What are possible causes of a vaginal infection?

Doctor's Answer

Why vaginal infections happen

Vaginal infections in women are relatively common. Most women will have at least one vaginal infection in their lifetime. This can be bacterial, fungal and viral. All these vaginal infections arise when the natural vaginal pH (mildly acidic) changes to become mildly alkaline. This then predisposes one to vaginal infections. In a mildly acidic environment, bacterial, fungal and viral infections are unlikely to thrive as this environment does not allow them to grow. Women are therefore encouraged to practice good personal hygiene, use specially formulated feminine washes and consume prophylactic oral probiotics.

Fungal infection of the vagina

One of the commonest vaginal infections affecting women is fungal infections, with candida being the most common. This can be the result of poor personal hygiene or intercourse. This usually presents with a thick, cheesy white discharge and can be associated with vaginal itch. A course of anti-fungal medication (oral and/or vaginal) should successfully clear it up.

Bacterial vaginosis

As for bacterial infections, bacterial vaginosis is a common example and is caused by the overgrowth of bacteria naturally found in the vagina. It typically presents with a thin, grey, white or green vaginal discharge, "fishy-like" vaginal odour, vaginal itching and sometimes a burning sensation during urination. Sometimes, women with bacterial vaginosis may not have any symptoms at all.

Group B streptococcus is a bacteria found in the intestines and genital area. Infected patients may not have any symptoms; if they do, then fever and vaginal discharge are usually reported.

Both these bacterial infections can be successfully treated with a course of appropriate antibiotics. For pregnant women, group B streptococcus infection is a cause of concern because, if not screened for and treated during pregnancy and labour, it can cause meningitis in the newborn baby.

Sexually transmitted infections

Sexually transmitted bacterial vaginal infections include chlamydia, gonorrhoea, and syphilis. Infected women usually manifest with fever, pelvic pain and vaginal discharge. For chlamydia and gonorrhoea especially, they need to be diagnosed and promptly treated with antibiotics as any delay may lead to Fallopian tube damage and eventual infertility. In cases in which a pelvic abscess has developed, surgical drainage may be needed especially if intravenous antibiotics do not work.

Herpes Simplex Virus (HSV)

Viral infections like HSV can present with pain, itching and genital ulcers. In mild infections, there may not be any symptoms. It is spread through sexual contact and skin-to-skin contact. There is a higher chance of recurrence but the symptoms and signs may be less severe than the initial infection and usually heals faster. HSV usually responds well to a course of oral or topical antiviral (acyclovir) treatment.

Human Papilloma Virus (HPV)

HPV infections arise from sexual intercourse. HPV is a major cause of genital warts and cancer (cervical, vaginal, vulva and anal). Genital warts are painful and, as a result, they usually present early (weeks after infection). These are initially treated conservatively with Imiquimod (boosts the immune system's ability to fight genital warts), Podophyllin (destroys genital wart tissue) or Trichloroacetic acid (burns off genital warts). If these fail, then genital warts can be frozen off, surgically cut off, removed via electrocautery or lasered off.

More of a concern is the HPV strains that cause cervical, vaginal, vulva and anal cancer as infections with this is asymptomatic initially. This is why women are encouraged to see their gynaecologist on a regular basis for routine pap smear screening for cervical cancer (which is the most common of the 4 cancers). Pap smears can only detect the infection, precancer (CIN) and cancer. They do not prevent HPV infection. All women are therefore encouraged to have cervical cancer vaccination as this is the ONLY way to prevent HPV infections which in turn prevents genital warts, precancer and cancer.

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