Vaginitis

Types of vaginitis

Bacterial vaginosis

Bacterial vaginosis is the most common cause of vaginal symptoms in women aged 15 to 44. It is linked to new or multiple sex partners, douching and lack of protective lactobacilli. It is not strictly an STI but is associated with sexual activity. It raises the risk of STIs and, in pregnancy, preterm birth.

Vaginal yeast infection

Vaginal yeast infections affect about 3 in 4 women at some point. Risk factors include antibiotics, pregnancy, uncontrolled diabetes, a weak immune system and high-estrogen contraceptives.

Trichomoniasis

Trichomoniasis is a common curable STI. Many people, especially men, have no symptoms. Partners must be treated to prevent reinfection, and retesting is recommended about 3 months after treatment.

Other causes

• Atrophic vaginitis: thinning and dryness from low estrogen after menopause, while breastfeeding or with some medicines
• Irritant or allergic vaginitis (contact dermatitis): from soaps, bubble baths, douches, scented pads, spermicides, latex or laundry products
• Skin conditions: lichen sclerosus and lichen planus
• Foreign body: a forgotten tampon or, in children, toilet paper or small objects, causing foul discharge
• Desquamative inflammatory vaginitis: uncommon, with purulent discharge and irritation
• Cervicitis from chlamydia or gonorrhea, which can cause discharge that looks like vaginitis

Symptoms

• change in discharge color, amount or consistency
• odor
• itching or irritation
• burning, especially when urine touches irritated skin
• pain or discomfort during sex
• redness and swelling of the vulva
• light spotting

Diagnosis

Self-diagnosis is often wrong; many women who treat themselves for yeast actually have BV or another cause. A clinician may:

• examine the vulva and vagina
• check vaginal pH
• look at discharge under the microscope (wet mount, KOH and "whiff" test)
• send swabs for molecular (NAAT) tests for BV, yeast and trichomonas
• test for chlamydia and gonorrhea
• culture yeast for recurrent infections to identify resistant species

Treatment

• Bacterial vaginosis: metronidazole or clindamycin (tablets or vaginal gel or cream), or other antibiotics. Avoid alcohol with metronidazole.
• Yeast infection: over-the-counter vaginal antifungals (such as miconazole or clotrimazole) or a prescription oral antifungal. Follow the label dose and complete the course.
• Trichomoniasis: metronidazole, with partners treated at the same time and no sex until both are cured.
• Atrophic vaginitis: vaginal moisturizers, lubricants and low-dose vaginal estrogen.
• Irritant vaginitis: stop the irritating product; use plain water and gentle unscented soap on the vulva only.

Recurrent vaginitis

Recurrent BV or yeast (4 or more episodes a year) can be managed with longer treatment courses followed by suppressive therapy. Boric acid vaginal suppositories are sometimes used for recurrent BV or resistant yeast under medical guidance; boric acid is toxic if swallowed and must be kept away from children.

Prevention

• avoid douching and scented feminine products
• wear breathable cotton underwear and change out of wet clothing promptly
• use condoms, which lower the risk of BV and STIs
• wipe front to back
• manage blood sugar if you have diabetes

Frequently asked questions

What is the difference between bacterial vaginosis and a yeast infection?

Bacterial vaginosis usually causes thin, gray-white discharge with a fishy odor and little itching. A yeast infection usually causes thick, white, odorless discharge with intense itching and soreness. They need different treatments, so testing is helpful.

What causes vaginitis?

The most common causes are bacterial vaginosis, yeast infections and trichomoniasis. Other causes include low estrogen after menopause, irritation from soaps or products, skin conditions and forgotten tampons.

Can vaginitis go away on its own?

Mild irritation from a product may settle once you stop using it, and BV sometimes clears on its own. Most infections, including trichomoniasis and many yeast infections, need treatment. See a clinician if symptoms do not improve.

Is vaginitis sexually transmitted?

Trichomoniasis is sexually transmitted. Bacterial vaginosis is linked to sexual activity but is not considered a classic STI. Yeast infections are generally not sexually transmitted. Testing for chlamydia and gonorrhea is often recommended with new symptoms.

Should my partner be treated for vaginitis?

Partners should be treated for trichomoniasis. Routine partner treatment has not been standard for bacterial vaginosis or yeast infections, although recent research suggests treating male partners may reduce BV recurrence, and guidance is evolving. Ask your clinician about your situation.