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Vaginal Thrush (left) and Bacterial Vaginitis (right)
VAGINITIS (Inflammation of the Vagina)
A healthy vagina promotes the growth of lactobacilli (bacteria that easily grow in milk – see below). If most bacteria in the vagina are lactobacilli other germs which are also usually present in small numbers in the vagina are unable to grow easily. If the balance of bacterial germs is changed by antibiotics, douching, hormonal changes, treatment of the cervix or other diseases which affect the vagina then the numbers of lactobacilli may decrease and the other bacteria may grow in larger quantities causing vaginal discharges and soreness (vaginitis). Common situations where a vaginitis may occur are vaginal thrush (candida is the most common yeast causing this), trichomonas (trich), gardnerella infections, bacterial vaginitis, and estrogen deficiency states post-menopause and postnatally with breastfeeding.
A bacterial vaginosis is caused by the presence of multiple different types of bacteria growing together but not yeasts. Flagyl or Fasigyn may be prescribed to treat bacterial vaginoses as these antibiotics do not kill lactobacilli. These antibiotics are not effective against thrush. In some circumstances the imbalance of bacteria in the vagina may be reversed by using an acidophilus yoghurt mix – see below.
Acidophilus bacteria are a type of lactobacillus. Lactobacilli grow in milk as they need lactose as their main food source. Lactose is the sugar that occurs in all milk products. The vaginal skin cells contain glycogen which is a more complex sugar than lactose but is similar to it. When the skin cells are shed into the vaginal cavity they break up and release their glycogen. It is also a sugar that lactobacilli feed on. Estrogen thickens the vaginal skin and increases the amount of glycogen available which in turn encourages the growth of the lactobacilli. Vaginal estrogen cream (Ovestin) is helpful in the treatment of menopausal vaginitis.
Lactobacilli, but not yeasts, are rapidly killed by most common antibiotics. The excessive growth of yeasts, which normally may be present in the vagina in small numbers, is the reason that thrush often follows antibiotic treatment.
TREATMENT OF GENITAL THRUSH (i.e. yeast, fungal infestation or Candida)
BETADINE DOUCHE (used to disinfect the vagina)
Douching is a way of washing out the vagina usually with dilute antiseptic solutions. An antiseptic solution is drawn up into a syringe (or soft bottle) which is attached to a nozzle. The nozzle is placed gently but deeply into the vagina before squeezing the fluid through it. Douching can be used when an unhealthy discharge is present. Douching in the presence of a healthy vagina may change the balance of normal lactobacilli bacteria and predispose to unwanted infections.
When symptoms occur douche using Betadine (diluted 1 in 10 with water). Douche once. If symptoms are severe a second or third douche may be required at 24 hour intervals. Having douched empty the vagina of fluid. This may be helped by inserting a tampon. Remove the tampon before proceeding as below.
ACIDOPHILUS YOGHURT MIX (to return healthy vaginal flora)
Empty the contents of four Blackmore’s acidophilus or Inner Health Plus capsules into half a teaspoonful of plain yoghurt and mix thoroughly. Parmalat Vaalia Yoghurt has acidophilus bacteria added after pasturization and is an ideal vehicle for providing this form of treatment.
Draw up the yoghurt mixture into a vaginal introducer (obtain from a Chemist) and insert into the vagina after the douche. Use the mixture on two other occasions at 12 hourly intervals (i.e. 3 applications but not necessarily after douching).
FOLLOW-UP AND MAINTENANCE
The procedure outlined above can be repeated at weekly intervals until you are confident that the vaginal flora has returned to a healthy condition. This process can be repeated as needed.
ANTIFUNGAL MEDICATIONS
- a) Standard antifungal agents may be inserted following the douche if the infection appears to be difficult to control. Options include Canesten or Nilstat Cream or Pessaries
- b) Fluconazole (Diflucan) tablets contain an anti-fungal that is absorbed from the bowel into the blood stream. This is useful in patients who have severe recurrent candida and in particular in people who are immuno-compromised from cancer and transplants treatment or AIDS. A rare complication of Diflucan is disruption of liver function and hence this should only be used if the symptoms are of such chronicity and severity that this small risk is thought to be warranted.
EXTERNAL (VULVAL) SKIN INFECTIONS
Wash the area thoroughly with water (no soaps) and clean away any debris. Dry thoroughly. Rub in Daktarin Cream two to three times daily over two to four weeks.
Secondary bacterial infections may be present. If symptoms do not respond a medical opinion may be necessary. The affected area should be cleaned gently but thoroughly with diluted antiseptic solution (e.g. 10 drops of Dettol in a glass of water). Rinse well with tepid water and dry thoroughly. The application of antiseptics, such as Betadine ointment or Savlon cream, may be helpful used twice daily for several days.
To prevent recurrent fungal skin infections, particularly if the area tends to chafe from sweating, use Dactozin Ointment. This is a thick zinc-based ointment and should only be used sparingly daily or on alternate days. Wearing panties at night time encourages sweating and the development of thrush. This habit should be discouraged!
Wetness from urinary leakage produces chaffing and is often associated with recurrent genital thrush. BEWARE of damp panty liners. Seek help if urinary leakage seems to be the problem as many women can be cured of this problem (see article above).
SOURCES OF RE-INFECTION
Re-infection may occur from yeast infestations in the washing machine, on clothing, towles, night wear and sheets, from your bowel or from your partner.
- i) Disinfect the washing machine with antiseptic such as Pine-O-Clean by putting the washing machine through a full cycle with a strong antiseptic solution.
- ii) Disinfect all items of clothing that are likely to re-infect you, such as underwear, bedclothes, sheets and towels.
Note that many disinfectants are bleaches and may discolour your clothing.
iii) Fungilin lozenges may be used to eliminate yeasts from the throat and bowel. Suck one lozenge up to four times a day i.e. after meals and before retiring to bed, for up to seven days.
- iv) If you feel re-infection is likely to be coming from your partner, he should follow the instructions as per External Skin Infections above. The penis needs to be cleaned thoroughly and, in the case of uncircumcised men, the antifungal creams can be placed under the prepuce.