Vaginal Health and Infection Treatment

Normal Vaginal Hygiene

The vagina is a self-cleaning organ that maintains a natural balance of microorganisms, mainly hydrogen peroxide-producing lactobacilli that keep a acidic pH (≤4.5), and it is recommended to clean only the external part (vulva) with water and mild soap, without introducing products inside the vagina, as suggested by the Centers for Disease Control and Prevention (CDC) 1, 3
External cleaning with water and mild soap is recommended, and douching should be avoided as it is associated with alterations of the normal vaginal flora and a higher risk of bacterial vaginosis, according to the CDC 1, 4

The three most common vaginal infections are bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis, with BV being characterized by the replacement of normal lactobacilli with anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis, as reported by the CDC 1, 3
Vulvovaginal candidiasis is generally caused by Candida albicans, and trichomoniasis is caused by Trichomonas vaginalis, according to the CDC 1, 5, 6

Vaginal pH measurement (>4.5 suggests BV or trichomoniasis) is a diagnostic tool, along with microscopic examination with saline solution to identify trichomonads or clue cells of BV, as recommended by the CDC 1, 2
Microscopic examination with KOH 10% is used to identify yeast or pseudohyphae of Candida and perform the whiff test, as suggested by the CDC 1, 7

Symptoms of BV include homogeneous, white, non-inflammatory vaginal discharge with a fishy odor, and diagnosis requires three of the following: characteristic discharge, clue cells on microscopy, pH >4.5, and fishy odor with KOH, as reported by the CDC 1, 4, 7
Treatment for BV is metronidazole in a single dose or a 7-day regimen, as recommended by the CDC 4

Symptoms of vulvovaginal candidiasis include itching, vulvar irritation, white discharge, vaginal pain, vulvar burning, and dyspareunia, and diagnosis is made by symptoms plus identification of yeast/pseudohyphae in KOH preparation or positive culture, as reported by the CDC 5, 6
Treatment options include intravaginal agents such as clotrimazole, miconazole, terconazole, butoconazole, or tioconazole, and oral fluconazole 150 mg in a single dose, as recommended by the CDC 5, 6

Symptoms of trichomoniasis include yellow-green vaginal discharge, bad odor, irritation, and dysuria, and diagnosis is made by identification of motile trichomonads in wet mount or culture, as reported by the CDC 1
Treatment for trichomoniasis is metronidazole in a single dose, and it is essential to treat sexual partners to prevent reinfections, as recommended by the CDC 1

Self-medication is only recommended for women previously diagnosed with candidiasis who experience the same symptoms, and if symptoms persist after treatment or recur within 2 months, medical attention should be sought, as suggested by the CDC 5, 6
Approximately 10-20% of women have Candida in the vagina without symptoms and do not require treatment, as reported by the CDC 5, 6

Using vaginal douches alters the natural balance of the vaginal flora and increases the risk of infections, as warned by the CDC 1, 4
Identifying Candida without symptoms is common, and approximately 10-20% of women have Candida in the vagina without symptoms and do not require treatment, as reported by the CDC 5, 6