Acute vaginitis is a rapidly occurring inflammatory process of an infectious or non–infectious nature affecting the mucous membrane of the vagina. Signs are hyperemia, itching and burning in the vaginal area, abundant atypical whiteness, dyspareunia, pain when urinating. Disease is diagnosed according to gynecological examination, pH-metry, microbiological, serological and PCR studies of vaginal secretions. Leading in the treatment of acute vaginitis is the elimination of the etiological factor, which is achieved through vaginal sanitation, anti-inflammatory and antimicrobial therapy with subsequent normalization of the microflora.
N76.0 Acute vaginitis
Acute vaginitis (acute colpitis) – pronounced inflammatory changes in the mucous membrane of the vestibule and walls of the vagina that occur in response to infection, allergens, chemical irritants, exposure to high temperature. Among women of reproductive age, there is a consistently high incidence with a high predisposition to chronic pathology and frequent relapses. Disease often occurs in combination with inflammation of the vulva (vulvovaginitis), urethra and cervix. The duration of the acute form of vaginitis does not exceed 2 weeks, subacute – 2 months. Acute vaginitis causes constant and significant discomfort, disrupts sexual life, can contribute to the involvement of other reproductive organs (uterus, ovaries) in inflammation, and during pregnancy – intrauterine infection and the formation of fetal defects, miscarriage.
In the development of pathology, the decisive role belongs to the infectious factor – bacteria, protozoa, viruses, fungi. In most cases, the role of etioagents is played by foreign microorganisms that have come from outside during sexual contact (STI) or from other foci of infection (for example, tuberculosis). The predisposing moment is a violation of the normal biotope of the vagina – excessive growth of saprophytic microflora and its acquisition of virulence against the background of a decrease in the titer of lactobacilli. This leads to a shift in pH to the alkaline side, a change in the composition and immune properties of vaginal secretions.
The development of acute vaginitis is facilitated by a decrease in general and local resistance (against the background of taking glucocorticoids, COCs and antibiotics, stress, hypovitaminosis), violation of the integrity of the epithelial cover of the vagina (injuries by foreign bodies, during abortion, RV, hysteroscopy, IUD installation), hormonal imbalance (hypoestrogenism, hypothyroidism, menopause, pregnancy), metabolic disorders (diabetes mellitus). Changes in the structure of the vagina (wall drooping, gaping of the genital slit) and vascular-trophic disorders of the genital mucosa support a decrease in the protective properties of vaginal mucus.
Acute vaginitis can be provoked by frequent changes of sexual partners, unprotected sexual intercourse, incorrect personal and intimate hygiene, exposure to chemical, thermal and allergic factors (burns, wearing synthetic underwear, intolerance to condoms, spermicides, antiseptics, intimate hygiene products, fabric conditioners). This disease in girls is possible with hematogenous spread of infection from other foci (for example, with scarlet fever), diathesis, helminthiasis, insufficient hygiene of the genitals, ingestion of foreign bodies into the vagina.
Acute vaginitis can be infectious (bacterial, fungal, protozoal, viral, mixed) and non-infectious (allergic, chemical, thermal) genesis. Infectious inflammation of the vagina by the type of causative agent that caused them are divided into specific (gonorrhea, syphilitic, trichomonas, chlamydia, mycoplasma, tuberculosis, etc.) and nonspecific.
Nonspecific (aerobic) acute vaginitis is usually caused by Enterobacteria (E. coli, Enterobacter spp., Enterococcus spp., Proteus mirabilis, etc.), streptococci and staphylococci (Str. pyogenes., Staph.aureus), diphteroids. The most frequent provocateur of fungal acute vaginitis (vaginal thrush) are yeast–like fungi of the genus Candida, viral pathogens of genital herpes (HSV-2), papillomavirus infection. There may be mixed etiological forms of acute vaginitis: protozoal-bacterial, fungal-bacterial, fungal-allergic, etc.
Depending on the preliminary factor in gynecology, post-abortion, postpartum, postoperative and allergic acute vaginitis are distinguished. According to the type of vaginal exudate, acute vaginitis is classified into serous, serous-purulent, gangrenous; according to the nature of changes in the mucous membrane – into simple, macular, granulose. Based on the age of the patients, acute vaginitis of girls, women of the reproductive and menopausal period is distinguished.
Various forms of acute vaginitis are accompanied by violent manifestations and rapid course, often combined with vulvitis, urethritis, endocervicitis. Patients complain of persistent itching and burning in the vagina and external genitalia, pain during sexual intercourse and pain during urination, the appearance of abundant uncharacteristic whites from the genital tract (with an admixture of pus, sometimes blood or an unpleasant odor). Hyperemia, edema and a tendency to bleeding of the mucous membrane of the vestibule and vaginal walls are detected, with severe episodes – desquamation of the epithelium, erosion and ulcers.
