Chronic vaginitis is a sluggish inflammation of the vaginal mucosa that occurs when infected with bacteria, fungi or protozoa. Predisposing factors include mechanical and chemical damage, decreased immunity, hormonal changes. Symptoms of chronic lesions include vaginal discharge, itching of the genitals, painful urination, discomfort at the time of intimacy. For diagnosis, microscopy and back-seeding of a vaginal smear, serological reactions, instrumental visualization are prescribed. Treatment is carried out by local means (candles, creams, vaginal tablets), systemic etiopathogenetic drugs.
ICD 10
N76.1 Subacute and chronic vaginitis
General information
In the structure of gynecological morbidity, complaints of discharge from the genital tract are noted on average in 70% of patients, and most of these symptoms are caused by vaginitis (colpitis). Vaginitis occurs in all age groups, but most often in young sexually active patients, in women after menopause. The disease requires the earliest possible diagnosis and comprehensive treatment, otherwise there is a risk of severe complications from the reproductive system.
Causes
Chronic vaginitis has a diverse etiological structure, but the vast majority of cases are caused by infectious factors. About 40-50% of colpitis is caused by bacterial vaginosis, in 20-30% of cases ‒ STIs (gonorrhea, trichomoniasis, ureaplasmosis, chlamydia). The following factors play a role in the development and chronization of vaginitis:
- Improper intimate hygiene. The lack of regular intimate hygiene is fraught with the proliferation of opportunistic microflora. Frequent douching and vaginal irrigation without a doctor’s appointment are also dangerous because they disrupt the normal vaginal microflora.
- Mechanical injuries. Chronic vaginitis develops due to micro-injuries of the vaginal mucosa, which are observed during rough sexual intercourse, improper insertion of tampons, menstrual cups. The cause of injury may be careless gynecological manipulations (manual examination, IUD placement, hysterosalpingoscopy).
- Exogenous influences. The cause of vaginitis is mucosal damage during douching with various concentrated solutions, some herbal decoctions, and the use of low-quality intimate lubricants. Occasionally, chronic inflammation develops when a foreign body enters the vagina.
- Features of sexual life. With frequent changes of sexual partners, refusal to use barrier contraception, a woman’s risk of disease increases, since contact with foreign microflora regularly occurs. At the same time, vaginitis can occur even in the absence of an STI in the partner as a consequence of vaginal dysbiosis.
- Uncontrolled medication intake. Chronic vaginitis is often the result of attempts to self-treat an acute process, when women, without consulting a doctor, independently prescribe antibacterial candles for themselves, take tablet medications. As a result, the resistance of pathogenic flora to medications increases, vaginal dysbiosis worsens.
- Hormonal changes. It was found that with hypoestrogenism, the risk of chronic vaginitis sharply increases, which is associated with increased dryness, violation of the vaginal microflora. This situation is observed in the menopausal period, with ovarian dysfunction, and other diseases of the reproductive organs.
- Reduced immune protection. An imbalance of local and general protective factors contributes to sluggish infection with colpitis. The condition is caused by exogenous (hypothermia, unfavorable environmental situation) and endogenous factors (chronic somatic pathology, secondary immunodeficiency).
Pathogenesis
Vaginitis often develops when an infection is introduced directly into the vagina from the outside. Much less often there is an endogenous path of infection, when pathogens migrate from chronic foci of infection. The second option is typical for non-specific pathogens, such as staphylococci, E. coli, proteus.
After infection, if local defense mechanisms fail, there is an interaction of exogenous sexually transmitted infection and endogenous vaginal microbiota. This is manifested by a change in the ratio of the obligate and facultative part of the microflora, the formation of a dysbiotic process as the initial stage of vaginitis.
In the future, infectious agents have a direct damaging effect on the cells of the mucous membrane, provoke swelling, hyperemia, the appearance of inflammatory exudate. Some pathogens can parasitize intracellularly (chlamydia, ureaplasma), which increases their resistance to immune defense factors used by drugs.
The chronization of vaginal infection is usually observed 6 months after infection, often with complete lack of treatment or against the background of inadequately selected therapy. Pathogens are embedded in the structure of conditionally pathogenic vaginal microflora, infections occur in a latent form or in the form of a carrier. In the period of exacerbation, the disease takes the form of a typical acute vaginitis.
Classification
According to the age of the patient, vaginitis of girls, women of reproductive age, colpitis of the menopausal and postmenopausal period are distinguished. Given the nature of vaginal discharge, they are serous, purulent, gangrenous. In gynecological practice, the most common division of the disease into 3 groups according to the type of pathogen:
- Specific vaginitis. The disease is caused by pathogenic microorganisms (mainly venereal infections) that enter the body from the outside during intimate contacts.
- Nonspecific vaginitis. Pathology is provoked by conditionally pathogenic flora, which is normally present in the vagina, but shows its negative properties due to a decrease in immune protection.
- Mixed vaginitis. It accounts for up to 10% of all cases of chronic colpitis, characterized by the simultaneous presence of specific and non-specific pathogens in the smear. The disease is characterized by a persistent recurrent course.
Symptoms of chronic vaginitis
For colpitis, a wave-like course with alternating periods of exacerbation and remission is typical. Increased symptoms are observed with hypothermia, emotional stress, increased physical activity, and in patients of reproductive age, exacerbation can be provoked by natural hormonal fluctuations during the menstrual cycle.
