absent. Culturing the discharge usually doesn’t help in determining the best treatment.
Sometimes making the vagina less acid may be enough to treat the problem. It will at least help in the treatment and help prevent the problem from returning. The easiest way to do this is to use a pre- measured vinegar and water douche. Excess douching, however, especially without using vinegar, can increase the problem.
The recommended antibiotic treatment for bacterial vaginitis has been metronidazole, taken orally, or either clindamycin vaginal cream or metronidazole gel applied topically. However, these treatments work only about two-thirds of the time, and the recurrence rate is greater that 50 percent. A recent study found that using chlorhexidine-based bioadhesive vaginal gel (Clomirex) or clotrimazole vaginal cream was even more effective.
The next time you see your doctor, make sure you talk about what you can do besides taking different antibiotics to help keep the problem from returning.
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