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Vaginitis in Adolescents

What is vaginitis?

Vaginitis is any inflammation or infection of the vagina. It is a common problem in females of all ages. One-third of females having at least one form of vaginitis at some time during their lives. It develops when the walls of the vagina become inflamed, because an irritant has disturbed the balance of the vaginal area. 

What causes vaginitis?

Bacteria, yeast, viruses, or chemicals in creams or sprays, or even clothing can cause vaginitis. Sometimes, vaginitis happens from organisms passed between sexual partners. A number of factors influence the vaginal environment. These include a female's health, her personal hygiene, medicines, hormones (particularly estrogen), and the health of her sexual partner. A disturbance in any of these factors can trigger vaginitis.

What are the most common types of vaginitis?

The following are the most common types of vaginitis:

  • Candida or "yeast" infection

  • Bacterial vaginosis

  • Trichomoniasis vaginitis

  • Viral vaginitis

  • Noninfectious vaginitis

Each of these types of infection has a different cause and can cause slightly different symptoms. This can make diagnosis hard. And, you can have more than one type of vaginitis at the same time.

Your healthcare provider will consider other causes of vaginal discharge too. These include gonorrhea and chlamydia. However, these organisms do not infect the vagina directly. If left untreated, gonococcal and chlamydial infections can lead to serious conditions, such as pelvic inflammatory disease (PID). PID increases a female’s risk of infertility, pelvic scarring, chronic pelvic pain, and ectopic (tubal) pregnancy. Chlamydia is one of the most common sexually transmitted infections in the U.S. It often goes undiagnosed.

What is candida or "yeast" infections?

Yeast infections, as they are commonly called, are caused by one of the many species of fungus known as candida, which normally live in the vagina in small numbers. Candida can also be present in the mouth and digestive tract in both males and females.

Yeast is normally present and well-balanced in the vagina. Infection happens when something in a female's system upsets this normal balance. For example, an antibiotic to treat another infection may upset this balance. In this case, the antibiotic kills the bacteria that normally protects and balances the yeast in the vagina. In turn, the yeast overgrows, causing an infection. Other factors that can cause this imbalance to happen include pregnancy, which changes hormone levels. Also, diabetes, which allows too much sugar in the urine and vagina, can be a factor.

What are the symptoms of a vaginal candida infection?

These are the most common symptoms of a candida infection:

  • A thick, white, cottage cheese-like vaginal discharge. It is watery and usually odorless

  • Itching and redness of the vulva and vagina

  • Pain with urination or sex

The symptoms of a vaginal candida infection may look like other conditions or medical problems. Always see a healthcare provider for a diagnosis.

Who is at risk for vaginal candida infections?

Any female can develop a yeast infection, but a woman may be at increased risk if she:

  • Has had had a recent course of antibiotics

  • Is pregnant

  • Has diabetes that is not well-controlled

  • Has HIV

  • Is using an immunosuppressant medicine

  • Is using high-estrogen contraceptives

  • Is undergoing corticosteroid therapy which weakens the immune system

How is a vaginal candida infection diagnosed?

Along with a complete medical history and physical and pelvic exam, you may also have a microscopic exam of the vaginal discharge.

Treatment for vaginal candida infections

Treatment for candida may include:

  • Antifungal vaginal creams and suppositories

  • Vaginal tablets

  • Oral antifungal medicines 

What is bacterial vaginosis?

Yeast infections are the most commonly discussed vaginal infection. It's the most common type of vaginitis in females of reproductive age. This infection is caused by bacteria, not yeast. With a bacterial vaginosis infection, certain species of normal vaginal bacteria grow out of control and trigger inflammation. 

What are the symptoms of bacterial vaginosis?

These are the most common symptoms:

  • A milky, thin discharge at times, or a heavy, gray, and sometimes green, discharge

  • "Fishy" odor of discharge

The symptoms of bacterial vaginosis may look like other conditions. Always see a healthcare provider for a diagnosis.

Treatment for bacterial vaginosis

Bacterial vaginosis is caused by bacteria. It is generally treated with antibiotics.

What is trichomoniasis?

Trichomoniasis, trichomonas, or trich as it is commonly called, is a sexually transmitted infection. It is caused by parasite called Trichomonas vaginalis. This parasite passes between partners during sexual intercourse. Since most males do not have symptoms with trichomoniasis, the infection is often not diagnosed until the female develops symptoms of vaginitis.

What are the symptoms of trichomoniasis?

These are the most common symptoms of trichomoniasis:

  • A frothy, often musty-smelling, greenish-yellow discharge

  • Itching or burning in and around the vagina and vulva

  • Swelling or redness at the opening of the vagina

  • Light bleeding, especially after intercourse

  • Burning during urination

  • Discomfort in the lower abdomen

  • Pain during intercourse

Some females with trichomoniasis have no symptoms. The symptoms of trichomoniasis may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

Treatment for trichomoniasis

Both partners must be treated for trichomoniasis to avoid reinfection. Treatment generally involves taking oral antibiotics. If a female has more than one sexual partner, each partner (and any of their other partners) should also be treated.

What is viral vaginitis?

Viruses are a common cause of vaginitis. Most are spread through sexual contact. One type of virus that causes viral vaginitis is the herpes simplex virus (HSV, or simply herpes). Its main symptom is pain in the genital area with lesions and sores. These sores are generally visible on the vulva, or vagina, but occasionally are inside the vagina. They can only be found during a pelvic exam. Once a female has the herpes virus in her, stress or emotional situations can be a factor in triggering an outbreak of herpes.

Another source of viral vaginitis is the human papillomavirus (HPV), a virus that is also transmitted through sexual contact. HPV is the main cause of cervical cancer in women. This virus also causes painless warts to grow on the vagina, rectum, vulva, or groin. However, visible warts are not always present. The virus is generally found by a test for HPV done with a Pap test.

An HPV vaccine can prevent infection by the particular strains of HPV that cause most cervical cancers. But it does not treat existing HPV infection or genital warts. The vaccine also helps prevent genital warts as well as some cancers of the vulva, vagina, and anus. The vaccine is given to children and young adults ages 9 to 26, preferably before they become sexually active. Ask your healthcare provider for more information.

Treatment for viral vaginitis

There is no cure for viral vaginitis. However, outbreaks of herpes simplex can be treated with antivirals, such as acyclovir, valacyclovir, or famciclovir. Although these medicines do not kill the virus, they can decrease the pain and shorten the length of the outbreak.

Most HPV infections resolve within 6 to 12 months. Some infections become persistent and can lead to some cancers of the vulva, vagina, and anus. It is no longer recommended that women under the age of 30 be tested for HPV. It is recommended that both girls and boys get an HPV vaccine. The vaccine is given to children and young adults ages 9 to 26, preferably before they become sexually active.  

What is noninfectious vaginitis?

Noninfectious vaginitis usually refers to vaginal irritation without an infection being present. Most often, this is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. Noninfectious vaginitis may be also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners.

What are the symptoms of noninfectious vaginitis?

These are the most common symptoms:

  • Vaginal itching

  • Vaginal burning

  • Vaginal discharge

  • Pelvic pain (particularly during intercourse)

The symptoms of noninfectious vaginitis may look like other conditions or medical problems. Always see a healthcare provider for a diagnosis.

Treatment for noninfectious vaginitis

Treatment for noninfectious vaginitis depends greatly on the cause. If the cause is a reaction to an irritant, the irritant should be avoided. 

Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Online Medical Reviewer: Sacks, Daniel, MD, FACOG
Date Last Reviewed: 5/1/2017
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