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Bacterial Vaginosis vs. Yeast Infection

Burning, itching and vaginal discharge are all-too-common symptoms for women during their reproductive years. Three out of four women will experience a yeast infection during their lifetime, and 50% of women will have more than one infection. But not all such symptoms are the result of yeast infections. A recent study found that only one in four women seeking treatment for a yeast infection was actually infected with Candida, the fungus responsible for yeast infections. So what are the other causes of these vaginal symptoms?

Yeast infections are the second most common cause of vaginal infections. The primary cause is actually bacterial vaginosis (BV). Women normally have resident bacteria in their vagina that are in a healthy state of balance with their surrounding tissues. But that balance can be disrupted by a number of things, including pregnancy (up to 16% of pregnant women have BV), hormonal changes, douching, foreign bodies (including IUDs), and even stress. This imbalance can cause an overgrowth of naturally occurring bacteria, which in turn can lead to infection, inflammation and discomfort. Although BV is not thought to be a sexually transmitted disease, it is more common in women with multiple sexual partners.

The third primary cause of vaginal infection is from Trichomonas, a parasite responsible for the trichomoniasis infection. There are five to eight million new cases of trichomoniasis each year in the United States. Trichomoniasis is particularly vexing because it may be asymptomatic in as many as 50% of the women who harbor the infection. The parasite can migrate up into the urinary tract, fallopian tubes and pelvis, causing infections and even preterm delivery and low birth weight babies. Trichomoniasis is considered to be a sexually transmitted disease.

All three of these infections can increase a woman’s susceptibility to HIV infection. The symptoms of each infection can be virtually indistinguishable, but there are certain characteristics of each.

Yeast infections are characterized by: redness, itching and burning around the vulva; foul-smelling, thick, white discharge (may look similar to cottage cheese); pain during intercourse and urination.

The signs and symptoms of BV and trichomoniasis may be quite similar to yeast infections in terms of redness, itching and pain. With BV, however, the discharge tends to be thin, white or yellowish, and more uniform in appearance. Trichomoniasis discharge is typically a frothy, greenish-yellow secretion. Simple laboratory tests can distinguish between each of these infections using a swab of the fluid taken during a pelvic exam.

Treatment for yeast infections
First-time yeast infections can generally be treated with the over-the-counter anti-fungal medication miconazole (Monistat, Femizol, Vagistat). Recurrent yeast infections may require prescription of an oral antifungal medication.

Treatment for BV
This depends on the particular bacteria identified from the swab sample. Antibiotics such as metronidazole and clindamycin may be prescribed. Because these are powerful medications with known side effects, it is important to establish the diagnosis before starting treatment. Unfortunately, there is a high rate of recurrence after therapy.

Treatment for trichomoniasis
Trichomoniasis infections are treated with the oral antibiotics metronidazole or tinidazole. Sexual partners should receive treatment as well.

Beware of self-diagnosis and treatment. Even among health professionals, the diagnosis is difficult to make based only on clinical signs and symptoms. Proper diagnosis usually requires microscopic examination of the discharge in order to distinguish between the three types of infections described above. In addition, vaginal discharge may be a symptom of more serious gynecological diseases and should be evaluated through a professional examination.

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