Acute vaginitis

Acute inflammation of the mucous membrane of the vagina (Latin - vagina, Greek - s.colpos) is diagnosed as acute vaginitis.

Epidemiology

8% of European and 18% of African American women report symptoms of vaginal discharge, odor, itching, and discomfort each year.

The prevalence of acute vaginitis is unknown. However, clinical experience suggests that 75% of women have candidal vaginitis at least once in their lifetime, up to 40-45% of women repeatedly experience this infection, and approximately 5-8% of the female population of reproductive age have four or more episodes of symptomatic Candida infection per year.

The World Health Organization estimates the cumulative prevalence of trichomonadal vaginitis at 15% (with middle-aged individuals most affected); the highest incidence of trichomoniasis (23-29% of women of childbearing age) is in Africa. [1], [2], [3]

Causes of the acute vaginitis

The most common cause of acute vaginitis (colpitis) is a condition such as bacterial vaginosis, a bacterial imbalance of the vaginal microflora with a decrease in the concentration of primary colonizing Gram-positive lactobacilli (Lactobacillus spp.) and an increase in gram-negative opportunistic bacterial anaerobes, most of which are part of the normal commensal vaginal microbiota. [4], [5]

Some experts believe that bacterial vaginosis is a type of vaginitis, although in more than half of cases the bacterial imbalance is asymptomatic. By the way, in medical terminology, the suffix -itis (-ites, -itis) means inflammation, while the suffix -osis (-osis, -esis, -sis, -asis) is present in the designation of clinical conditions or diseases.

Most often, acute bacterial vaginitis is etiologically related to the multiplication and activation of anaerobic and facultative bacteria present in the vagina, and 90% of vaginal infections are mixed.

The second most common is invasion of the vaginal mucosal epithelium by the yeast-like fungus Candida albicans. Acute candidal vaginitis caused by them is also called vaginal candidiasis or thrush. Candida so often affects not only the vagina but also the vulva that it is commonly referred to as vulvovaginal candidiasis. [6], [7]

Acute trichomonadal vaginitis or trichomoniasis is caused by a sexually transmitted protozoan infection, the single-celled protozoan parasite trichomonad (Trichomonas vaginalis).

Acute nonspecific vaginitis is also bacterial in origin, but what sets it apart is that inflammation develops due to bacteria that are nonspecific to the vagina, including Escherichia coli (E. Coli), Staphyloccocus, Streptococus agalactiae, and others.

The causative agent of acute viral vaginitis is usually Herpes simplex - herpes simplex virus (HPV); a more common definition of this condition is genital herpes.

Traumatic damage to the vaginal mucosa due to overstretching with infection can cause acute vaginitis after childbirth - as a postpartum complication.

The psychosomatics of predisposition to vaginal infections is thought to be related to chronic stress that can impair immunity through the neuroendocrine system (hypothalamic-pituitary-adrenal axis), which not only controls the stress response but also regulates interactions between glands, hormones, and midbrain regions that mediate energy metabolism, digestion, general metabolism, and body adaptation.

Risk factors

Risk factors for the development of acute inflammation of the vaginal mucosa include:

• Weakening of immunity (including after immunosuppressive therapy with corticosteroids);
• endocrine disruption;
• pregnancy;
• unprotected sex;
• sprays and the use of spermicides, which are vaginal chemical contraceptives;
• prolonged use of antibiotics;
• diabetes.

And the most likely factor in the decrease in the proportion of lactobacilli in the vaginal microbiota is the dramatic reduction in estrogen production, which leads to a decrease in the glycogen content of the vaginal epithelium necessary for the existence of these bacteria. [8]

Pathogenesis

The pathogenesis of acute vaginitis (colpitis) is due to the overgrowth of opportunistic flora and opportunistic pathogens (Prevotella sp., Mobiluncus sp., Atopobium vaginae, Bacteroides fragilis sp, Gardnerella vaginalis, Peptostreptococcus anaerobius, Bacteroides sp., Fusobacterium sp., Veillonella sp.) against the background of a decrease in the number of lactic acid bacteria, which normally make up 90-95% of the vaginal microbiota.

Lactobacillus provides control of microflora composition and suppression of overgrowth of potentially pathogenic microbes - reducing their adhesion to epithelial cells. The vaginal epithelium is protected by 2-hydroxypropanoic (lactic) acid produced by lactobacilli - maintaining normal pH at 3.84.4, as well as inhibitors of pathogenic microorganisms, in particular, hydrogen peroxide produced and peptides with antimicrobial activity synthesized by their ribosomes - bacteriocins (lactocin 160, cripazine, etc.).

The mechanism of pathogenic action of Mobiluncus bacteria is associated with its enzyme neuraminidase (sialidase), which cleaves mucin, which facilitates bacterial adhesion to vaginal mucosal cells and destruction of their structure. Specific enzymes of Atopobium sp. Bacteria allow them to block the function of the complement system, in particular, stimulating the release of anti-inflammatory cytokines, as well as ensuring the determination of the antigen-antibody complex on the surface of the microbial cell.

