Natural BV Treatment Book
Noninfectious causes of vaginitis include irritants (eg, minipads, spermicides, povidone-iodine, topical antimycotic drugs, soaps and perfumes) and contact dermatitis (eg, latex condoms and antimycotic creams). 2. Typical symptoms, including pruritus, irritation, burning, soreness, and variable discharge, are most commonly confused with acute candida vaginitis. The diagnosis should be suspected in symptomatic women who do not have an otherwise apparent infectious cause. 3. Management of noninfectious vaginitis includes identifying and eliminating the offending agent. Sodium bicarbonate sitz baths and topical vegetable oils may provide some local relief. Topical corticosteroids are not recommended.
Candida vulvovaginitis accounts for one-third of vaginitis. Up to 75 of women report having had at least one episode of candidiasis. The condition is rare before menarche. It is less common in postmenopausal women, unless they are taking estrogen replacement therapy.
Bacterial vaginosis can be diagnosed by the use of clinical and microscopic criteria. The CDC states that for the disease to be diagnosed, three of the following signs or symptoms must be present (1) a homogeneous, white, noninflammatory discharge that smoothly coats the vaginal walls (2) presence of clue cells on microscopic examination (epithelial cells coated by bacteria) (3) pH greater than 4.5 and (4) a fishy odor to the discharge after addition of KOH (whiff test). 3 Gram staining, which demonstrates a concentration of bacterial morphotypes characteristic of BV, is an acceptable laboratory method of diagnosing BV. Culture of G. vaginalis is not recommended.3
During menarche, pregnancy, and lactation and after menopause, the vaginal epithelium lacks the stimulation of estrogen. The maturation of the vaginal and urethra mucosa depends on the presence of estrogen and can be altered by the absence of estrogen or the presence of antiestrogenic factors, such as hormones, drugs, or diseases. Menopause results in a vaginal mucosa that is attenuated, pale, and almost transparent as a result of decreased vascularity. The vagina loses its normal rugae. The squamous epithelium atrophies, the glycogen content of the cells decreases, and the vaginal pH ranges from 5.5 to 7.0. The mucosa is only three or four cells thick and is less resistant to minor trauma and infection. Marked atrophic changes can cause atrophic vaginitis. It is important to distinguish between symptomatic atrophic vaginitis, which is rare, and an atrophic vagina that is a result of physiologic changes of menopause. When symptomatic vaginitis occurs, the vaginal epithelium is thin,...
Normal VulyovaqinalEnyironment Bacterial Vaqinosis Candida Vaginitis Trichomonas Vaginalis Contact Vulvovaginitis Vaginal Foreign Bodies Pinworms Atrophic Vaginitis Chapter References The most common causes of acute vulvovaginitis include (1) infections, (2) irritant or allergic contact vulvovaginitis, (3) local response to a vaginal foreign body, and (4) atrophic vaginitis. The three most frequent infectious causes are trichomoniasis (caused by Trichomonas vaginalis), bacterial vaginosis (BV caused by replacement of normal flora by overgrowth of anaerobes and Gardnerella vaginalis), and candidiasis (usually caused by Candida albicans).2 BV is the most common cause of vaginal discharge or malodor. Polymicrobial infection in women with vaginitis is not uncommon. Vulvovaginal candidiasis, contact vaginitis, and atrophic vaginitis may occur in virgins and after menopause, but other forms of infectious vulvovaginitis are generally found only in sexually active women. 2 TABLE 104-1...
Candida species are a common cause of vaginitis. While there are no reliable figures as to prevalence of vulvovaginal candidiasis (VVC) because the disease is not reportable, it is estimated that 75 percent of women will experience at least one infection during their childbearing years (with the highest attack rate during the third trimester of pregnancy), making it the second commonest vaginal infection.2 A small subpopulation of women, less than 5 percent, have repeated episodes of disease with no apparent factors being responsible for recurrent infection. Factors that enhance the germination of Candida (e.g., pregnancy and estrogen therapy) tend to precipitate symptomatic vaginitis, while conditions that inhibit germination (normal flora and local mucosal cell-mediated immunity) prevent acute vaginitis in carriers of yeast. The growth of Candida is held in check by the normal vaginal flora, and symptoms of vaginitis usually occur only when the normal balance is upset. Conditions...
In addition to the IgG-binding proteins associated with staphylococci and streptococci, an increasing number of both gram-positive and gram-negative bacteria have been reported to express immunoglobulin-binding proteins with reactivity for IgA, IgD and IgM, as well as a protein that binds to certain k light chains (Table 2). To date, no disease association has been suggested for any of the putative IgA-, IgM-and IgD-binding proteins. The Fc binding protein associated with H. somnus has been implicated as a virulence factor in cattle and an association between expression of protein L, a light chain-binding protein, by Peptococcus magnus and vaginal infections has been proposed.
