For many women, the terms vaginal infection and yeast infection are synonymous. However, yeast, or Candidiasis/Candida albicans, is only one of several possible vaginal infections or problems. Two other common vaginal infections are trichomoniasis and bacterial vaginosis.
The Vagina and Normal Discharge
The vagina connects the cervix, the opening to the uterus, to the vulva, the skin folds on the exterior of the body enclosing the openings to the female reproductive and urinary tracts.
Just as dead cells slough off the skin, the cells lining the vagina also are discarded and replaced. These vaginal cells mix with fluid produced by nearby glands, forming a thin, normal discharge. Unfortunately, many women have come to believe that any vaginal discharge is abnormal and should be treated. Access to a variety of over-the-counter vaginal products seems to support this misunderstanding.
The presence of a thin vaginal discharge without odor, vaginal itching, or discomfort is perfectly normal. Using an unscented pantyliner to absorb the fluid and protect your underwear is the only useful “treatment.” However, discharge can be an important sign of an infection as well. So, read on below for guidelines as to when to contact your healthcare provider.
Yeast, a Common Culprit
The Centers for Disease Control (www.cdc.gov) reports that about 75 percent of women will experience a vaginal yeast infection at least once in their lives. What kind of infection is it and why is it so common?
Candida, which is a type of yeast or fungus, is normally found in the human body. When things are in balance it usually causes no problems. But, when the internal environment is offset, this yeast can proliferate. Symptoms include: thick, white, odorless vaginal discharge (often described as resembling cottage cheese). vaginal itching and burning. pain or discomfort with urination or sexual intercourse. vulvular redness or irritation. About 80 percent of yeast infections are caused by a specific species of Candida, called Candida albicans.
The remaining twenty percent of yeast infections are caused by other types of Candida. These infections may require treatment with special medications that are different from the usual treatment. While yeast infections are not considered sexually transmitted diseases (STDs), they can still be transmitted between partners. Try to avoid intercourse until you have completed treatment and the symptoms have subsided.
Antifungal medication Since yeast is a fungus, treatment involves an anti-fungal medication. Several vaginal creams or suppositories are available over the counter. Sometimes an oral medication is prescribed by a physician, if the condition is more severe or not responding to initial treatment. Treatment just for the irritation and itching will not cure the infection. If using an oral medication, you may also need a topical vaginal cream to soothe the discomfort until the infection has been properly treated. If using vaginal creams or suppositories, don’t use a tampon. They can absorb the medication. Use sanitary pads instead.
While nonprescription, over-the-counter medications for yeast infections are readily available, be sure that you do indeed have a yeast infection before using them. As described below, other vaginal infections can have symptoms similar to those associated with yeast infections. If these infections are not treated properly, they can have serious consequences. If this is your first infection, be sure to have your doctor check the discharge under a microscope to make an accurate diagnosis. Symptoms such as pain or burning with urination could indicate a urinary tract infection, which would require prescription antibiotics. If you have recurrent yeast infections, do not continue to self-medicate: Go to your healthcare provider.
Do I Really Have a Yeast Infection?
Self-diagnosis of a yeast infection may not be as obvious as one would think. A 1997 study at Temple University Medical School reported in the July issue of Obstetrics and Gynecology, found that only 28 percent of female participants presenting with recurrent yeast infections had candidiasis. Eleven percent actually had bacterial vaginosis (BV, see below), a more serious condition.
This study also reported that 15 percent of these women had irritant dermatitis, a skin reaction from coming in contact with an irritating product or substance. This condition was exacerbated by using over-the-counter medications for a problem they did not have.
In a 1996 Israeli study, reported in the November/December issue of Archives of Family Medicine, researchers found that some women reporting a history of yeast infections and BV had instead contracted trichomoniasis, chlamydia, or herpes simplex.
Predisposing factors Yeast feeds on glucose, which is the body’s form of sugar, so anything that increases the blood sugar or alters the hormonal balance that regulates blood sugar can encourage yeast to grow out of control.
These conditions include: diabetes pregnancy, especially in the third trimester birth control pills steroids antibiotics immunocompromised states, such as with HIV infection Prevention To decrease your risk of a yeast infection, make the environment less favorable for its growth. Here are some tips: If you are diabetic, keep your blood sugar as close to normal as possible. Keep the genital area clean, cool, and dry. Avoid tight-fitting clothing that retains heat and traps moisture. Use white cotton underpants to allow for better air circulation and to decrease the risk of a dye-related irritation. Dry off well after a shower or swimming, using a cool hand-held hair dryer if needed. Change as soon as possible out of wet clothes, including bathing suits. After urinating, wipe from front to back: yeast can exist in the intestinal tract and be swept into the vagina, along with E. coli and other bacteria, when wiping from back to front. Avoid douching and using other irritants such as perfumed bath products and colored/scented toilet paper.
