vaginitis--%20trichomoniasis,%20candidiasis,%20bacterial%20vaginosis
VAGINITIS: TRICHOMONIASIS, CANDIDIASIS, BACTERIAL VAGINOSIS

Trichomoniasis is caused by a flagellated protozoan, Trichomonas vaginalis. It is always sexually transmitted.

Bacterial vaginosis is the most common cause of vaginitis, vaginal discharge or malodor. Its prevalence is similar in both pregnant and non-pregnant women.

Vulvovaginal candidiasis is caused by overgrowth of yeasts where 70-90% of cases are secondary to Candida albicans. It most commonly occurs when the vagina is exposed to estrogen (ie, reproductive years, pregnancy) and may be precipitated by antibiotic or corticosteroid use. Immunocompromised and diabetic women are also at risk.

Patient Education

  • Patient needs to be informed about the nature of the infection and the importance of taking full course of the medication
  • Counsel patients on possible complications of vaginitis and therapy
    • Bacterial vaginosis is associated with post-procedure pelvic inflammatory disease (PID), IUD insertion or other instrumentation, vaginal cuff cellulitis, and pregnancy-related problems (eg late miscarriage, preterm birth, premature rupture of membranes, chorioamnionitis, postpartum endometritis); patients with bacterial vaginosis are also at increased risk of HIV, chlamydia, gonorrhea and herpes infection
    • Trichomoniasis is associated with increased HIV transmission and adverse pregnancy outcomes (eg preterm delivery, premature rupture of membranes, low birth weight)
  • Inform patients with bacterial vaginosis to avoid vaginal douching, use of shower gel and antiseptic agents or shampoo in the bath tub
  • Advise patients with vulvovaginal candidiasis to avoid tight fitting synthetic clothes and use of local irritants
  • Antifungal vaginal creams used for vulvovaginal candidiasis treatment can damage latex condoms, cervical caps, and diaphragms 
  • Consider alternative contraceptive method in women with recurrent vulvovaginal candidiasis who are utilizing combined hormonal contraception
  • Advise trichomoniasis and bacterial vaginosis patients on how to lower their risk of acquiring sexually transmitted infections
    • Tailor counseling to the patient’s specific risk factors
    • Abstinence, condom use
    • Careful selection of partners
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