Vaginitis (colpitis)

Vaginitis is an infectious or noninfectious inflammatory process of the vaginal mucosa, and sometimes vulva. The main clinical manifestations of the disease include the following symptoms: vaginal discharge, irritation, itching and flushing of the mucous membrane. Diagnosis is based on the study of vaginal secretions. The treatment is aimed at the cause of the disease and on the elimination of clinical symptoms.

Vaginitis is one of the most common and frequent gynecological diseases. Most often affects vulva (vulvitis) or vulva and vagina (vulvovaginitis).

Epidemiology

It is estimated that about 7.4 million new cases of vaginitis are registered each year in the world. The prevalence of the disease is 29%.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of the vaginitis

The most common causes of the disease vary with the age of the patients.

In children, vaginitis is usually caused by infection and microflora of the gastrointestinal tract (nonspecific vulvovaginitis). The common provoking factors in girls aged 2-6 years are weak hygiene of the external genital organs (for example, rubbing the external genitalia behind in front of the defecation act, when children do not wash their hands after the toilet, combing the genitals if there is itching). Chemicals in foam baths or soaps can cause inflammation. Foreign bodies (for example, napkins) can also cause nonspecific vaginitis with the presence of bloody discharge from the vagina. Sometimes the development of vulvovaginitis in girls occurs as a result of infection with certain infectious agents (for example, streptococci, staphylococci, candida), sometimes pinworms.

Women of reproductive age develop vaginitis most often of an infectious nature. The most common type of lesions is trichomonas and vaginitis, which is transmitted sexually; bacterial vaginosis and candidal vaginitis. In normal women of reproductive age, saprophyte lactobacilli are the predominant element of normal vaginal microflora. Microbial contamination with these bacteria maintains the pH of the vaginal contents in the normal range (3.8-4.2), thus preventing the growth of pathogenic bacteria and fungi. In addition, high estrogen levels retain the thickness of the vaginal epithelium, thus supporting local defense.

[11], [12], [13], [14], [15], [16], [17], [18]

Risk factors

There are factors that lead to the multiplication of bacterial and fungal infectious microorganisms in the vagina, shifting the pH of the vaginal contents to the alkaline side. These changes are amplified during menstruation, with sexual contact with infected sperm. The decrease in the number of lactobacilli in the vagina is associated with the wearing of tight underwear with poor aeration, poor hygiene and frequent douching of the vagina. Vaginitis can be the result of the introduction of foreign bodies in the vagina (for example, forgotten tampons). Less common is non-infectious vaginitis.

After menopause, there is a decrease in estrogen in the body, which leads to a thinning of the vaginal mucosa and increases the risk of infection and inflammation. Some methods of treatment (for example, removal of the ovaries, irradiation of the pelvic organs, certain types of chemotherapy) also lead to a decrease in the level of estrogens. Poor hygiene of the genitals (for example, in patients with incontinence or bedridden) can lead to chronic inflammation of the vulva and vagina due to chemical irritation with urine and feces or as a result of nonspecific infection.

Bacterial vaginosis, candidal vaginitis and trichomonas vaginitis are less common in postmenopausal women, but inflammation may develop in patients with risk factors. At any age, there are certain factors that predispose to the development of a vaginal or vulvar infection. These are fistulas between the intestine and the genital tract, which allow the intestinal microflora to settle in the genital tract; irradiation of the pelvic organs; the presence of tumors that affect the tissues and thus lead to a decrease in the body's defenses. Noninfectious vulvitis can occur at any age as a result of hypersensitivity or an allergic reaction to the spraying of hygiene sprays or perfumes, the use of menstrual pads, laundry soap, bleach, fabric softener, dye, synthetic fibers, bath foam, toilet paper, sometimes spermicidal vaginal lubricants creams, latex condoms, vaginal contraceptive rings or diaphragms.

[19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]

Symptoms of the vaginitis

With vaginitis, vaginal discharge increases, which must be distinguished from normal discharge. Normal discharge most often occur at high estrogen levels in the body. For example, in newborn girls during the first 2 weeks of life, there is often a small bleeding from the vagina, which is due to the fact that the levels of estrogens transmitted to her from the mother at birth, dramatically decrease. The level of estrogen increases for several months before the menarche. During this period, normal discharge from the vagina appears. Normal vaginal discharge is usually milky white and mucous, odorless, does not cause irritation of the vaginal epithelium. Normally, excretions help moisturize the vagina and can leak into the underwear. Pathological discharge as a result of vaginitis is accompanied by itching, hyperemia of the mucous membrane, sometimes with burning, pain or mild bleeding. Itching is worse during sleep. There are also dysuric disorders or dyspareunia.

With atrophic vaginitis, discharge from the vagina is meager, most often there is dyspareunia, the mucous membrane of the vagina becomes thinner and the dryness increases. Although the symptoms vary with different types of vaginitis, there is much in common between them.

Vulvit can cause flushing, itching and sometimes soreness, discharge from the vulva.

