Vaginal infections refer to conditions where the vaginal flora is disrupted, leading to an overgrowth of pathogens such as bacteria, fungi, or protozoa.
Types of
Vaginal Infections
1. Candidiasis (Moniliasis /
Candida Vaginitis)
- Causative Agent: Candida albicans
(a gram-positive yeast-like fungus).
- Risk Factors:
- Diabetes
mellitus
- Immunosuppression
(HIV infection)
- Prolonged
antibiotic therapy
- Pregnancy
- Oral
contraceptives
- Symptoms:
- Thick, curdy, white vaginal discharge
- Intense vulvovaginal itching
- Red, swollen vulva
- Diagnosis:
- Microscopy (KOH mount) - Budding yeast cells and pseudohyphae
- Culture on Sabouraud’s agar
- Treatment:
- Fluconazole / Itraconazole (oral
antifungals)
- Nystatin vaginal pessaries
2. Bacterial Vaginosis (BV)
- Causative Agent: Gardnerella vaginalis
- Symptoms:
- Thin, homogenous, grayish-white vaginal discharge
- Fishy odor (positive whiff test with KOH)
- Vaginal pH > 4.5
- Diagnosis:
- Amsel criteria (3 out of 4 present)
- Thin
homogeneous discharge
- Positive
whiff test
- Clue
cells on microscopy
- pH
> 4.5
- Treatment:
- Metronidazole 500 mg PO BID for 7 days
3. Trichomoniasis
- Causative Agent: Trichomonas vaginalis
(a protozoan).
- Mode of Transmission:
- Sexual contact
- Contaminated towels or toilet seats
- Symptoms:
- Greenish-yellow, frothy, foul-smelling vaginal discharge
- Strawberry cervix (colpitis macularis)
- Vulvar irritation and itching
- Diagnosis:
- Wet mount microscopy - Motile trichomonads
- Culture / NAAT
- Treatment:
- Metronidazole 2g PO single dose
- Vaginal hygiene maintenance
4. Chlamydial Vaginitis
- Causative Agent: Chlamydia trachomatis
- Symptoms:
- Mucoid vaginal discharge
- Dysuria
- Lower abdominal pain
- Diagnosis:
- Culture / Serological test (NAAT, PCR)
- Treatment:
- Tetracycline 500 mg QID for 7 days
5. Atrophic Vaginitis (Senile
Vaginitis)
- Caused by: Low estrogen levels
(postmenopausal women).
- Symptoms:
- Yellowish vaginal discharge
- Vaginal dryness
- Pruritus vulvae
- Painful intercourse (dyspareunia)
- Diagnosis:
- Thin, fragile vaginal mucosa
- Elevated vaginal pH
- Treatment:
- Estrogen replacement therapy (topical estrogen cream)
Investigations
for Vaginal Infections
- Microscopy (Gram stain, wet mount, KOH mount)
- Culture (Sabouraud’s agar, Thayer-Martin
medium)
- pH testing (Normal vaginal pH: 3.8–4.5)
- Nucleic Acid Amplification Tests (NAAT)
Management
& Prevention
- Maintain good perineal hygiene
- Avoid excessive vaginal douching
- Use barrier protection (condoms) during sexual activity
- Regular screening for STIs in high-risk individuals
1.
Abnormal vaginal discharge
(white, yellow, or greenish, thick or watery)
2.
Itching, burning sensation, and
irritation in the vaginal area
3.
Swelling and redness of the vulva
4.
Painful urination and discomfort
during intercourse
5. Unpleasant odor associated with vaginal discharge
1. Sepia
Indications:
- Chronic Vaginitis with yellowish, offensive
vaginal discharge.
- Leucorrhea before and after menses, causing
weakness and backache.
Keynote Symptoms:
- Vaginal
dryness, causing pain during intercourse.
- Dragging
sensation in the pelvis.
- Aversion
to sexual activity.
- Symptoms
worsen from cold air and improve with vigorous exercise.
- Brownish
pigmentation on the face.
2. Pulsatilla
Indications:
- Thick, creamy, or yellowish-green vaginal discharge.
- Vaginitis after taking hormonal contraceptives.
Keynote Symptoms:
- Mild
and weepy nature, seeking consolation.
- Symptoms
change frequently.
- Worse
in warm rooms, better in open air.
- Lack
of thirst despite dryness.
- Itching
and irritation in the vaginal area.
3. Kreosotum
Indications:
- Profuse, foul-smelling, acrid vaginal discharge
causing burning.
- Vaginal inflammation and ulceration due to chronic infections.
Keynote Symptoms:
- Corrosive
vaginal discharge that irritates and inflames the skin.
- Extreme
burning and itching in the vaginal area.
- Worse
before and after menstruation.
- Urine
is dark and offensive.
- Marked
sensitivity of the vaginal mucosa.
4. Borax
Indications:
- Vaginitis with white, curd-like discharge (Candida infection).
- Burning and rawness in the vagina, especially during urination.
Keynote Symptoms:
- Sensation
as if warm water is flowing from the vagina.
- Vaginal
discharge is sticky and copious.
- Extreme
vaginal sensitivity, making intercourse painful.
- Symptoms
worsen from downward motion (e.g., walking downstairs).
- White
ulcers or spots in the vagina.
5. Mercurius Solubilis
Indications:
- Thick greenish-yellow vaginal discharge with a fishy odor
(Trichomoniasis).
- Inflammation and ulceration of the vaginal mucosa.
Keynote Symptoms:
- Vaginal
discharge worsens at night.
- Profuse
sweating that doesn’t relieve symptoms.
- Burning
pain in the vagina and urethra.
- Excessive
salivation and metallic taste in the mouth.
- Swollen
and tender lymph nodes.
