Types of vaginal infections
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Types of Vaginal Infections
Vaginal infections are a prevalent gynecological issue affecting women of reproductive age. These infections can lead to various health complications if not properly diagnosed and treated. The most common types of vaginal infections include bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AV), and trichomoniasis. This article provides an overview of these infections, their causative agents, and their implications.
Bacterial Vaginosis (BV)
Pathogenesis and Prevalence
Bacterial vaginosis is the most common cause of vaginitis, accounting for 40% to 50% of cases4. It is characterized by an imbalance in the vaginal microbiota, where the normal Lactobacillus-dominated flora is replaced by anaerobic bacteria such as Gardnerella vaginalis, Atopobium vaginae, and Mobiluncus species1 4. BV is often associated with a higher risk of acquiring sexually transmitted infections (STIs) such as Chlamydia trachomatis and Mycoplasma genitalium3 10.
Diagnosis and Treatment
Diagnosis of BV typically involves clinical criteria such as Amsel's criteria or Nugent scoring, which assess the presence of clue cells and the overall bacterial composition4. Treatment usually includes antibiotics like metronidazole or clindamycin, and recent studies suggest that probiotics may help restore normal vaginal flora and reduce recurrence rates8.
Vulvovaginal Candidiasis (VVC)
Pathogenesis and Prevalence
Vulvovaginal candidiasis is caused by an overgrowth of Candida species, particularly Candida albicans, which accounts for 20% to 25% of vaginitis cases4. VVC is characterized by symptoms such as itching, burning, and abnormal discharge. Factors like vaginal douching can increase the likelihood of non-albicans Candida infections, which are often more resistant to common antifungal treatments6.
Diagnosis and Treatment
Diagnosis involves clinical examination and laboratory tests such as potassium hydroxide microscopy and culture on differential media4. Treatment typically includes antifungal medications like fluconazole, and recent research highlights the role of Candida virulence factors in the pathogenesis of VVC5.
Aerobic Vaginitis (AV)
Pathogenesis and Prevalence
Aerobic vaginitis is less common but still significant, accounting for a notable proportion of vaginal infections. It is caused by aerobic bacteria such as Escherichia coli and Enterococcus faecalis1. AV is often associated with inflammation and a higher risk of coinfections with other types of vaginitis1.
Diagnosis and Treatment
Diagnosis involves microbiological examination through Gram-stain and PCR assays targeting specific bacterial genes1. Treatment usually includes antibiotics, and maintaining a healthy vaginal microbiota is crucial for prevention.
Trichomoniasis
Pathogenesis and Prevalence
Trichomoniasis is caused by the protozoan parasite Trichomonas vaginalis and accounts for 15% to 20% of vaginitis cases4. It is a sexually transmitted infection that can lead to severe complications if left untreated.
Diagnosis and Treatment
Diagnosis involves clinical examination and laboratory tests such as nucleic acid amplification tests (NAATs)4. Treatment typically includes antiprotozoal medications like metronidazole.
Other Infections
Pathobionts and STIs
Other less common but significant vaginal infections include those caused by pathobionts such as Streptococcus, Staphylococcus, and Haemophilus species. These infections are often associated with maternal and neonatal complications and pelvic inflammatory disease9. Additionally, infections like human papillomavirus (HPV) and Neisseria gonorrhoeae are influenced by the vaginal microbiota, with high-Lactobacillus vaginal microbiota offering some protective effects3.
Conclusion
Understanding the various types of vaginal infections, their causative agents, and their implications is crucial for effective diagnosis and treatment. Bacterial vaginosis, vulvovaginal candidiasis, aerobic vaginitis, and trichomoniasis are the most common types, each requiring specific diagnostic and therapeutic approaches. Maintaining a healthy vaginal microbiota through probiotics and other interventions can help prevent these infections and improve overall vaginal health.
Sources and full results
Most relevant research papers on this topic
Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis
Ecuadorian women with healthy vaginal microbiota are less likely to have vaginal infections, while those with unhealthy microbiota are more likely to have infections.
Observational Study
Rigorous JournalVaginal Infections: A Common Gynecologic Disorder. -
Vaginal infections are common gynecologic disorders, often misdiagnosed and mixed, with trichomoniasis, candidiasis, and bacterial vaginosis being the most common types.
The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis.
High-Lactobacillus vaginal microbiota may play a protective role against HPV and C. trachomatis infections, while no clear trend was detected for N. gonorrhoeae and M. genitalium infections.
Meta-AnalysisRigorous Journal
Highly CitedVaginal Infection: Review Article
Bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis are the most common causes of vaginitis, with bacterial vaginosis being the most common cause and newer laboratory tests aiding in diagnosis.
Literature ReviewVirulence Factors of Candida spp. and Host Immune Response Important in the Pathogenesis of Vulvovaginal Candidiasis
Candida virulence factors and host immune response play crucial roles in the pathogenesis of vulvovaginal candidiasis, with host cell interactions and innate immune mechanisms also playing a role.
Does vaginal douching affect the type of candidal vulvovaginal infection?
Vaginal douching does not influence the type of Candida infection in vulvovaginal candidiasis, but regular performance increases the likelihood of having non-albicans types and resistance to common antifungal agents.
Observational StudyHaemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis.
Haemophilus vaginalis vaginitis, a newly defined specific infection, is a pathogenic bacterium with clinical manifestations and requires simultaneous husband treatment.
Observational StudyHighly CitedTreating vaginitis with probiotics in non-pregnant females: A systematic review and meta-analysis
Probiotics significantly reduce recurrence and improve cure/remission rates in treating common vaginal infections in non-pregnant females.
Meta-AnalysisRigorous JournalPathobionts in the Vaginal Microbiota: Individual Participant Data Meta-Analysis of Three Sequencing Studies
Pathobionts co-occur with lactobacilli and BV-anaerobes in vaginal microbiota, but do not expand as much as BV-anaerobes do in dysbiotic situations.
Meta-AnalysisBacterial vaginosis-associated vaginal microbiota is an age-independent risk factor for Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis infections in low-risk women, St. Petersburg, Russia
Bacterial vaginosis-associated vaginal microbiota is an age-independent risk factor for sexually transmitted infections, and promoting a protective vaginal microbiota is crucial for both high- and low-risk women.
Observational StudyRigorous Journal