Vaginal Infections -- How to Diagnose and Treat Them Appropriately

Sara M. Mariani, MD, PhD

Disclosures

November 18, 2003

In This Article

Introduction

Vaginal infections represent a relatively benign disease that is associated with:

  • More than 10 million office visits annually

  • Frequent recurrence

  • Increased pregnancy and surgical risk

  • Half a billion dollars in healthcare costs

One of the most frequent diseases in sexually active adolescent and adult women, vaginitis need to be diagnosed with accuracy and treated properly to reduce such a high disease burden, even if they are not associated with life-threatening complications.[1,2,3,4,5,6,7,8] Consequences may, in fact, be significant in pregnant women, as vaginitis may be associated with:

  • Postoperative pelvic infections

  • Preterm rupture of membranes, labor, and birth

  • Postcesarean and postpartum infections

  • A 40% higher risk of low-birth-weight infants

As discussed by Dr. Karen Carroll,[1] of the Johns Hopkins Hospital, Baltimore, Maryland, in collaboration with Dr. Gerri Hall,[2] of the Cleveland Clinic Foundation, Cleveland, Ohio, at the 2003 Annual Meeting of the American Society of Clinical Pathology, presenting symptoms may be similar, but different micro-organisms may be responsible for the infection; thus, there are different therapeutic strategies that should be adopted.

Infections are involved in more than 90% of the cases coming to observation for vaginal irritation and discharge. Other, less frequent causes may be mechanical, chemical, or allergic reactions (eg, to latex). It is estimated that approximately 80% of nonpregnancy, nonroutine visits to a gynecologist are prompted by the presence of a vaginal discharge.

A protozoan, Trichomonas vaginalis, and a fungus, Candida albicans, are the micro-organisms most frequently involved as causative agents. Group B Streptococci, on the other hand, are often responsible for the so-called nonspecific vaginitis (bacterial vaginosis [BV]). Bacterial infections may be associated with the presence of Gardnerella vaginalis, which may act as a useful marker.[2]

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