What is a Vaginal Eco-system?
An ecosystem is a biological environment where all the organisms living in a particular area interact with each other and the environment to find the best solution for that specific area.
The vagina is a typical ecosystem because it contains good and bad organisms that interact with each other and the environment within the vagina. The vaginal ecosystem is in place when more than 90% of the organisms in the vagina are good bacteria and the environment remains acidic (pH between 3.5 & 4.2).
The majority of the good bacteria in the vagina is called Lactobacilli and consists of many species. Lactobacilli keep the vagina acidic by excreting lactic acid while some excrete hydrogen peroxide to prevent the growth and/or to kill bacteria, Candida and viruses, including the HIV virus.
It is therefore critical not to disturb the inside of the vagina to ensure the good organisms will always dbe in control. If you disrupt the vaginal ecosystem for example when you douche or drinking broad spectrum antibiotics, then your chances of getting infected with bad organisms including HIV is very high.
The definition of vaginitis is inflammation of the vagina and is very common. The vagina is the muscular canal extending from the cervix to the outside of the body (vulva).
The two most common types of organisms causing vaginitis are candida and bacteria. All women will have at least one experience of vaginitis in her life. It is important to know that you may get vaginitis from Candida and Bacterial Vaginosis, even if you never had sex. It is mainly caused by an environmental change within the vagina (disruption of the vaginal ecosystem) which allow either Candida or Bacteria (or both) to multiply and dominate the environment in the vagina at the expense of the good bacteria (Lactobacilli).
A woman with this condition may have itching or burning and may notice a discharge. There are many factors that predispose a woman to develop Vaginitis such as douching (washing out all the good and bad organisms), stress, diet, and others.
Ninety percent of Vaginitis is caused by one of the following 3 vaginal infections:
Candida is often mistaken as being the most prevalent. In reality Bacterial Vaginosis is by far the most common vaginal infection
Candida albicans: A yeast-like fungal organism is found in small amounts in the normal human intestinal tract, normally kept in check by the body's own helpful bacteria. Candida albicans can increase in numbers when this balance is disturbed to cause candidiasis of the intestinal tract, or yeast infections of other parts of the body. C. albicans causes thrush. Also called Monilia albicans.
Signs and symptoms of a vaginal yeast infection are a white cheesy discharge that typically itches and irritates the vagina and surrounding outer tissues. On occasion there may be pain with sexual intercourse or burning with urination.
Delfran has a new EcoCare Comfort swab that you can get at your pharmacy to test the pH of the vagina. If the swap shows that the pH is below 5 and there is a discharge and the vagina is itching, then it is most probably a Candida infection.
Obtain an antifungal OTC product at your local Pharmacy.
Understand more about the vaginal Ecosystem.
The question we should ask ourselves is why South Africa has the highest rate of HIV positive patients, amongst the highest rate of preterm labour/births and female related infertility (in particular blocked tubes). Bacterial Vaginosis is implicated in all the above.
Bacterial Vaginosis (BV) is the most common vaginal infection to affect women in their reproductive age. Studies show that as many as 62% of females (those that are HIV positive 74%) in Khayelitsha have Bacterial Vaginosis.
The cause of BV is not fully understood. BV is defined as a shift in the ecosystem of the vagina where the dominant Lactobacilli concentration (good bacteria) is replaced by different other types of bacteria (harmful bacteria) which causes a chemical imbalance within the vagina. This increases the pH of the vagina to above 4.5 and has a negative effect on the vagina’s defence mechanism. The vagina is now exposed to harmful bacteria, viruses, fungus, toxins and enzymes produced by these organisms.
BV has been diagnosed in virgins and females that are not sexually active and is therefore not a sexually transmitted disease.
If a female is of the black race, smokes, douches, uses an intrauterine device (IUD), has a new sexual partner or several sexual partners (including lesbian partners), she will have a higher risk of developing BV.
Bacterial Vaginosis: Symptoms
- Vaginal discharge
- Smelly vagina (Fish odour)
- Disuria (difficulty to urinate)
The vaginal discharge is thin and white or gray in colour. Up to 50% of patients do not have a vaginal discharge.
The main symptom of BV is an abnormal, foul-smelling (fish-like odour) vaginal discharge. In those patients that do not have a discharge, the fishy odour may be more noticeable after sex.
The good organisms keep the vagina fresh. The bad organisms are responsible for the smell in the vagina because they produce amines. The amines makes the vagina less acidic (pH above 4.5) that prevent the good organisms to grow or multiply and refresh the vagina.
It is therefore important to kill the bad organisms quickly but more importantly to allow the good bacteria to grow again so that they can refresh the vagina. The best treatment is one single dose of medicine to kill the organisms and help to restore the vaginal pH so that the good bacteria can grow again. If you continue to douche weekly (even if it is medicine) you kill the good bacteria every time you douche and the vagina will continue to smell and you have to douche again.
