Vaginal Infections

Vaginitis

What is Vaginitis?

Vaginitis is an inflammation of the vagina, causing discomfort and often prompting people with a vaginato visit an obstetrician-gynecologist (ob-gyn). It can happen at any age and has various causes, each requiring different treatments. Sometimes it can become recurrent meaning it occurs 4 or more times in a year which is higher risk to occur if you have autoimmune conditions such as HIV and diabetes.

Causes of Vaginitis

The vagina naturally contains bacteria and yeast that help keep it healthy. When this balance is disrupted, it can lead to vaginitis, with symptoms like itching, burning, unusual odor, or increased discharge.

• Antibiotics can kill good bacteria leading to yeast overgrowth.
• Hormonal changes such as low estrogen levels during pregnancy, breastfeeding, or menopause.
• Douching, and irritants such as washes, hygeine products, scents/chemicals in hygiene products, fabric softeners, lubricants, certain material in sex toys or condoms, tight-fitting clothing or damp clothing leading to moisture which can upset the natural balance.
• Spermicides and vaginal intercourse.
• Infections like yeast infections, bacterial vaginosis, and trichomoniasis.

Types of Vaginitis

1. Yeast Infection (Candidiasis):
   • Cause: A fungus called Candida, normally present in small amounts in the vagina. Antibiotics, pregnancy, diabetes, or a weak immune system can increase the risk by disrupting the natural balance.
   • Symptoms: Itching, burning, swelling of the vulva, pain during urination or intercourse, and sometimes a thick, white discharge without odor.
   • Treatment: Over-the-counter treatments or prescribed antifungal medications can help. However, if symptoms persist, it’s important to consult an OB-GYN to make sure there is not another medical issue, other causes triggering infection and you are on the correct treatment.
2. Bacterial Vaginosis (BV):
   • Cause: Not an infection but a shift in normal vaginal bacteria types. Often seen when “good” bacteria decrease, allowing other types to increase growth.
   • Symptoms: Thin, gray discharge with a strong fishy odor, often more noticeable after menstruation or sex. Itching is uncommon but may occur if there is a lot of discharge. Sometimes there are no symptoms.
   • Treatment: Antibiotics taken orally or as a vaginal gel or cream.
3. Trichomoniasis:
   • Cause: A sexually transmitted infection caused by a parasite, Trichomonas vaginalis. Having trichomoniasis increases the risk of other STIs.
   • Symptoms: Yellow-gray or green discharge with a fishy smell, burning, irritation, and sometimes pain during urination.
   • Treatment: Antibiotics, usually metronidazole, for both you and your partner to prevent reinfection. It’s important to avoid sex until treatment is completed.
4. Atrophic Vaginitis:
   • Cause: Low estrogen levels, often during menopause or breastfeeding, leading to dryness and irritation. When this occurs around menopause, it’s sometimes called genitourinary syndrome of menopause.
   • Symptoms: Dryness, itching, burning, and pain during sex.
   • Treatment: Estrogen therapy applied directly to the vagina, available as creams, tablets, or rings, can relieve symptoms. Water-based lubricants may also help.

Diagnosis of Vaginitis

To diagnose vaginitis, an ob-gyn may take a sample of vaginal discharge to test. To ensure accurate results:

• Avoid using vaginal medications for 3 days before the appointment.
• Avoid douching, vaginal sex, or using spermicides before your visit.

Treatment depends on the cause, and it’s essential to follow the medication instructions even if symptoms improve. Stopping treatment early may cause the symptoms to return. If you are being treated for vaginitis with medications it is recommended to hold on placing anything in the vagina – this can irritate, depending on the type of infection cause re-infection if you have sex, and make it harder to heal. If symptoms persist after treatment, consult your ob-gyn for further evaluation.

Prevention Tips

You can reduce your risk of vaginitis with these steps:

• Avoid douching and let the vagina clean itself naturally.
• Use unscented products and avoid feminine sprays or scented tampons.
• Wash with plain warm water on the vulva instead of soap or detergents that can disrupt the natural balance. Avoid washing the internal vagina, this disrupts the normal bacteria and yeast environment.
• Clean devices like diaphragms, spermicide applicators, and sex devices thoroughly after each use.
• Use condoms during sex to prevent infections.
• Check with your OB-GYN about preventing yeast infections if you are prescribed antibiotics.

