Vaginitis is an inflammation of the vagina of different causes. Vagina is protected from infection by its acidity (pH 4.5 to 5), due to the presence of Doederlein germs that convert glycogen into lactic acid. Ovarian hormones (estrogen and progesterone) also have an important role in the protection of the vagina and they form the vaginal epithelium up to the superficial and intermediate layers which contain glycogen.

Causes

Vaginitis may occur due to: infection (infectious vaginitis), local physical or chemical irritation (non-infectious vaginitis), and the influence of the hormone (atrophic vaginitis).

Clinical picture

Three most common types of vaginal infections are bacterial vaginitis (bacterial vaginosis) or bacterial infection, thrush (candidiasis) or fungal infection, trichomoniasis, an infection by the protozoa Trichomonas vaginalis.

Bacterial vaginitis – it is characterized by the appearance of homogeneous, white or green discharge from the vagina, followed by unpleasant smell and the sense of itching. BV is caused by increased growth of the bacteria of which the most important is Gardnerella vaginalis. It should be mentioned that most women do not have all of these symptoms, and some even have none of the above. In these cases, the so-called asymptomatic bacterial vaginitis, the diagnosis can be set only by the examination, so women are often aware of their condition only after a regular gynecological examination.

Vaginal candidiasis - the main symptom is persistent and unpleasant itching, sometimes extended to the area of the rectum. It is followed by thick, white, cheesy odorless discharge that may appear in very small quantities. One may also experience pain, mainly during sexual intercourse.

Vaginal candidiasis has the following symptoms:

• erythema (redness) and swelling of the labia with smaller lesions (pustule-papule-change)
• vaginal erythema (redness) with adhesive, thick discharge.
• cervix usually remains normal.

Trichomonas vaginalis - Many patients have no symptoms, no signs of the disease (20 - 50%). Symptoms include discharge from the vagina that can be white, gray, yellow, green, and strong unpleasant smell of discharge (smell of rotten fish). There may be a burning sensation when urinating, itching and bleeding after sexual intercourse.

Trichomonas infection has the following symptoms:

• vagina is erythematous (reddened) and edematous (swollen) with excoriation (peeling of epithelium)
• thick vaginal discharge that can be white, gray, yellow or green
• small petechiae on the cervix
• "colpitis macularis" is specific for Trichomonal infection, and 2-5% of patients have it.

Diagnosis

It is set after the examination of the vaginal wall, appearance and smell of vaginal discharge, vaginal purity degree.

The degree of vaginal purity is expressed in the form of 6 groups, by taking vaginal secretions and microscope examination.

Group I:   secretions containing vaginal epithelium, small number of leucocytes, some bacteria and Doederlein germs (physiological)
Group II:  less vaginal cells, increased number of leukocytes, more bacteria and fewer Doederlein germs (physiological)
Group III: high number of leukocytes, a number of staphylococci, streptococci, bacillus coli, without Doederlein germs,
Group IV: gonococcus
Group V:  trichomonas vaginalis
Group VI: candidiase

Treatment

Vaginal candidiasis - for the treatment of fungal infections there is a variety of oral medications, vaginal creams, gels and vaginal tablets with antifungal effect. In the cases of drug resistance, boric acid may be applied.

Bacterial vaginitis - bacterial vaginitis treatment typically involves taking oral antibiotics and concomitant application of vaginal cream, gel or vaginal tablets according to the advice of a gynecologist.

Trichomonas vaginalis - Unlike in the case of the bacterial or fungal infection, in the case of vaginal trichomoniasis both partners should be treated. Typical treatment of trichomoniasis involves taking oral antibiotics and local application of vaginal tablets on the advice of a doctor. Trichomoniasis withdraws soon after starting treatment, but sometimes it can be necessary to repeat the treatment. It is important to simultaneously treat both partners, and that partners refrain from sexual intercourse during treatment.

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