What is more dangerous is that nearly half of woman with BV do not know that they have BV and show no symptoms. A study performed in Birmingham, Alabama showed that 63% of females with BV never noted any vaginal “wetness” during the last 6 months and 75% of women with BV never noted any vaginal odour.
Some woman noted that the vaginal odour increase after sex or menstruation because the pH of the vagina becomes less acidic.
It is therefore important to test if the pH of your vagina is between 3.5 and 4.2. If it is not the vaginal ecosystem is disrupted and may increase your risk of being contaminated with other bacteria or viruses including HIV.
The grade of itching may vary between patients.
Some patients may experience pain during urination.
BV is not the innocent infection as it was thought to be in the past. BV is associated with several gynaecological and obstetric risks:
- Increase the woman’s susceptibility of HIV if exposed to the HIV virus.
- Increase the chances that an HIV infected woman can pass HIV to her sex partner.
- Increase the women’s susceptibility of other Sexually Transmitted Diseases (STD’s) such as Chlamydia and Gonorrhea.
- Increase the development of Endometritis, Pelvic Inflammatory Disease (PID) (Inflammation of the uterus/womb and fallopian tubes) and Vaginal Cuff Cellulitis after invasive procedures.
- Pelvic Inflammatory Disease (PID) can cause infertility (blocked tubes) or cause damage to the fallopian tubes to increase the future risk of ectopic pregnancy. It is a life threatening condition when the fertilized egg grows in the fallopian tube and not in the uterus.
- Early miscarriage
- Late abortion
- Premature rupture of membranes
- Premature labour
- Preterm birth
- Intra-amniotic infection
- Postpartum endometritis
The complications above are quite serious and could have long term implications for any female, mother and child.
Bacterial Vaginosis: Diagnostics
It is difficult for a woman to diagnose a specific vaginal infection and often women go to the pharmacy for treatment.
A new diagnostic product, EcoCareTM Comfort, is available which will enable women to make the correct decision in the pharmacy or in the privacy of her own home. If the EcoCareTM Comfort shows a pH of above 5, then get an appropriate product to correct the disrupted vaginal ecosystem.
The doctor might utilize the following to diagnose BV.
i. Amsel or Clinical criteria
The doctor will evaluate the following –
b. Vaginal pH (use EcoCare Comfort)
c. After taking a vaginal swab: Whiff test (smell if discharge has a fish-like odour)
d. Investigate under a microscope.
ii. Gram stain test
The doctor will take a vaginal swab, smear it on a slide and forward it to a laboratory where a specialized person will investigate the slide. They use a Nugent score to quantify the infection. Although it takes time to perform this test, it is the most accurate test.
The following test should not be used for the diagnosis of Bacterial Vaginosis.
i. PAP Smear
Although BV is not a sexually transmitted disease, it is included in the Sexually Transmitted Disease Treatment Guidelines 2006 of the Centers for Disease Control and Prevention in the USA. These guidelines specify that a PAP smear has no clinical utility for the diagnosis of BV because of low sensitivity.
The 2006 National Guidelines for the Management of Bacterial Vaginosis of the British Association for Sexual Health and HIV recommends only the Amsel criteria and the Gram stain test.
Bacterial Vaginosis: Treatment
The aim of the treatment is to normalize the vaginal ecosystem. The ideal product should preferably be a single dose, kill the bad bacteria, normalize the vaginal pH, lactobacilli sparing (not kill good bacteria) and safe to use during pregnancy.
Treatment during Pregnancy
Treatment is especially important for pregnant women due to the fact that BV is highly associated with early miscarriage, late abortion and preterm labour/birth. The focus must be on prevention and women should be screened and treated for BV before becoming pregnant to ensure that they have a normal healthy vaginal ecosystem. Maintaining a healthy ecosystem during pregnancy is important and EcoCareTM Comfort is an ideal product to monitor the vaginal ecosystem during those months.
Treatment before surgical procedures
Fifty percent of patients are asymptomatic and some physicians recommend that patients due for surgical procedures, for example hysterectomy or abortion etc., should be screened and treated for BV to reduce their risk of developing PID.
Understand more about the Ecosystem.
Trichomonas is a sexually transmitted disease (STD). The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.
Many women have signs or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. The infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within 5 to 28 days of exposure
If you experience any of the symptoms above or had a new sex partner in the last 6 months, test with EcoCare™ Comfort to see whether the pH of your discharge is elevated. If pH is above 5, consult your doctor or healthcare provider.
Please contact your healthcare provider for appropriate treatment.