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Home  > Genital Warts > Vaginosis and vaginitis –– bacterial, viral and fungal causes and symptoms

Vaginosis and vaginitis –– bacterial, viral and fungal causes and symptoms

HPV can cause vaginosis or vaginitis with vaginal discharge that is commonly misdiagnosed as bacterial vaginitis or vaginosis caused by candida, gardnerella, or trichomonas. HPV infection may cause vulvar pain and itching. In all cases of vaginosis or vaginitis, a Digene test should be done to look for HPV; however, if the Digene test is negative, keep in mind that this does not rule out HPV because only 1/3 of the HPV types are detected by the Digene test.

Dermatol Clin 1998 Oct;16(4):817-22:

Human papillomavirus. Subclinical and atypical manifestations.

Strand A, Rylander E Department of Medicine, Dermatology, and Venereology, University Hospital, Uppsala, Sweden.

"Subclinical HPV infections, together with latent infections, are probably the most likely outcome after exposure to HPV. Subclinical infection is associated with symptoms such as burning, fissuring, and dyspareunia (painful intercourse) in some patients. Recently, results have been presented showing a median duration of HPV infection of only 8 months, and after 24 months, only 9% of the women studied continued to be infected. This provides the possibility to reassure patients with HPV infection that it is most likely a transient infection, and one should not worry unduly."

Patients with depressed or defective immune systems and smokers are the ones who most frequently become symptomatic from HPV infections. Most others will develop immunity before clinical symptoms can occur. Once clinical symptoms such as genital warts, cervical dysplasia, vaginosis, or vaginitis develop, immune support should be used.

Obstet Gynecol 1995 Feb;85(2):215-9:

Clinical presentation of gynecologic infections among Indian women.

Singh V, Sehgal A, Satyanarayana L, Gupta MM, Parashari A, Chattopadhya D. Institute of Cytology and Preventive Oncology, Maulana Azad Medical College Campus, New Delhi, India.

"Objective: To study the clinical presentation of different gynecologic infections among Indian women.

Methods: This was a cross-sectional study of 257 women that included clinical, cytologic, colposcopic, and microbiologic screening for various gynecologic infections.

Results: Human papillomavirus (HPV) was the leading infection, affecting 127 (49.4%) women; however, overt warts were only seen in seven (2.7%) patients. Women infected with HPV had a 60.3-fold higher risk of developing a bleeding ectopia compared to those with other infections; women with an unhealthy cervix and cervical ectopias also had an increased risk of HPV infection (7.6- and 2.8-fold, respectively).

Bacterial vaginosis, detected in 33.5% of the women studied, had an increased risk of bleeding ectopia (9.3-fold), cervical ectopia (3.1-fold), cervicitis (2.9-fold), vaginitis (6.9-fold), and cervical hypertrophy (2.1-fold).

Chlamydial infection, detected in 23.3% of the patient population, was associated with an eightfold increase in the risk of an unhealthy cervix and a fourfold increase in risk of a hypertrophied cervix. Immunoglobulin-A antibodies to the herpes simplex virus were detected in 53 (20.6%) women.

More than half (55.2%) of the women had two or more infections, and the mean delay of seeking medical treatment was 7-13 months.

Conclusion: The specific finding of bleeding cervices was associated with HPV and bacterial vaginosis, hypertrophied cervices with chlamydia and bacterial vaginosis, and unhealthy cervices with chlamydia and HPV infections."

Gynecol Obstet Invest 1997;43(1):49-52:

Gynecological symptoms and vaginal wet smear findings in women with cervical human papillomavirus infection.

Sikstrom B, Hellberg D, Nilsson S, Kallings I, Mardh PA. Institute of Clinical Bacteriology, Uppsala University, Sweden.

"Objective: To investigate the signs, symptoms and changes in the vaginal milieu that could be associated with cervical human papillomavirus infection (CHPI).

