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Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause complications, such as increased susceptibility to sexually transmitted infections including HIV and pregnancy complications.
It has been shown that HIV-infected women with bacterial vaginosis (BV) are more likely to transmit HIV to their sexual partners than those without BV. Diagnostic criteria for BV have also been associated with a female genital tract factor that induces expression of HIV.
There is evidence of an association between BV and increased rates of sexually transmitted infections such as HIV/AIDS. BV is associated with up to a six-fold increase in HIV shedding. There is also a correlation between the absence of vaginal lactobacilli and infection by Neisseria gonorrhea and Chlamydia trachomatis. BV is a risk factor for viral shedding and herpes simplex virus type 2 infection. BV may increase the risk of infection with or reactivation of human papillomavirus (HPV).
In addition, bacterial vaginosis an intercurrent disease in pregnancy may increase the risk of pregnancy complications, most notably premature birth or miscarriage.
Pregnant women with BV have a higher risk of chorioamnionitis, miscarriage, preterm birth, premature rupture of membranes, and postpartum endometritis. BV is associated with gynecological and obstetric complications. Data suggest an association between BV, tubal factor infertility, and pelvic inflammatory disease. Women with BV who are treated with in vitro fertilization have a lower implantation rate and higher rates of early pregnancy loss.
Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that:
- Trichomoniasis is associated with increased risk of transmission and infection of HIV.
- Trichomoniasis may cause a woman to deliver a low-birth-weight or premature infant.
- The role of trichomonas infection in causing cervical cancer is unclear, although trichomonas infection may be associated with co-infection with high-risk strains of HPV.
- "T. vaginalis" infection in males has been found to cause asymptomatic urethritis and prostatitis. In the prostate, it may create chronic inflammation that may eventually lead to prostate cancer.
Healthy vaginal microbiota consists of species which neither cause symptoms or infections, nor negatively affect pregnancy. It is dominated mainly by Lactobacillus species. BV is defined by the disequilibrium in the vaginal microbiota, with decline in the number of lactobacilli. While the infection involves a number of bacteria, it is believed that most infections start with Gardnerella vaginalis creating a biofilm, which allows other opportunistic bacteria to thrive.
One of the main risks for developing BV is douching, which alters the vaginal flora and predisposes women to developing BV. Douching is strongly discouraged by the U.S. Department of Health and Human Services and various medical authorities, for this and other reasons.
BV is a risk factor for pelvic inflammatory disease, HIV, sexually transmitted infections (STIs), and reproductive and obstetric disorders or negative outcomes. It is possible for sexually inactive persons to develop bacterial vaginosis.
Bacterial vaginosis may sometimes affect women after menopause. Also, subclinical iron deficiency may correlate with bacterial vaginosis in early pregnancy. A longitudinal study published in February 2006, in the "American Journal of Obstetrics and Gynecology", showed a link between psychosocial stress and bacterial vaginosis persisted even when other risk factors were taken into account. Exposure to the spermicide nonoxynol-9 does not affect the risk of developing bacterial vaginosis.
Having a female partner increases the risk of BV by 60%. The bacteria associated with BV have been isolated from male genitalia. BV microbiota has been found in the penis, coronal sulcus, and male urethra, in the male partners of infected females. Partners who have not been circumcised may act as a ‘reservoir’ increasing the likelihood of acquiring an infection after sexual intercourse. Another mode of transmission of the BV-associated microbiota is to a female sexual partner via skin-to-skin transfer. BV may be transmitted via the perineal enteric bacteria from the microbiota of the female and male genitalia.
There were about 58 million cases of trichomoniasis in 2013. It is more common in women (2.7%) than males (1.4%). It is the most common non-viral STI in the U.S., with an estimated 3.7 million prevalent cases and 1.1 million new cases per year. It is estimated that 3% of the general U.S. population is infected, and 7.5-32% of moderate-to-high risk (including incarcerated) populations.
Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal or postpartum women. Sometimes it can occur in young girls before puberty. In these situations the estrogen support of the vagina is poor.
Cervicitis can be caused by any of a number of infections, of which the most common are chlamydia and gonorrhea, with chlamydia accounting for approximately 40% of cases. As many half of pregnant women are asymptomatic with a gonorrhea infection of the cervix. "Trichomonas vaginalis" and herpes simplex are less common causes of cervicitis. There is a consistent association of M. genitalium infection and female reproductive tract syndromes. M. genitalium infection is significantly associated with increased risk of cervicitis.