Managing Vaginitis

Vaginitis can be uncomfortable, but it’s usually treatable once the cause is identified. Following your ob-gyn’s guidance, completing treatments as directed, and adopting preventive habits can reduce the likelihood of recurring symptoms. If you notice any signs of vaginitis, reach out to your healthcare provider for appropriate care. While the first treatment usually clears the infection there are many reasons why it  can persist or recur and need re-tested and treated again. Do not ignore if your symptoms do not improve with the first treatment.

Sexually Transmitted Infections

STIs also known as sexually transmitted infections, are common and a lot of people who have them do not have symptoms. These are infections that are spread from one person to another – usually during vaginal, anal, or oral sex. Treatment is important, without this, these infections can lead to serious health complications. It is easy to get tested and treated for STIs.

It is estimated 1 in 5 people in the U.S currently have a STI. This continues to increase each year based on global data. 

 

STI Testing 

STIs frequently do not have symptoms meaning you do not notice anything different. Testing is the only way to know if you have an infection. If you have had any kind of sexual contact this can spread the infection and lead to health complications for you or the other person(s). Talk to your provider about getting tested to help treat and prevent the passing of the infection.

Frequently Asked Questions

Chlamydia, Gonorrhea, Trichomoniasis and Syphilis

Chlamydia, gonorrhea, trichomonas and syphilis are common sexually transmitted infections (STIs) that can lead to serious health problems if untreated. Knowing the symptoms, treatments, and ways to prevent these STIs can help protect your health.

Chlamydia

Chlamydia is the most common nationally notifiable STI in the United States. It’s caused by bacteria that spread through vaginal, anal, or oral sexual contact, and it often infects areas like the cervix, urethra, or rectum.

• Symptoms: Chlamydia frequently has no symptoms. When symptoms appear, they may include yellow vaginal discharge, bleeding between periods, painful urination, or rectal pain.
• Testing: A urine sample or swab from the infected area (vagina, mouth, rectum) can detect chlamydia. Yearly screening is recommended for women under 25 or those over 25 with risk factors.
• Risk Factors: Having multiple partners, a new partner, or an STI in the past raises the risk of chlamydia.
• Treatment: Chlamydia is treated with antibiotics. Both you and recent partner(s) (within the past 60 days) should be treated to prevent reinfection. Avoid sex until treatment is completed, or until 7 days from start of treatment. Get retested after three months to confirm the infection is gone.
• Complications: If you do not get treated you can develop pelvic inflammatory disease which leads to permanent organ damage such as pain, infertility or ectopic pregnancy. It also increases your risk of getting HIV. If you have chlamydia during pregnancy you can pass it onto your newborn during birth and lead to eye infections, pneumonia and cause pregnancy complications.
• Prevention: Lower your chances of getting gonorrhea by practicing safe sex, using condoms and oral dams, and testing regularly for STIs.

Gonorrhea

Gonorrhea often occurs alongside chlamydia and is the second most common nationally notifiable STI in the U.S. It spreads in similar ways and can infect the reproductive organs, urethra, anus, eyes, and throat.

• Symptoms: Like chlamydia, gonorrhea may cause no symptoms. When present, symptoms include yellow discharge, painful urination, bleeding between periods, and rectal discomfort.
• Testing: Gonorrhea can be diagnosed through a urine test or swab of the infected area. Routine yearly screening is recommended for at-risk individuals.
• Risk Factors: The risk factors are the same as those for chlamydia.
• Treatment: Gonorrhea requires two antibiotics—an injection and a pill. Like chlamydia, partners should be treated to avoid reinfection. Avoid sexual contact until treatment is complete, do not have sex for 7 days from starting your treatment. You should also get retested in 3 months to make sure your infection is gone.
• Complications: Gonorrhea can spread to reproductive organs and cause pelvic inflammatory disease (PID) and lead to permanent damage such as infertility, ectopic pregnancy and chronic pelvic pain. It can also increase your risk of getting infected with HIV. If you are pregnant at the time of having gonorrhea and give birth your newborn can have complications such as blindness, joint infections or blood infections.
• Prevention: Lower your chances of getting gonorrhea by practicing safe sex, using condoms and oral dams, and testing regularly for STIs.