Inflammatory vaginitis has been reported. Balantidium has been described in the urinary bladder of an infected individual (Knight, 1978a Ladas et al., 1989 Maleky, 1998). Pulmonary lesions can occur in immunocompromised patients without obvious contact with pigs, nor history of diarrhea prior to pulmonary infection (Anargyrou et al., 2003). Balantidium pneumonia has been described in a 71-year-old woman suffering from anal cancer (Vasilakopoulou et al., 2003). Chronic colitis and inflammatory polyposis of the rectum and sigmoid colon and an intrapulmonary mass have been described in a case with balantidiasis (Ladas et al., 1989).
The diagnosis of trichomoniasis vaginitis is made through use of the hanging-drop slide test, which has a sensitivity of 80 to 90 percent in symptomatic patients. A cotton swab is used to obtain a specimen of secretions from the vaginal vault (not the endocervix) and is placed within a drop of normal saline solution on a glass slide. Microscopic examination reveals many polymorphonuclear leukocytes (PMNs) and motile, pear-shaped, flagellated trichomonads, which are slightly larger than the leukocytes. As a screening test in asymptomatic individuals, the microscopic test may only be 40 percent sensitive, but has virtually 100 percent specificity. Cultures are about 95 percent sensitive and should be considered in symptomatic patients with elevated pH, PMN excess, and absence of motile trichomonads and clue cells.
VAGINITIS Vaginitis is the most common cause of pelvic pain and vaginal bleeding in prepubertal children. The immature anatomy and the hypoestrogenic state predispose children to this condition. In this age group, Staphylococcus epidermidis and diphtheroids are the predominant vaginal flora. Lactobacillus, which metabolizes glycogen to lactic acid in adults, is not found in children. This contributes to the alkaline environment of the prepubertal vagina, and as a consequence, children may develop infections with organisms that are not pathogenic in adults. This topic is covered in greater depth in Chap 104.
Danazol (Danocrine) has been highly effective in relieving the symptoms of endometriosis, but adverse effects may preclude its use. Adverse effects include headache, flushing, sweating and atrophic vaginitis. Androgenic side effects include acne, edema, hirsutism, deepening of the voice and weight gain. The initial dosage should be 800 mg per day, given in two divided oral doses. The overall response rate is 84 to 92 percent.
Clinical trichomoniasis in women varies from asymptomatic state in 10 to 50 of infected women to an obvious vaginitis, 15 which may be either acute or chronic in nature. Women with asymptomatic infection have a normal vaginal pH and flora 16 but during the following 6 months up to 50 of these patients will develop symptoms. Acute infection is characterized by diffuse vulvitis due to a copious leucorrhea the discharge is usually frothy, yellow or green, and mucopurulent.1-17-1 Small hemorrhagic spots may be seen in the vaginal and cervical mucosa, which is commonly referred as a ''strawberry appearance'' and is observed only in 2 of the patients. These signs and symptoms are cyclic and worsen around the time of menses. 4,17 In chronic infection symptoms are mild with pruritus and dyspa-reunia vaginal secretion may be scanty and mixed with mucus. 15,20 Although vaginitis is the most common manifestation of T. vaginalis infection the disease may also be associated with infertility,...
Many known factors are associated with preterm labor. More common ones include PROM, abruptio placentae, drug abuse (particularly of cocaine and amphetamines), multiple gestations, polyhydramnios, cervical incompetence, and infection. Sexually transmitted diseases, including syphilis, gonorrhea, Chlamydia, and bacterial vaginosis are two to three times more likely to be associated with preterm labor. The presence of low-grade infection is felt to be one of the most important causes of PROM because bacterial colonization can reduce the tensile strength of membranes. 16 Of importance is the association of digital pelvic examinations and increased frequency of PROM. As a result of this finding, cervical examinations should not be performed from 37 weeks gestation unless the results of the examination will clearly influence clinical management. Of course, all digital examinations during pregnancy should be done using sterile gloves. In addition to the routine physical examination, the...