Vaginitis is the disruption of the healthy vaginal microbiota. The vaginal microbiota consists of those organisms which generally do not cause symptoms, infections, and results in good pregnancy outcomes, and is dominated mainly by Lactobacillus species. The disruption of the normal microbiota can cause a vaginal yeast infection. Vaginal yeast infection can affect women of all ages and is very common. The yeast "Candida albicans" is the most common cause of vaginitis. Specific forms of vaginal inflammation include the following types:
Infectious vaginitis accounts for 90% of all cases in reproductive age women:
- Candidiasis: vaginitis caused by proliferation of "Candida albicans", "Candida tropicalis", "Candida krusei"
- Bacterial vaginosis: vaginitis caused by increased growth of "Gardnerella" (a bacterium).
- Aerobic vaginitis
Other less common infections are caused by gonorrhea, chlamydia, "Mycoplasma", herpes, "Campylobacter", improper hygiene, and some parasites, notably "Trichomonas vaginalis". Women who have diabetes develop infectious vaginitis more often than women who do not.
Vaginal infections often have multiple causes (varies between countries between 20 and 40% of vaginal infections), which present challenging cases for treatment. Indeed, when only one cause is treated, the other pathogens can become resistant to treatment and induce relapses and recurrences. Therefore, the key factor is to get a precise diagnosis and treat with broad spectrum anti-infective agents (often also inducing adverse effects).
Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infectious vaginitis. Physical factors that have been claimed to contribute to the development of infections include the following: constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast.
While infections may occur without sex, a high frequency of intercourse increases the risk. Personal hygiene methods or tight-fitting clothing, such as tights and thong underwear, do not appear to increase the risk.
A vaginal yeast infection results from overgrowth of candida albicans, or yeast, in the vagina. This is a relatively common infection, with over 75% of women having experienced at least one yeast infection at some point in their life. Risk factors for yeast infections include recent antibiotic use, diabetes, immunosuppression, increased estrogen levels, and use of certain contraceptive devices including intrauterine devices, diaphragms, or sponges. It is not a sexually transmitted infection. Candida vaginal infections are common; an estimated 75% of women will have at least one yeast infection in their lifetime. Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. Vaginal itching is the most common symptom of candida vulvovaginitis. Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. The diagnosis of Candida vulvovaginitis is made by looking at a sample taken from the vagina under the microscope that shows hyphae (yeast), or from a culture. It is important to note that the symptoms described above may be present in other vaginal infections, so microscopic diagnosis or culture is needed to confirm the diagnosis. Treatment is with intra-vaginal or oral anti-fungal medications.
Cervices is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Death may occur. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms.
The condition is often confused with vaginismus which is a much simpler condition and easily rectified with simple exercises.
In pregnancy, higher levels of estrogen make a woman more likely to develop a yeast infection. During pregnancy, the "Candida" fungus is more common, and recurrent infection is also more likely. There is tentative evidence that treatment of asymptomatic candidal vulvovaginitis in pregnancy reduces the risk of preterm birth.
The disease is classified as either gonococcal urethritis, caused by "Neisseria gonorrhoeae", or non-gonococcal urethritis (NGU), most commonly caused by "Chlamydia trachomatis". NGU, sometimes called nonspecific urethritis (NSU), has both infectious and noninfectious causes.
Urethritis is part of triad of Reiter's Syndrome.
Other causes include:
- Adenoviridae
- Uropathogenic "Escherichia coli" (UPEC)
- Herpes simplex
- Cytomegalovirus
- "Mycoplasma genitalium"
- Reactive arthritis
- "Trichomonas vaginalis"
- "Ureaplasma urealyticum"
- "Methicillin-resistant Staphylococcus aureus"
- "Group B streptococcus"
Bacterial vaginosis (BV) is an infection caused by a change in the vaginal flora, which refers to the community of organisms that live in the vagina. It is the most common cause of pathological vaginal discharge in women of childbearing age and accounts for 40–50% of cases. In BV, the vagina experiences a decrease in a bacterium called lactobacilli, and a relative increase in a multitude of anaerobic bacteria with the most predominant being "Gardnerella vaginalis". This imbalance results in the characteristic vaginal discharge experienced by patients with BV. The discharge in BV has a characteristic strong fishy odor, which is caused by the relative increase in anaerobic bacteria.[1] The discharge is typically thin and grey, or occasionally green. It sometimes is accompanied by burning with urination. Itching is rare. The exact reasons for the disruption of vaginal flora leading to BV are not fully known. However, factors associated with BV include antibiotic use, unprotected sex, douching, and using an intrauterine device (IUD). The role of sex in BV is unknown, and BV is not considered an STI. The diagnosis of BV is made by a health care provider based on the appearance of the discharge, discharge pH > 4.5, presence of clue cells under the microscope, and a characteristic fishy odor when the discharge is placed on a slide and combined with potassium hydroxide ("whiff test"). The gold standard for diagnosis is a gram stain showing a relative lack of lactobacilli and a polymicrobial array of gram negative rods, gram variable rods, and cocci. BV may be treated with oral or intravaginal antibiotics, or oral or intravaginal lactobacillus.