Trichomoniasis

Trichomoniasis also called “trich” for short is a STI that is easily cured with antibiotics. Most people with this do not have symptoms.

It is a parasite spread during sex through semen, pre-cum, and vaginal fluids. It can also be spread through vulva to vulva contact, sharing sex toys. Unlike other STIs it usually does not infect the mouth or anus.

• Symptoms: Most do not have symptoms, but if they do they will green, yellow, gray frothy and/or bad-smelling vaginal discharge, blood in your vaginal discharge, itching or irritation in and around the vagina, swelling around the genitals, pain with sex, pain or increased frequency with urination.
• Testing: Trichomoniasis can be diagnosed through a urine test or swab of the infected area. 
• Treatment: Trichomoniasis is treated with antibiotics. Both you and recent partner(s) should be treated to prevent reinfection. Avoid sex until treatment is completed, or until 7 days from start of treatment.
• Complications: You can pass this onto other partners, it can increase your risk of chances of getting HIV and other STIs. If you are pregnant and have trichomoniasis and give childbirth your baby can be born early or at a lower birth weight.
• Prevention: Use condoms and practice safe sex practices. Get regular testing for STIs to lower your risk of spreading and getting STIs during sex.

Syphilis

Syphilis, caused by bacteria, progresses through stages and can cause long-term health problems if left untreated. In Spokane County region this has increased over recent years.

• Symptoms by Stage:
  • Primary: A painless sore, or chancre, appears at the infection site and heals on its own within weeks.
  • Secondary: If untreated, syphilis progresses to a rash (often on the hands and feet) and flu-like symptoms. Flat warts may appear on the genitals.
  • Latent: The infection is still present in the body but shows no symptoms.
  • Late Stage: Untreated syphilis can cause severe damage to the brain, heart, and nervous system.
• How is Syphilis spread? By sexual skin contact when touching one of the painless sores, also known as chancres. It is passed when your vulva, vagina, penis anus or mouth touches the sore. It can also pass during pregnancy and childbirth to the baby, called congenital syphilis.
• Testing: Syphilis is diagnosed with blood tests. Pregnant women are tested routinely to protect the fetus.
• Treatment: Antibiotics effectively treat syphilis. The length of treatment depends on how long you’ve been infected. Partners should also be treated.
• Prevention: using condoms every time you have sex is one of the best ways to prevent syphilis.

Health Problems Related to These STIs If left untreated, these infections can lead to:

• Pelvic Inflammatory Disease (PID) in women, which may cause chronic pain, scarring in the fallopian tubes, and infertility.
• Ectopic Pregnancy due to scarring, which can be life-threatening.
• Disseminated Gonococcal Infection (DGI) in untreated gonorrhea, where bacteria spread to other areas like the skin and joints, causing pain and fever.
• Congenital Syphilis if syphilis is passed to a fetus, potentially harming multiple organs, and eventually can lead to death of a newborn. It can lead to miscarriage, preterm delivery, stillbirth. Pregnant individuals with STIs need early and consistent treatment to reduce risks.

STIs and Pregnancy

During pregnancy, chlamydia, gonorrhea, and syphilis increase the risk of early labor, ruptured membranes, and stillbirth. Newborns exposed to chlamydia or gonorrhea during birth may develop eye infections or pneumonia, while syphilis can cause congenital syphilis, affecting multiple organs. Pregnant individuals should be tested early and treated promptly to protect their baby.

Prevention and Partner Notification

Preventing STIs includes:

• Using condoms during vaginal, oral, or anal sex. Practicing safe sex measures 
• Knowing your partner’s history and STI status, as multiple partners increase infection risk.
• Getting tested annually for chlamydia and gonorrhea if you’re in a high-risk category.