Acute trichomonas vaginitis is characterized by the appearance of a large number of foamy secretions of a mucopurulent nature with a fetid odor, with the involvement of the cervix – a symptom of “strawberry cervix”. Gonorrheal acute vaginitis is characterized by abundant thick pus-like white, for syphilitic – ulcerative lesions of the external genitalia and vagina. Nonspecific vaginitis is accompanied by noticeable yellow-green discharge. With candidiasis acute vaginitis, grayish-white curd, flaky discharge and plaque on the walls and vestibule of the vagina, vulva erosion are noted.
With herpetic acute vaginitis, painful ulcers and various lesions of the mucous membrane are determined, with pappilomatous – painful warts of light or purple color in the vagina, on the vulva, in the groin. Allergic vaginitis can occur against the background of other manifestations of allergies – hay fever, asthma, atopic dermatitis.
Untreated acute vaginitis leads to chronic recurrent inflammatory processes of the reproductive tract and urinary tract, during pregnancy it poses a threat of infection of the fetus and amniotic fluid (chorioamnionitis), premature rupture of the membranes of the fetal bladder and miscarriage, the development of postpartum endometritis, newborn pneumonia, infertility in women.
Diagnosis of acute vaginitis is based on data from clinical and laboratory studies – gynecological examination, screening tests (pH-metry), microscopy of native or Gram-stained vaginal smear, cultural analysis of vaginal discharge, urethra and cervical canal, PCR and serological methods (ELISA, PIF, RIF).
With nonspecific acute vaginitis, a large number of Le (>10), exfoliated epithelial cells (10 or more), abundant gr+ and gr- microflora are bacterioscopically detected. An increase in the pH of vaginal secretions > 6.5 is indicative. With the help of bacteriological analysis, species identification of pathogens of acute vaginitis, qualitative and quantitative assessment of the state of the vaginal biotope, sensitivity to antimicrobial drugs is carried out.
Serodiagnostics data in acute vaginitis help to determine the titer of highly specific IgM, IgG and IgA antibodies to the pathogen antigens and the stage of the infectious process. The increased concentration of IgE serves as a marker of the allergic nature of acute vaginitis. If syphilis is suspected, specific serological treponemal reactions are used. PCR makes it possible to establish a wide range of pathogens in one clinical sample – the creation of a “microbiological passport” of the patient. Differential diagnosis is carried out between various etiological forms of colpitis, as well as acute vaginitis and bacterial vaginosis.
Treatment of acute vaginitis is carried out by a gynecologist in a complex, taking into account the etiology of inflammation and includes local sanitation of the vagina and vulva, systemic etiotropic therapy, normalization of the vaginal microflora. In some cases, parallel treatment of the sexual partner is required.
Etiotropic (antibacterial, antimycotic, antiviral) drugs can be applied topically – vaginally (in the form of candles, balls, capsules, cream) and systemically – orally and intramuscularly. In bacterial form, antibiotics are prescribed taking into account the sensitivity of the isolated pathogen to them: in syphilitic, penicillins, macrolides, cephalosporins are indicated; gonorrheic – penicillins, tetracyclines, fluoroquinolones inside and intramuscularly. In chlamydia, mycoplasma and ureaplasma acute vaginitis, doxicillin, azithromycin, ofloxacin are effective.
In the case of nonspecific form, topical application of antiseptic vaginal suppositories and ointments, complex preparations, disinfectants (hydroxymethylquinoxalindioxide, miramistin), baths with furacillin, potassium permanganate, decoctions of medicinal herbs is sufficient. In candidiasis acute vaginitis, antimycotics in the form of vaginal candles and cream (ketoconazole, clotrimazole, itraconazole), local nonspecific agents (sodium tetraborate) are used, fluconazole is administered orally. With severe itching, desensitizing and sedative drugs, corticosteroid ointments are indicated. Nitroimidazoles (orally and topically) are effective in trichomoniasis. Herpetic vaginitis requires the use of antiviral agents inside, candles, tampons with ointments (acyclovir, brom naphthoquinone). To normalize the biocenosis of the intestine and vagina, eubiotics are prescribed.
During the course of therapy, hygiene rules, sexual abstinence and a diet should be observed with the exception of spicy, salty, smoked and fatty, and the restriction of sweet. The result of treatment is confirmed by laboratory indicators of normocenosis. Prevention is reduced to the formation of proper hygiene skills and healthy habits, the exclusion of casual sexual relations, the restriction of the use of tampons, intimate hygiene products with perfumes, synthetic and tight underwear.