If symptomatic, testing is recommended. The risk of contracting Micoplasma infection can be reduced by the following:
- Using barrier methods such as condoms
- Seeking medical attention if you are experiencing symptoms suggesting a sexually transmitted infection.
- Seeking medical attention after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
- Getting a STI history from your current partner and insisting they be tested and treated before intercourse.
- Avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
- Abstinence
Neonates, especially if preterm, are susceptible to "M. hominis" infection.
Meningoencephalitis in neonates has been described and M. hominis may be a significant causative agent of neonatal sepsis or meningitis.
"M. hominis" has been associated with chorioamnionits. "M. hominis" is associated with miscarriage.
Regular testing for sexually transmitted infections is encouraged for prevention. The risk of contracting pelvic inflammatory disease can be reduced by the following:
- Using barrier methods such as condoms; see human sexual behavior for other listings.
- Seeking medical attention if you are experiencing symptoms of PID.
- Using hormonal combined contraceptive pills also helps in reducing the chances of PID by thickening the cervical mucosal plug & hence preventing the ascent of causative organisms from the lower genital tract.
- Seeking medical attention after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
- Getting a STI history from your current partner and strongly encouraging they be tested and treated before intercourse.
- Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
- Reducing the number of sexual partners.
- Sexual monogamy.
- Abstinence
Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria (bacteria in the urine) is between three and six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections. The risk of an associated infection can be decreased by catheterizing only when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter.
Male scuba divers utilizing condom catheters and female divers utilizing external catching devices for their dry suits are also susceptible to urinary tract infections.
In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex. The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In post-menopausal women, sexual activity does not affect the risk of developing a UTI. Spermicide use, independent of sexual frequency, increases the risk of UTIs. Diaphragm use is also associated. Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinary tract infection.
Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus. As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora. Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections.
Chronic prostatitis in the forms of chronic prostatitis/chronic pelvic pain syndrome and chronic bacterial prostatitis (not acute bacterial prostatitis or asymptomatic inflammatory prostatitis) may cause recurrent urinary tract infections in males. Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.
PID can cause scarring inside the reproductive system, which can later cause serious complications, including chronic pelvic pain, infertility, ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other complications of pregnancy. Occasionally, the infection can spread to in the peritoneum causing inflammation and the formation of scar tissue on the external surface of the liver (Fitz-Hugh–Curtis syndrome).
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination. It is usually caused by infection with bacteria. The bacterial infection is often sexually transmitted, but not in every instance. Urethritis can be idiopathic.
A sexually transmitted infection present in a pregnant woman may be passed on to the infant before or after birth.
The risks and transmission probabilities of sexually transmitted diseases are summarized by act in the table:
Prognosis is highly variable. Spontaneous remission is common. Complete cure can be obtained with proper antibiotic treatments to kill the causative bacteria, such as tetracycline, doxycycline, or erythromycin. Prognosis is more favorable with early treatment. Bacterial superinfections may complicate course. Death can occur from bowel obstruction or perforation, and follicular conjunctivitis due to autoinoculation of infectious discharge can occur.
Many STIs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less often—depending on type of infection) the mouth, throat, respiratory tract and eyes. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body. The amount of contact with infective sources which causes infection varies with each pathogen but in all cases a disease may result from even light contact from fluid carriers like venereal fluids onto a mucous membranes.
Some STIs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding.
Healthcare professionals suggest safer sex, such as the use of condoms, as a reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, but safer sex cannot be considered to provide complete protection from an STI. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk.
It is possible to be an asymptomatic carrier of sexually transmitted diseases. In particular, sexually transmitted diseases in women often cause the serious condition of pelvic inflammatory disease.
Genital elephantiasis or esthiomene, which is the dramatic end-result of lymphatic obstruction, which may occur because of the strictures themselves, or fistulas. This is usually seen in females, may ulcerate and often occurs 1–20 years after primary infection.
Fistulas of, but not limited to, the penis, urethra, vagina, uterus, or rectum. Also, surrounding edema often occurs. Rectal or other strictures and scarring. Systemic spread may occur, possible results are arthritis, pneumonitis, hepatitis, or perihepatitis.
It is not a major issue but is to be resolved as soon as possible. It can be a natural defense mechanism that the vagina uses to maintain its chemical balance, as well as to preserve the flexibility of the vaginal tissue. The term "physiologic leukorrhea" is used to refer to leukorrhea due to estrogen stimulation.
Leukorrhea may occur normally during pregnancy. This is caused by increased bloodflow to the vagina due to increased estrogen. Female infants may have leukorrhea for a short time after birth due to their in-uterine exposure to estrogen.