Telling your partner about an STI, also known as partner notification, allows them to seek treatment, which can prevent reinfection. Partner notification can be done directly or through public health services, which may offer anonymous notification options.

Managing STIs

Managing STIs involves early testing, completing treatment as prescribed, and following up if symptoms persist. Safe sex practices, informing partners about infections, and consulting healthcare providers if symptoms return can reduce spread and recurrence. Regular check-ups and discussing prevention with your provider help maintain sexual health.

 

Understanding HPV and the HPV Vaccine

What is HPV?

Human papillomavirus (HPV) is a common sexually transmitted infection (STI). Most sexually active people will contract HPV at some point, even without intercourse. HPV can cause genital warts and, if untreated, lead to cancer. The HPV vaccine is a safe way to prevent HPV-related diseases.

How is HPV Spread?

HPV spreads through skin-to-skin contact, especially during vaginal, anal, or oral sex, often without symptoms, which makes it easy to spread unknowingly.

HPV and Genital Warts

Certain “low-risk” HPV types, like types 6 and 11, cause genital warts, which are treatable but do not lead to cancer.

HPV and Cancer

“High-risk” HPV types, such as types 16 and 18, can lead to cancers including cervical, anal, vaginal, penile, mouth, and throat cancers. Most HPV infections clear on their own, but persistent ones can increase cancer risk. Regular screenings, like Pap tests, can detect cell changes in the cervix early.

HPV Vaccine Benefits

The HPV vaccine effectively prevents infections from HPV types causing most cases of genital warts and cervical cancer. It’s widely used and has no serious side effects. Since it doesn’t contain live viruses, it cannot cause HPV infection.

How Effective is the HPV Vaccine?

The HPV vaccine,known as Gardasil-9, is most effective when given before sexual activity begins. Completing the recommended doses can reduce HPV-related disease risk by up to 99%.

When Should People Get the HPV Vaccine?

The ideal age for the HPV vaccine is 11 or 12, but it’s available as early as age 9 and up to age 26. For people between 27 and 45, the vaccine is still available but should be discussed with a healthcare provider.

HPV Vaccine Schedule

The vaccine is given in a series:

• Ages 9 to 14: Two shots, with the second shot given 6 to 12 months after the first.
• Ages 15 to 26: Three shots, spaced over 6 months.
• Ages 27 to 45: Also follows a three-dose schedule if chosen.

If a dose is missed, there’s no need to start over; the next shot can be given as soon as possible.

Side Effects of the HPV Vaccine

The most common side effect is mild soreness or redness at the injection site. Severe reactions are rare. If you have had a side effect or have concerns for a more severe reaction please report this here.

Frequently Asked Questions

• How long does cervical cancer take to develop from HPV? It can take 3 to 7 years for cervical changes to become cancerous. Regular screening can catch changes early.
• Can I get the HPV vaccine if I’ve already had sex? Yes, the vaccine still protects against HPV types you haven’t encountered.
• Do I still need cervical cancer screening if vaccinated? Yes, since the vaccine doesn’t protect against all cancer-causing HPV types.
• What if I miss a shot? You don’t need to start over; schedule the next dose soon.
• Can HPV be prevented with condoms or dental dams? These can reduce HPV risk but don’t fully protect against it, as HPV infects areas not covered by these barriers.

HPV Vaccine After an Infection

For those treated for abnormal cell changes due to HPV, the vaccine can help prevent recurrence, especially for people aged 27 to 45 with moderate to severe cell changes.

Key Takeaways

1. HPV is common, often without symptoms, and can cause warts or cancer.
2. The HPV vaccine is highly effective against most HPV-related diseases.
3. Regular cervical cancer screenings are essential, even if vaccinated.
4. Using condoms or dental dams offers additional protection against HPV.
5. Discuss any questions about the vaccine with your healthcare provider.

Managing HPV

Managing HPV combines prevention, vaccination, and regular screenings. Vaccination is essential, but screening and using protection during sex remain important to reduce risks from HPV types not covered by the vaccine. For those with prior infections, the HPV vaccine can help lower the risk of recurrence, providing extra peace of mind.