Tricky Trichomoniasis
The Center for Disease Control estimates that approximately two to three million Americans suffer from Trichomoniasis each year. Trichomoniasis is a common vaginal infection that is usually transmitted sexually. This STD is caused by a protozoan parasite, and requires antibiotics to cure the infection. Since many of its symptoms are the same as for other vaginal infections, it is best diagnosed under a microscope. Treating yourself just for the genital discomfort could result in delayed treatment of the infection itself. Trichomoniasis afflicts both men and women, although men often have no symptoms.
Women’s symptoms include: green, frothy, foul-smelling discharge vulvular irritation, redness, swelling, and itching burning or pain with urination urge to urinate pain with intercourse possible lower abdominal pain While some women may develop symptoms within one to three weeks of infection, others may only experience symptoms after six months or more. Delayed treatment can have serious consequences, increasing the risk of: pelvic inflammatory disease (PID) infertility cervical cancer HIV transmission maternal-to-child infection when pregnant, with an increased risk of preterm labor and a low-birth-weight baby Treatment Treatment should be directed toward both partners, as reinfection can occur. To minimize reinfection, it is best to abstain from sex until both partners have finished the course of antibiotics and symptoms have subsided.
Use of condoms can decrease the potential for transmission. Having multiple partners increases your chance of contracting Trichomoniasis, as well as other STDs.
Bacterial Vaginosis
While bacterial vaginosis (BV), also known as Gardnerella, is one of the most common causes of an abnormal vaginal discharge, much remains unknown about this condition. Sexual activity is believed to play a role in its transmission. Having multiple partners appears to increase the risk of its spreading. Yet, women who are not sexually active have also been diagnosed with BV.
Symptoms can include: thin white or gray discharge. distinctive fishy odor of discharge, which is more pronounced when exposed to an alkali substance such as soap (when showering) or semen. little or no vaginal itching or irritation. Treatment Antibiotics will treat BV, and partners of women infected with BV do not necessarily need to be treated. About 50 percent of women with BV may not be symptomatic. Since this infection may resemble other vaginal infections, microscopic examination is the best way to determine an accurate diagnosis. Infection rates appear to be greater with IUD (intrauterine device) use, as the insertion of foreign bodies into the body predisposes to the development of infections, in general.
Women with untreated BV have a greater risk of: infertility tubal pregnancy premature labor low birth-weight baby gonorrhea HIV transmission first-trimester miscarriage The CDC recommends that all women delivering a baby preterm be checked for BV. Since BV is related to changes in the bacterial environment, contact with dirty hands or unclean tampon use can increase the chance of developing BV. In addition, the insertion of a cannula, or tube, into a woman’s uterus during infertility treatment can increase the risk of spreading an existing BV infection deeper into the woman’s reproductive organs.
In the Israeli study mentioned above, there was a significant decrease in the incidence of BV when women ate their daily “dose” of yogurt with L. acidophilus. Pasteurized yogurt (without live cultures) did not have the same beneficial effect.
Chlamydia
The CDC estimates that 70 to 75 percent of women with chlamydia infections may be asymptomatic. That means that three out of four women with chlamydia may have no symptoms at all. About four million people are affected yearly, mostly teens and those in their early 20s. Transmission is common, as it is considered highly contagious. Potential symptoms include: vaginal discharge pain with urination or intercourse genital irritation and redness Treatment Antibiotics are used to treat chlamydia. The CDC estimates that about 30 to 50 percent of all PID cases may be due to undiagnosed chlamydial infection. Untreated PID can progress to reproductive tract damage, which can lead to infertility and an increased risk of ectopic pregnancies. Babies born to infected, but untreated moms can develop eye infections leading to blindness.
The Current Condition According to the CDC, more than 12 million cases of sexually transmitted diseases are reported every year. Countless more go undiagnosed and unreported. Untreated STDs can result in PID, infertility, and negative pregnancy outcomes.
Infection can exist without your experiencing symptoms or being aware of the symptoms, so regular medical care with screening for STDs is important. You can have an STD that is damaging your reproductive health, even though neither you, nor your partner, have any symptoms. If you are concerned about anonymity and do not want to discuss STDs with your doctor, there are clinics that exist separately from routine medical offices, and specialize in the treatment of STDs.
While a regular relationship with your healthcare provider is always best, if you do not want to share these details with your doctor, get screening and treatment somewhere else. Delaying treatment can create further problems, as these infections can affect your reproductive as well as your general health.