Children and adolescents may insert objects intravaginally during periods of genital exploration or sexual stimulation. In young girls, the most commonly inserted foreign bodies are rolled-up pieces of toilet paper, toys, and small household objects. 1 In adolescents and adult women, it is often a forgotten tampon or sponge contraceptive. Foreign objects left in place for more than 48 h can cause severe localized infections due to Escherichia coli, anaerobes, or overgrowth of other vaginal flora. Patients present with a foul-smelling and or bloody vaginal discharge. The only treatment necessary for vaginitis secondary to the presence of a foreign body is removal of the object.1 In most cases, the vaginal discharge and odor will disappear without further therapy within several days.
Prevents scurvy helps to heal ulcers causes constipation unpasteurized milk has more nutrients than pasteurized a glass of milk before bed causes drowsiness mothers who drink a lot of milk have colicky babies milk and other dairy products are fattening and should be avoided on a low-fat diet the calcium in milk and other foods causes kidney stones Prevents vaginal yeast infections cures vaginitis, constipation, and diarrhea yoghurt applied topically heals a sunburn
Two of these ligands, BMS 378806 and Pro542, specifically bind to the CD4 binding site of the HIV-1 gp120 protein and prevent virus entry 87, 88 . BMS 378806 is a small molecule that works allosterically to prevent gp120 conformational changes required for its binding to CD4 89 and Pro542 is a polyvalent CD4-IgG2 fusion protein that has a much longer half life in vivo than soluble CD4 alone 87 . Alternatively, the C52L peptide is a gp41-bind-ing ligand that was derived as a sequence modification of the FDA-approved T20 enfuvirtide peptide 90 . These ligands block formation of virus gp41 six-helix bundles that are required for fusion between the virus and cell membranes 19 . BMS 378806 and C52L have anti-infective activities across multiple HIV-1 subtypes, but BMS 378806 activity is much greater against subtype B virus 91, 92 . Pro542 anti-infective activity in human cervical explants indicates that it can block both localized infection within the tissue and trans infection via...
Lactobacilli and bifidobacteria, sometimes combined with Streptococcus thermophilus, are the main bacteria used as probiotics in fermented dairy products. Most probiotic research has been done with nutra-ceutical preparations, but yogurt has been shown to alleviate lactose intolerance, prevent vaginal can-didosis in women with recurrent vaginitis, and reduce the incidence or severity of gastrointestinal infections.
Measurement of vaginal pH should always be determined. The pH of the normal vaginal secretions is 4.0 to 4.5. A pH above 4.5 suggests bacterial vaginosis or trichomoniasis (pH 5 to 6), and helps to exclude candida vulvovaginitis (pH 4 to 4.5). coccobacilli (clue cells), and polymorphonuclear cells (PMNs). The addition of 10 potassium hydroxide to the wet mount is helpful in diagnosing candida vaginitis. Culture for candida and trichomonas may be useful if microscopy is negative. Clinical Manifestations of Vaginitis Candidal Vaginitis Bacterial Vaginosis Atrophic Vaginitis
Symptoms of vaginitis include vaginal discharge, pruritus, irritation, soreness, odor, dyspareunia and dysuria. Dyspareunia is a common feature of atrophic vaginitis. Abdominal pain is suggestive of pelvic inflammatory disease and suprapubic pain is suggestive of cystitis.
In a multicenter study, including 2322 women, the Pearl Index of efficacy in compliant patients was 0.8. Irregular bleeding was uncommon (5.5 of cycles), and withdrawal bleeding occurred in 98.5 of cycles. Compliance was 86 , with 15 of women discontinuing treatment because of an adverse event, most commonly device-related discomfort, headache, or vaginal discharge vaginitis. Only 2.5 of discontinuations were device related.
The vulva usually appears normal in bacterial vaginosis. Erythema, edema, or fissure formation suggest candidiasis, trichomoniasis, or dermatitis. Trichomonas is associated with a purulent discharge candidiasis is associated with a thick, adherent, cottage cheese-like discharge and bacterial vaginosis is associated with a thin, homogeneous, fishy smelling discharge. The cervix in women with cervicitis is usually erythematous and friable, with a mucopurulent discharge. Abdominal or cervical motion tenderness is suggestive of PID.
The clinical symptoms of UTI in an adult are dysuria, frequency, and lower abdominal pain. However, the correlation between symptoms and the presence of infection is inexact as only 50 to 60 percent of women with dysuria have significant bacteriuria.24 Internal dysuria, a burning suprapubic pain during urination associated with bladder tenderness, is more associated with UTIs as compared to external dysuria, the burning sensation as urine passes over inflamed perineal tissue. In females, external dysuria or a history of vaginal discharge is more associated with vaginitis, cervicitis, or pelvic inflammatory disease than with a UTI.