Prevotella and Mobiluncus bacteria produce butanedioic (succinic) acid, which prevents neutrophils from traveling to their site of infiltration, provoking the accumulation of pro-inflammatory cytokines.

The most important factor in the pathogenicity of Gardnerella vaginalis is the formation of a biofilm (structured community of microbes) on the vaginal mucosa, which ensures bacterial survival and a high level of adhesion to epithelial cells. Another factor is the damaging effect of the cytolysins sialidase and VLY (vaginolysin) on the vaginal epithelium by destroying its protective mucous layer and lysis of epithelial cells.

During the course of Candida albicans infection, filamentous branches (hyphae) are formed, increasing adhesion to the vaginal mucosa. Damage to epithelial cells occurs due to the breakdown of their glycogen (leading to a fermentation reaction) and activation of T cells and neutrophils caused by Candida antigens - their cell wall glycoproteins (beta-glucans, chitin, mannoproteins).

Symptoms of the acute vaginitis

The first signs of acute vaginitis are manifested by irritation, redness and swelling of the large and small labia, as well as an increase in vaginal discharge. And the most common symptoms of the disease include:

• changes in the color and consistency of vaginal discharge, which may be white, gray, watery or frothy. In candidiasis, the discharge is curdy, while in trichomonadal vaginitis it is copious, frothy and smelly, greenish-yellow in color;
• unpleasant vaginal odor;
• itching or burning in the external genital area.

Pain in acute vaginitis can be in the form of dyspareunia (painful intercourse) - when affected by trichomonads, as well as dysuria (painful urination) - in vaginal candidiasis, acute trichomoniasis and viral vaginitis - genital herpes. In the latter case, pain is caused by ulcerations that form after vesicles rupture.

This is also how acute vaginitis in pregnancy manifests itself, for details see. - Colpitis in pregnancy [9]

Vaginal thrush is especially common in early pregnancy.

How acute vaginitis in a girl occurs and what symptoms are manifested by acute vaginitis in a girl, read - Vulvaginitis in girls.

Complications and consequences

Acute vaginitis can be complicated by transformation into a chronic form, as well as characteristic for inflammatory gynecologic diseases ascending spread of infection.

The consequences can be inflammation of the pelvic organs: the urethra (urethritis), bladder (cystitis), the mucous membrane of the cervical canal (endocervicitis), the appendages of the uterus - ovaries and fallopian tubes (salpingo-oophoritis), the mucous membrane of the uterus (endometritis), the surrounding uterine tissue (parametritis).

In addition, acute bacterial vaginitis in pregnant women is associated with an increased risk of late miscarriage, amniotic fluid infection, preterm labor, birth tract trauma, and perinatal infections. [10]

Diagnostics of the acute vaginitis

Diagnosis of acute vaginitis begins with a gynecologic examination of patients and collection of anamnesis with the nature of symptoms. [11]

Tests include: determination of vaginal pH, vaginal smear and smear culture for flora - vaginal microflora analysis, and microbiological and bacterioscopic examination of vaginal dischargea. If possible, a femoflor screen analysis (PCR examination of a scraping of epithelial cells from the vagina) is performed. A general blood count, blood ELISA, and urinalysis are also required. [12]

Detection of trichomoniasis requires screening for other STIs. [13]

Instrumental diagnosis consists of a colposcopy.

And differential diagnosis is made with bacterial vaginosis, atrophic vaginitis, allergy, chemical irritation, cervicitis.

Treatment of the acute vaginitis

Most often, patients (except those diagnosed with candidal vaginitis) are prescribed oral antibiotics of the group of imidazole derivatives with antiprotozoal action - Metronidazole (Metrogil, Flagyl, etc.) or Tinidazole. Also used is an antibacterial drug of the lincosamide group - Clindamycin tablets (300 mg orally twice a day for seven days). [14], [15]

In the treatment of vaginal candidiasis - acute candidal vaginitis - antifungal drugs are used, primarily antimycotics of the azole group Fluconazole (Flucostat, Diflucan, Fucis and other trade names). They are also used tablets for thrush, most often it is Pimafucin (Natamycin). [16]

HPV-induced viral vaginitis is treated with Acyclovir (200 mg 5 times a day for five days).

A good therapeutic effect is given by suppositories for acute vaginitis. [17] More details in the publications:

• Colpitis treatment with suppositories
• Vaginal suppositories for infections
• Vaginitis suppositories
• Trichomoniasis suppositories
• Candida suppositories
• Herpes suppositories
• Candles for inflammation in gynecology
• Vaginal discharge suppositories

In addition, during the period of the disease, it is especially important to adhere to the rules of personal hygiene. And to the question of patients, whether it is possible to have sex with acute vaginitis, gynecologists give a negative answer.

Prevention

Preventive measures involve intimate hygiene and protected sexual intercourse. Despite the lack of evidence, it is often recommended to wear cotton underwear and loose-fitting clothing, and to avoid syringing and the use of scented hygiene products as a preventive measure against acute candidal vaginitis.