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$Unique_ID{BRK04319}
$Pretitle{}
$Title{Vulvovaginitis}
$Subject{Vulvovaginitis Vaginitis Nonspecific Vaginitis Vaginitis Garderella
Vaginalis Vaginitis Haemophilus Vaginalis Trichomoniasis Genital Candidiasis
Yeast Infection Bacterial Vaginitis Chlamydia }
$Volume{}
$Log{}

Copyright (C) 1990 National Organization for Rare Disorders, Inc.

761:
Vulvovaginitis

** IMPORTANT **
It is possible that the main title of the article (Vulvovaginitis) is not
the name you expected.  Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Vaginitis
     Nonspecific Vaginitis
     Vaginitis, Garderella Vaginalis
     Vaginitis, Haemophilus Vaginalis
     Trichomoniasis
     Genital Candidiasis
     Yeast Infection
     Bacterial Vaginitis

Information on the following diseases can be found in the Related
Disorders section of this report:

     Chlamydia

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Vulvovaginitis is a common bacterial infection characterized by the
simultaneous inflammation of the external parts of the female genital organs
(vulva) and the canal that leads from the uterus to the external opening
(vagina).  It is one of the most frequent causes of genital symptoms in
women.  When only the vagina is inflamed, the disorder is called vaginitis.
The symptoms and treatments of Vulvovaginitis depend on the specific bacteria
that caused the disorder.

The most common types of vulvovaginitis are Genital Candidiasis (also
called Yeast Infection), Trichomoniasis, and Nonspecific Vaginitis (also
called Haemophilus Vaginalis Vaginitis, Bacterial Vaginitis or Garderella
Vaginalis Vaginitis).  Some types of vulvovaginitis are rarer than others.

Vulvovaginitis occurs when the normal acid/alkaline balance of the vagina
is disturbed.  Yeast, fungi and other harmful organisms which are normally
present may grow in excessive amounts causing infection of the vaginal walls.

Symptoms

The symptoms of Genital Candidiasis may include moderate to severe itching
(pruritus) or burning of the vaginal area, difficult or painful urination
(dysuria) and a thick discharge which may resemble cottage cheese.  More
rarely, there is a thin, watery discharge.  Symptoms usually increase during
the week before the menstrual period.  Approximately 10% of the male sexual
partners of infected women may develop symptoms such as abnormal redness and
itching of the penis.  (For more information, choose "Candidiasis" as your
search term in the Rare Disease Database.)

Symptoms of Trichomoniasis type of Vulvovaginitis may include severe
itching and a thin, frothy, offensive smelling discharge.  There is usually
inflammation of the vulva, and painful, difficult urination.  Symptoms
usually begin or become worse during or immediately after the menstrual
period.  Some women do not show symptoms for six months after infection has
begun.  Trichomoniasis bacteria can be isolated in 30% to 70% of the male
sexual partners of infected women.  Most men show no symptoms, but should be
treated to stop transmission to their female sexual partners.

Women with Nonspecific Vaginitis usually have a light discharge which may
contain bubbles and have a "fishy" odor.  Initially, there is little
inflammation of the vulva and three-quarters of infected women will show no
symptoms.  Symptoms of Nonspecific Vaginitis are not related to the stages of
the menstrual cycle.  Later symptoms may include inflammation of the vulva,
itching or burning of the vaginal area, and painful or difficult sexual
intercourse (dyspareunia).

Causes

Vulvovaginitis may occur as a result of a disturbance in the normal balance
of acidity and alkalinity in the vagina.  This allows bacteria, yeast or
other harmful organisms to grow.  Factors which may increase susceptibility
to these infections are birth control pills, pregnancy, poor diet,
antibiotics, frequent douching with chemical products, deodorant sprays,
laundry soaps, fabric softeners and bath water additives.  Tight, nonporous,
nonabsorbent underclothing which does not provide adequate ventilation to the
area, along with poor hygiene may increase the growth of bacteria and fungi.
Sensitivity to spermicides, sexual lubricants or latex on a diaphragm or
condom may also cause irritation and disturb the natural balance.

Certain forms of Vulvovaginitis may be transmitted sexually.  More
rarely, vaginal infection may be the result of foreign bodies, a viral
infection such as herpes, pinworm or tumors of the reproductive tract.

Genital Candidiasis (Yeast Infection) is caused by the fungus Candida.
Antibiotics taken for infection elsewhere in the body may reduce the normal
bacterial content of the vagina, allowing yeasts to overgrow.  Women on oral
contraceptives are more susceptible to vaginal infections since hormonal
changes may also upset the natural balance between bacteria and yeast in the
vagina.  Genital Candidiasis is rarely transmitted by sexual relations.  (For
more information on this disorder, choose the term "Candidiasis" for your
search term in the Rare Disease Database.)