A variety of assays for simultaneous detection of mollicutes and other pathogens have been described, e.g., a multiplex real-time PCR assay to detect M. pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in respiratory samples. 17 In addition, a multiplex RT-PCR for the detection of M. pneumoniae and eight additional respiratory pathogens has been constructed.1-18-1 Simultaneous detection of M. hominis together with the bacterial vaginosis-associated pathogens Lactobacillus spp. and Gardnerella vaginalis by real-time PCR has been described. 19
Risk factors for PID within a sexually active population include multiple sexual partners, history of other STDs, substance abuse, and frequent vaginal douching. Younger age is associated with increased risk, possibly because of a larger zone of cervical ectopy in young women, increased cervical mucosal permeability, lower prevalence of protective chlamydial antibodies, risk-taking behavior, or a combination of these factors. 4 Barrier contraception is associated with lower risk of PID. IUD use is associated with a 2 to 9 fold increased risk for PID, with the highest risk in the first four months after insertion. 56 Oral contraceptive pills (OCPs) increase the risk of endocervical infection, probably by increasing the zone of cervical ectopy. However, OCPs decrease the risk of symptomatic PID, possibly by increasing the viscosity of cervical mucus, decreasing menstrual blood flow (and hence decreasing retrograde menstruation), or modifying local immune responses. 7 Bilateral tubal...
Disease Control and Prevention (CDC) also recommend prophylaxis against Trichomonas and bacterial vaginosis.19 T.a.ble 2.9 0.-.1 presents the current CDC guidelines for antibiotic choices. A negative pregnancy test should be documented on the chart prior to administering antibiotics a positive pregnancy test will alter the choice of antibiotics. See Chapte.L1.37 for further information on treatment of STDs. Hepatitis B prophylaxis should be considered if the assailant is felt to belong to high-risk group for the disease. The CDC recommends postexposure vaccination with the first dose administered at the time of the initial exam.19 Administration of hepatitis B immune globin (HBIG) may also be considered. For those who have been vaccinated, a booster and HBIG should be given only if antibody titers are inadequate.
Critics of the cervical mucus method note that some women may have difficulty assessing their own discharge. It does take practice, and this is something that you might want to discuss with your doctor. Also, your cervical mucus may change if you have a vaginal infection or medical illness or if you are taking certain medications.
The above SIV cervical-vaginal infection studies in NHPs attempt to predict how a male-to-female sexual infection occurs when the genital tract epithelium is intact. However, the likelihood of normally occurring mucosal lesions in the female vagina and those produced during coitus or from local inflammation due to ulcerative non-HIV sexually transmitted infections (STIs) would provide a more direct route for HIV-1 to breach the genital tract epithelium and access the numerous CD4+ lymphocyte and macrophage virus targets in the
Serum, vaccines, antigens, and antitoxins are derived from many food-animal tissues acquired both during the slaughter and processing of and by primary extraction from hyperimmunized animals. The true biologicals serve as preventive and treatment regimes in both humans and animals and are primarily derived from blood. Other animal tissues have been primary for the replication of cell-culture vaccines. Biotechnology continues to alter vaccine production processes, but animal by-products and their extractions are still important components. Purified animal blood is fractionated into many vital end products for numerous medical applications. Examples include thrombin, which is used for blood coagulation agents and skin graft procedures, fibrin used in surgical repair of internal organs, and fibrinolysin, an enzyme used to assist digestive and vaginal infections, as well as for wound cleaning agents.
Smears that are unsatisfactory for evaluation may have scanty cellular material or may be obscured by inflammation, blood, or debris so that more than 75 percent of the cells are uninterpretable. Unsatisfactory Pap smears should always be repeated in two to four months. If the cells are obscured by inflammation, an attempt should be made to clear the inflammatory process (eg, treat cervicitis or vaginitis) prior to repeating the smear.
Bacterial vaginosis is the most common cause of vaginitis in women of childbearing age, with prevalence of 560 . B. Microbiology and risk factors. Bacterial vaginosis represents a change in vaginal flora characterized by a reduction of lactobacilli and an increase of Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, anaerobic gramnegative rods, and Peptostreptococcus species. Risk factors for bacterial vaginosis include multiple or new sexual partners, early age of first coitus, douching, cigarette smoking, and use of an intrauterine contraceptive device.
The vaginal pH is typically 4 to 4.5, which distinguishes candidiasis from Trichomonas or bacterial vaginosis. The diagnosis is confirmed by finding the organism on a wet mount adding 10 potassium hydroxide facilitates recognition of budding yeast and hyphae. Microscopy is negative in 50 of patients with vulvovaginal candidiasis.