The main symptom of chronic vaginitis is vaginal discharge, which has an atypical consistency, color or smell. Depending on the type of pathogen, the discharge can be white curd, foamy with a fishy smell, yellow or yellow-green purulent. In most cases, white spots are not observed constantly, but correlate with periods of exacerbation of the disease.
The second characteristic sign of colpitis is itching in the vagina. Unpleasant sensations increase during urination, sexual intercourse, a few days before the start of menstruation. With the aggravation of the process, women complain of constant pain and burning, sharp soreness during intimacy, rubbing and discomfort from underwear. The inflamed mucosa is more easily injured, so sometimes there are spotting spotting.
Complications
Chronic vaginitis is an insidious disease that, in the absence of pronounced symptoms, causes severe consequences, up to irreversible reproductive health disorders. In 13-25% of cases, women with untreated colpitis suffer from habitual miscarriage, in 8-12% intrauterine infection of the fetus is observed.
Chronic inflammation often passes to neighboring genitals — the uterus and fallopian tubes. Inflammatory changes result in the formation of adhesions that disrupt the patency of the fallopian tubes. Against this background, women often face tubal-peritoneal infertility, and with successful conception, there is a possibility of ectopic pregnancy.
Sluggish venereal infections are fraught with antigenemia, sensitization of the body, which is clinically manifested by allergic skin rashes, reactive arthritis. With an extensive inflammatory process in the pelvic organs, Fitz-Hugh-Curtis syndrome (perigepatitis) develops in 15-30% of cases, there is also a risk of tubovarial abscess, pelvioperitonitis.
Diagnostics
If there are complaints of discomfort, vaginal discharge, a consultation with an obstetrician-gynecologist is indicated. The examination begins with a standard examination in mirrors, which shows hyperemia of the vaginal mucosa, layering of pathological secretions on its walls, superficial epithelial damage. A bimanual examination of the uterus is also performed. To clarify the diagnosis, the following diagnostic methods are performed:
- Instrumental visualization. In order to comprehensively assess the state of the reproductive system, colposcopy and ultrasound of the pelvic organs are prescribed. If the diagnostic results reveal problems, the examination is supplemented with hysteroscopy, diagnostic laparoscopy.
- A smear from the vagina. For the express diagnosis of vaginitis pathogens, a test is performed with KOH for a “fishy” smell, which is typical for bacterial vaginosis. The biomaterial undergoes microscopic examination to visualize bacteria, protozoa and fungi that could cause chronic inflammation.
- Cultural method. Sowing the discharge from the vagina on special nutrient media is a prerequisite for confirming the diagnosis. After growing colonies, determining the type of pathogen, testing for sensitivity to antibiotics is recommended.
- Serological reactions. The study of blood serum for antibodies to sexually transmitted infections gives fast and accurate results. According to the indications, a PCR diagnosis of the discharge or vaginal smears is prescribed in order to type the pathogen with maximum accuracy.
Treatment of chronic vaginitis
Treatment is indicated for all women with a symptomatic form of the disease, with a latent course of infection ‒ during planning or gestation, at the stage of preparation for invasive gynecological manipulations. At the first stage, elimination of the pathogen is carried out, at the second — correction of the vaginal flora. Pathology requires complex local therapy, for which the following groups of drugs are used:
- Antimicrobial agents. They are selected taking into account the selected pathogen: it is possible to take antibiotics, antiparasitic or antifungal medications, various combined forms. The drugs are used in the form of vaginal suppositories or tablets, which have a strong local effect.
- Antiseptics. Solutions of chlorhexidine, lactic acid are successfully used as an adjunct to etiotropic therapy. They contribute to the destruction and elimination of pathogens, violate the integrity of biofilms of opportunistic microorganisms, and have fewer side effects.
- Probiotics. Taking drugs with lactobacilli is the main method of restoring microflora in chronic inflammation. Medications reduce the subjective symptoms of the disease, prevent relapses of chronic disease, because they create unfavorable conditions for the reproduction of pathogenic pathogens.
- Hormones. Vaginal creams, suppositories with estrogens are effective for eliminating signs of a chronic course of the disease during menopause, as well as in young women suffering from diseases of the endocrine organs.
Systemic therapy is rarely prescribed, mainly in the complicated course of the disease. With severe itching and discomfort that interferes with daily life, antihistamines show a good effect. Synthetic and plant immunomodulators are used to correct the immune status. Estrogen drugs can be used to restore the hormonal background.
In non-infectious chronic processes, it is necessary to identify the provoking factor and limit contacts with it. Often a woman needs to change the gel for intimate hygiene to a hypoallergenic option, limit the wearing of synthetic tight underwear. If you are allergic to hygiene products, products from other companies or alternative methods (menstrual cups, reusable pads) are considered.
Prognosis and prevention
Chronic vaginitis is difficult to treat, characterized by a recurrent course, so patients often require long-term therapy. If medical recommendations are followed, it is possible to eliminate the causal factors of the disease, so the prognosis is generally favorable. With the development of complications of colpitis, the prognosis depends on the severity and response to treatment.
To reduce the risk of chronic disease, women are recommended to observe the hygiene of the reproductive organs with the use of formulations for sensitive areas of the body, to abandon care products with flavors and preservatives, to avoid low-quality pads or tampons during menstruation. When having sex with a new partner, it is mandatory to use a condom. When choosing underwear, you should give preference to natural fabrics and models with a free fit.