Trichomoniasis is caused by the parasitic protozoa Trichomonas Vaginalis,
and is usually transmitted by sexual intercourse.  Occasionally
Trichomoniasis may be transmitted nonsexually since Trichomonas can survive
for several hours on wet surfaces.  Contact with infected moist objects such
as towels, bathing suits, underwear, washcloths, toilet seats and locker room
benches may result in this type of Vulvovaginitis.

Nonspecific Vaginitis can be caused by the bacteria Haemophilus Vaginalis
or Garderella Vaginalis.  Nonspecific Vaginitis is commonly transmitted by
sexual intercourse.

Affected Population

Vulvovaginitis occurs most commonly in women during their reproductive years.
Genital Candidiasis occurs frequently in pregnant and diabetic women.
Certain types of Vulvovaginitis may be contracted through sexual intercourse
and in turn spread to sexual partners.

Related Disorders

Symptoms of the following disorder can be similar to those of Vulvovaginitis.
A comparison may be useful for a differential diagnosis:

Chlamydia is a common sexually transmitted infection which results in
inflammation of the tube that conducts urine from the bladder to the outside
of the body (urethra).  It is characterized by vaginal discharge and pain on
urination.  Chlamydial Infection is also common in men who get it from their
sexual partners.  (For more information of this disorder, choose "Chlamydia"
as your search term in the Rare Disease Database.)

Therapies:  Standard

Women with Genital Candidiasis are usually successfully treated with a local
antifungal imidazole drugs, (e.g., miconazole).  Polyene drugs (i.e.,
nystatin) are also commonly prescribed.  Treatment may be in the form of
vaginal suppositories, creams or powders.  Recurrence is frequently a
problem, and those who suffer from repeated infections may need to avoid the
use of antibiotics.  Switching to a lower dosage oral contraceptive may also
be helpful to these individuals.  Eating yogurt may help in prevention of
yeast infections since it contains harmless bacteria which may help restore
the acid/alkaline balance in the vagina.  Men with Candidiasis infection may
be treated by a topical anticandidal medication.  (For more information on
this disorder, choose "Candidiasis" as your search term in the Rare Disease
Database).

The Trichomoniasis type of Vulvovaginitis is usually treated orally with
the drug Metronidazole.  Clotrimazole may also be prescribed for intravaginal
use.  Douching with an acidic preparation may be recommended by some
physicians.  Infected individuals of both sexes are usually advised to
abstain from sexual intercourse until the infection is cured.

Nonspecific Vaginitis is also treated with the drug Metronidazole.
Vaginal suppositories and propionic acid jelly are also commonly prescribed.
Pregnant women are occasionally treated with Ampicillin.  Approximately 25%
of infected individuals will have recurrences requiring treatment.  Initial
treatment of infected women need not involve treatment of their sexual
partners.  However simultaneous treatment of their sexual partners is
usually encouraged for women with recurrent infections.  Sexual intercourse
is usually not recommended until the infection clears.

There are numerous precautions suggested to avoid vaginal infections.
Women should be reminded to keep the external genitalia clean, and dry the
area carefully after bathing; avoid irritating sprays and soaps; wear cotton
instead of polyester underwear; avoid pants that are tight in the crotch and
thighs; change tampons frequently; and make sure that sexual partners are
free of infections and receive proper therapy when indicated.

Therapies:  Investigational

This disease entry is based upon medical information available through July
1990.  Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate.  Please
check with the agencies listed in the Resources section for the most current
information about this disorder.

Resources

For more information on Vulvovaginitis, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT 06812-1783
     [phone]

     American Social Health Network
     100 Capitola Dr., Suite 200
     Research Triangle Park, NC  27713
     [phone]

     National Sexually Transmitted Diseases Hotline
     [phone]

     Council for Sex Information and Education
     444 Lincoln Blvd., Suite 107
     Venice, CA  90291

     NIH/National Institute of Allergy and Infectious Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

References

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown and
Co., 1987.  Pp. 1528-1529.

THE MERCK MANUAL, Volume 1, 14th Ed.:  Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982.  Pp. 1705-1708.

ANTIMICROBIAL EFFECTS OF NIRIDAZOLE ON GARDNERELLA VAGINALIS.  R.M.
Bannatyne et al.; INFECTION (Mar-Apr 1987; 15(2):128).

THE ROLE OF BENZYDAMINE IN THE TOPICAL TREATMENT OF THE SO-CALLED NON-
SPECIFIC VAGINITIS.  E.M. Magliano et al.; INT J TISSUE REACT (1987;
9(2):151-6).