Study design: Women (n = 972) attending for contraceptive advice were tested for human papillomavirus in cervical samples. Results of gynecological history, examination, and vaginal wet smear findings were compared between CHPI patients and negative women.

Results: Sixty-six (6.8%) of the women had a CHPI. Bacterial vaginosis was more common among those with, than without, CHPI, but the significance of this association was abolished after adjustment for age and for markers of sexual risk-taking.

Vaginal discharge with a fishy odor, a positive amine test, and genital fissures showed significant correlations with CHPI, which persisted after adjustments. Symptoms of proctitis also correlated with CHPI, and remained significant after adjustment for anal sex.

Conclusion: Bacterial vaginosis is associated with the presence of CHPI, possibly due to sexual behavioral factors. However, several other features, in particular the presence of amines, may be independently associated with CHPI."

Int J Gynaecol Obstet 1998 Nov;63(2):145-52:

Symptoms and signs in single and mixed genital infections.

Mardh PA, Tchoudomirova K, Elshibly S, Hellberg D. Centre of Sexually Transmitted Diseases, Uppsala University, Sweden.

"Objective: To compare symptoms and signs in women with single and mixed genital infections.

Methods: The study population comprised 996 apparently healthy women. Gynecological symptoms and signs were looked for and diagnostics for the most prevalent gynecological infections were made.

Results: When co-infections were excluded, chlamydial infections, bacterial vaginosis and cervical human papillomavirus infections were associated with a fishy malodor; for the two former conditions an easily bleeding ectopy was also found.

Vaginal candidosis showed characteristic symptoms and signs.

Genital warts were associated with dysuria, general and lower abdominal pain. Out of 494 women with a genital infection, 112 (22.7%) had a mixed infection, which in some cases influenced symptoms and signs.

Conclusion: Many women who consider themselves gynecologically healthy, may nevertheless harbor one or more infectious agents. The need to exclude multiple infections is obvious. Positive predictive values were for specific symptoms and signs were generally low."

Diagn Cytopathol 1999 Apr;20(4):199-202:

Biological behavior and etiology of inflammatory cervical smears.

Singh V, Parashari A, Satyanarayana L, Sodhani P, Gupta MM, Sehgal A. Institute of Cytology & Preventive Oncology, Marg, New Delhi, India.

"Study design: Two hundred and fifty-seven consecutive women attending a major maternal and child health (MCH) center were studied clinically, colposcopically, cytologically, and microbiologically for different gynecologic infections.

Results: Out of 257 cases, 207 (80.5%) had inflammatory cervical smears, of which 183 (88.4%) were infected with one or more genital tract infections.

Bacterial vaginosis (risk, 22.6-fold), chlamydia (risk, 21.6-fold), and human papillomavirus (HPV) (risk, 13.5-fold) were independently associated with inflammatory smears. In addition, significantly higher proportions of women with inflammatory smears had cervical ectopies (28.5% vs. 10.2%) and bleeding ectopies (30.9% vs. 4.1%) as compared to noninflammatory smears. Women infected with bacterial/parasitic genital infections were given specific treatment. These women were followed up at regular intervals to assess the efficacy of antimicrobial therapy. During follow-up examination, only 26 women (12.6%) showed negative smears. Sixteen women developed squamous intraepithelial lesions (SIL) during follow-up, and 163 women had persistent inflammatory smears.

Multivariate analysis revealed that persistent inflammatory smears were associated with herpes simplex virus (HSV) infection, as revealed through detection of IgA antibodies to HSV (risk, 11.5-fold). Progression of SIL was associated with HPV infection (risk, 17.6 fold).

Conclusion: Thus, inflammatory smears are associated with different types of infection, most of which do not respond to antimicrobial therapy."

Since most cervical inflammation does not respond to antimicrobial therapy, it is more commonly viral in nature, frequently caused by HPV. If HPV is suspected, immune supportive measures should be considered.

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Dr. Joe Glickman, Jr., M.D.

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