The Most Common Vaginal Health Problem
Vaginitis is one of the most common reasons women visit their healthcare providers (HCPs) and is a complex health issue impacting millions of women. Vaginitis is a general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora. About 90% of vaginitis is caused by bacterial vaginosis (BV), vulvovaginal candidiasis (Candida vaginitis, CV commonly known as yeast infections) and Trichomonas vaginalis (TV)(1). All are similar and often misdiagnosed. Each cause of vaginitis has its own characteristics, consequences, and treatment recommendations. However, there are now new objective, comprehensive, and accurate diagnostic tests available, which allow women to be more effectively diagnosed and therefore treated.
- Bacterial Vaginosis (BV)—BV is the most common vaginal condition affecting an estimated 21 million women ages 14 to 49 years old (2). Women with this infection, which occurs when there is an imbalance of naturally occurring bacteria in the vagina, tend to experience an uncomfortable vaginal discharge (2). BV is associated with having multiple male or female partners, a new sex partner, douching, lack of condom use and lack of vaginal lactobacilli; women who have never been sexually active are rarely affected.
- Vulvovaginal Candidiasis (Candida vaginitis, CV)—Commonly known as a yeast infection, vulvovaginal candidiasis is a result of overgrowth of a fungal organism, usually Candida albicans (1). An estimated 75% of women will have at least one episode of a yeast infection in their lifetime and 40–45% will have two or more episodes (5).
- Trichomonas vaginalis (TV)—Sometimes referred to as “trich,” TV is the most prevalent non-viral sexually transmitted infection (STI) in the United States, affecting an estimated 3.7 million persons (6).
Symptoms & Quality of Life Impact
Symptoms of the three causes of vaginitis can vary but may include any combination of the following, among others:
- increased vaginal pH
- abnormal vaginal discharge, odor, itching or burning
- pain during urination or sexual intercourse
- spotting or bleeding
Vaginitis can have a significant impact on a woman’s health and overall well-being. Of note, many women with recurring yeast infections miss as much as a week of work due to untreated Candida vaginitis (7). BV is also known to recur in more than 50% of women and has a severe impact on lifestyle, in both self-esteem and sex lives (8,9).
Many women feel embarrassed and self-conscious of their symptoms and are often confused about why they experience recurrent vaginitis; they may become frustrated at their lack of control over their health (10).
The Value of an HCP Diagnosis & Laboratory Testing
Oftentimes, many women try to self-diagnose and self-treat before visiting a HCP, assuming that abnormal vaginal discharge, itching or irritation is due to a simple yeast infection that can be treated with over-the-counter medications (4). However, misidentifying infections and enabling the wrong treatment increases the potential for recurrent and persistent infections (3). Diagnosis can be especially complicated due to the prevalence of co-infections, as approximately 20-30% of women with BV are co-infected with Candida species (6).
Therefore, a careful history, examination and laboratory testing to determine the etiology of vaginal symptoms are warranted. HCPs are able to take one swab sample and test for several disease states and infections. Testing with molecular diagnostic assays such as the Aptima® BV and Aptima® CV/TV assays provide an objective, comprehensive and accurate method for diagnosing the cause of vaginitis.
Treatment recommendations vary between BV, yeast infections, and TV, which further reinforces why it’s so important to be accurately and objectively diagnosed by an HCP on the underlying cause of vaginitis. Potential treatment includes:
- Bacterial Vaginosis (BV)—Treatment for BV may include antibiotic regimens, while treatment for uncomplicated yeast infections may include antifungal medication (3).
- Vulvovaginal Candidiasis (Candida vaginitis, CV)—Short-course topical formulations effectively treat uncomplicated yeast infections.
- Trichomonas vaginalis (TV)—TV may require an antibiotic regimen, and it’s recommended that a woman’s partner also be tested and treated for TV to prevent reinfection. Treatment reduces symptoms and signs of TV infection and might reduce transmission (5).
Potential Health Complications
When left untreated or not properly treated, vaginal conditions can put women at risk for a wide variety of complications. Those complications may include:
- Bacterial Vaginosis (BV)—Left untreated, BV can increase a woman’s chance of spontaneous abortion, preterm birth and getting an STI, such as chlamydia, gonorrhea, herpes simplex virus (HSV) or HIV (6).
- Vulvovaginal Candidiasis (Candida vaginitis, CV) —Yeast infections caused by other Candida species, such as Candida glabrata, can be more difficult to treat, and may require more aggressive therapies. Candida glabrata is resistant to some antifungals and requires a different treatment pathway than other non-resistant Candida species (4).
- Trichomonas vaginalis (TV)—Left untreated, TV infection is associated with an increased risk of HIV acquisition and prolonged HPV infection, increased chance of getting a STI such as chlamydia or pelvic inflammatory disease, and pregnancy-related risks including premature delivery, low birth weight and infertility (7).
- ACOG Practice Bulletin No. 72. Clinical management guidelines for obstetrician-gynecologists: Vaginitis. Obstet Gynecol reaffirmed 2019; 107(5): 1195-1206.
- Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. External. Sex Transm Dis. 2007 Nov;34(11):864-9.
- Hologic. Aptima CV/TV Assay Package Insert. https://www.hologic.com/package-inserts/diagnostic-products?portfolio=136.
- Center for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/bv.htm. Updated 2015. Accessed November 15, 2019.
- Center for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/candidiasis.htm. Updated 2015. Accessed November 15, 2019.
- Center for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/trichomoniasis.htm. Updated 2015.Accessed November 15, 2019.
- Aballea, et al., Subjective health statusand health-related quality of life among women with Recurrent Vulvovaginal Candidiosis in Europe and the USA. BioMed Central. 2013.
- Data on file. Vaginitis Patient Survey. Hologic, Inc., June 2019.
- Bradshaw CS, et al. High Recurrence Rates of Bacterial Vaginosis over the Course of 12 Months after Oral Metronidazole Therapy and Factors Associated with Recurrence. J Infect Dis. 2006;193(11):1478–1486. doi.org/10.1086/503780.
- Bilardi, et al., The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis. PLOS One. 2013.
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