The discharge from the cervical canal can be the result of cervicitis (for example, because of the inflammation of the pelvic organs); may resemble vaginitis; pain in the abdomen, soreness in the movement of the cervix or cervicitis in the inflammatory process in the organs of the small pelvis. Watery discharge with an admixture of blood can be the result of vulvar or vaginal cancer; Cancer can be differentiated from vaginitis by performing a Pap test. If girls have vaginal discharge, you can suspect a foreign body. Itching of the vagina and discharge can result from skin lesions (eg, psoriasis, dermatomycosis), which can differentiate from an anamnesis of the disease and the results of a skin examination.

Forms

Violations	Symptoms	Criteria for diagnosis	Results of microscopic studies	Differential diagnosis
Inflammatory	Symptoms related to the postmenopausal period: purulent discharge, dryness in the vagina, thinning of the mucosa, dyspareunia, dysuria	pH> 6, negative amine test and characteristic results of microscopic research	Increase in polymorphonuclear nuclears and cocci; decrease in the number of lactobacilli; parabolic cells	Erosive flat lichen
Bacterial vaginosis	Gray, suspicious smelling discharge, often with itching and irritation; absence of dyspareunia	Three of the following: gray discharge, pH> 4.5, fish smell, key cells	Key cells; decrease in the number of lactobacilli; increase in cocco-bacillary microflora	Trichomonal vaginitis
Candidiasis	Thick white discharge; itching of the vagina or vulva with or without burning, irritation or dyspareunia	Typical discharges, pH <4.5 and results of microscopic examination	Yeast-like fungi, pseudomycelia, or mycelium; best studied with 10% potassium hydroxide solution	Contact irritating or allergic vulvitis, chemical irritation, vulvodynia
Trichomonal vaginitis	Profuse, fetid, yellow-green discharge; dysuria; dyspareunia; hyperemia	Identification of a pathogenic microorganism by microscopy (sometimes cultural diagnosis)	Movable protozoa; increased polymorphonuclear cells	Bacterial vaginosis, inflammatory vaginitis

[34], [35], [36], [37], [38], [39], [40], [41], [42]

Diagnostics of the vaginitis

Vaginitis is diagnosed on the basis of a clinical picture and with the help of laboratory data. First, the vaginal secretion obtained by examination in mirrors is examined and the pH of the vaginal contents is determined (at intervals from 4.0 to 6.0). Then the secret is applied to two slides with a cotton swab and diluted with 0.9% sodium chloride solution on the first glass (saline wet fixation) and 10% potassium hydroxide on the second glass (KOH fixation).

The data of the culture test are necessary if the results of the microscopic examination are negative or the symptoms of the disease persist.

If a fish odor is detected during the test with KOH (amine test), which is the result of amine production, you can suspect trichomonas vaginitis or bacterial vaginosis. A smear with wet fixation with saline must be microscopically examined as soon as possible to detect trichomonads. After some time after fixing the smear, Trichomonas become immobile and are more difficult to diagnose during microscopic examination. KOH destroys the cellular material, with the exception of yeast fungi, facilitating the identification of the pathogen. If the clinical picture and laboratory data are insufficient to establish a diagnosis, it is necessary to take the excreta for culture culture on the fungi.

In cases of trichomoniasis vaginitis, children should be excluded from sexual violence; if they have unexplained vaginal discharge, cervicitis, a checkup for sexually transmitted infections is necessary. If women have bacterial vaginosis or trichomonas vaginitis (and thus have an increased risk of developing sexually transmitted diseases), cervical tests should be performed to identify gonorrhea or chlamydia as the most common causes of sexually transmitted diseases (sexually transmitted) pelvic organs.

[43], [44]

Treatment of the vaginitis

Efforts are being made to reduce vaginal discharge and decrease microbial growth, including hygiene of the genitals, wearing loose clothing, using hygroscopic cotton swabs to improve air circulation. It is necessary to avoid the use of soap and unproven hygiene products (eg, female hygiene sprays). Periodic use of ice or warm sedentary baths with or without baking soda can reduce soreness and itching.

If the symptoms of the disease are mild or severe or do not respond to treatment with the above measures, it is necessary to prescribe medications. If itching is actual, the appointment of glucocorticoids (for example, 1% hydrocortisone for topical application), for the treatment of the vulva, but not for the vagina. Oral antihistamines reduce itching and cause drowsiness, contributing to better sleep of patients.

Any infection or other cause of vaginitis requires treatment. Foreign bodies should be removed. Pre-pubertal girls are taught the proper hygiene of the genital organs (for example, rubbing the genitals from the front to the back after feces, and careful washing of the hands). If the inflammation of the vulva occurs due to urinary incontinence or in patients bedridden, the correct hygiene of the genitals can best help.

Prevention

Prevention of the candida type of vaginitis involves the use of cotton underwear. Avoid using vaginal fragrant soaps, shower gels, deodorants. Douching is not recommended, as they disrupt the normal bacterial balance in the vagina.

Prevention of bacterial vaginosis includes a healthy diet, minimizing stressful situations.

Prevention of trichomoniasis of colpitis lies in the practice of safe sex through the use of condoms.

[45], [46], [47], [48], [49], [50], [51], [52], [53]