Vaginitis is inflammation of the vagina, often resulting in increased discharge and or pruritus, and usually caused by an identifiable microbe (see Table 26-1). There are several common organisms that cause vaginitis Bacterial (Gardnerella), Candida, and Trichomonas. The distinguishing features are described with the following characteristics.
The differential diagnosis of vaginal bleeding during the first trimester should include abortion (most common cause), ectopic pregnancy, and GTD. Other causes include implantation bleeding (physiologic) seen around or just after the time of expected menses due to the burrowing of the embryo into the highly vascular decidual tissue, cervical ectropion, and cervicitis due to infection from gonorrhea, Chlamydia, or bacterial vaginosis.
ENTEROBIUS (PINWORM) Adult Enterobius (pinworm) resides in the cecum, appendix, ileum, and ascending colon after its eggs are ingested. The gravid female migrates to the anus, especially at night, where it causes intense pruritus. Autoinfection with hand-to-mouth transmission is possible after scratching. A host of problems from vaginitis to enuresis have been attributed to Enterobius infection without good evidence. It is most prevalent in temperate climates during the winter and fall. The diagnosis is confirmed with a cellophane tape swab of the anus. All family members should be examined. Treatment is with pyrantel pamoate, albendazole, or mebendazole and should be repeated after 2 weeks.
Sexually transmitted pathogens cause several common syndromes. Infection with Neisseria gonorrhoea or Chlamydia trachomatis frequently results in urethritis, cervicitis, or the constellation of symptoms and signs that suggest the presence of pelvic inflammatory disease. HSV, Treponema pallidum, and Haemophilus ducreyi are common agents of ulcerative genital disease, while vaginal discharge is commonly caused by infection with Trichomonas vaginalis or Candida spp. or by bacterial vaginosis. The accuracy of bedside diagnosis of vaginitis based on clinical features and simple bedside A wide range of sensitivities (50-100 ) have been reported for EIA for gonococcus, when performed on genital specimens, although these tests do appear specific (95-99 ) for gonococcal infection when compared with culture.57-62 Factors that may depress the sensitivity of gonococcal EIA include disturbances of normal vaginal flora associated with concommittant vaginitis in women,62 and the degree of dilution...
Public discussion in recent years has focused on a syndrome including fatigue, premenstrual tension, gastrointestinal symptoms and depression. Dismukes et al.5 conducted a 32-week randomised, double-blind, crossover study using four different combinations of nystatin or placebo given orally or vaginally in 42 premenopausal women who met current criteria for the syndrome and had a history of Candida vaginitis. The outcomes studied were the changes from baseline scores for vaginal, systemic and overall symptoms, and the results of standardised psychological tests. Both active drug and placebo significantly reduced the clinical symptoms. The active-treatment regimens were more effective than placebo in relieving vaginal symptoms. All regimens, however, produced similar reductions in psychological symptoms and global indexes of distress.5
Several complications of pregnancy, such as pre-eclampsia, fetal distress, fetal growth restriction, abruptio placenta, fetal death, placenta previa, and multiple gestations, are associated with preterm delivery, either spontaneous or induced. Importantly, developments in obstetric and neonatal care, and the consequent increase in obstetric interventions, are likely to be associated with the increase in rates of preterm delivery observed in recent years. Although several lifestyle factors and conditions have been implicated as possible causes, a definitive etiology has not been determined, making it difficult to identify women at risk and to implement preventive strategies. Poor nutrition, cigarette smoking, and alcohol and drug abuse have been indicated as possible risk factors, as well as young maternal age, poverty, short stature, occupational factors, and psychological stress. In addition, genetic factors are likely to be involved in the etiopathogenesis of pre-term delivery, as...
An interesting study investigated the relationship between female genital candidiasis and Candida colonisation of their partners. A total of 125 women experiencing an acute episode of recurrent candidal vaginitis were enrolled.30 Oral, penile and ejaculate cultures were also prepared from their male sexual partners. The rates of oral and rectal colonisation with Candida species in the women were 36 (45 125) and 45 (56 125), respectively. The male partners' oral cavities were positive in 23 (29 125) the penile coronal sulcus in 16 (20 125) and seminal fluid in 14 (18 125), respectively. In a follow up of 1 year, the clinical and microbiologic cure rate in the study group was 72 (95 125). The rate of relapse was not influenced by the treatment of Candida colonisation of the female intestinal tract, but the recurrence rate in the group with treatment of the sexual partner was lower (16 versus 45 , P 0-0019).30 This is the first study to show that treatment of the partner had an effect...
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Bacterial Vaginosis Facts
This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.