Telltale signs of vaginal infections

The vagina can go almost without notice as long as it's healthy. But discomfort "down there" often means something is amiss.

Symptoms affecting the vagina and vulva (the external genital area surrounding the vagina) are among the top reasons women seek care at gynecologic, primary care, or urgent care offices. Much of the time, vaginal infections are to blame, says Alisa Pascale, a women's health nurse practitioner at Harvard-affiliated Massachusetts General Hospital's Vulvar and Vaginal Disorders Clinic.

A handful of other conditions can also contribute to vaginal itching, burning, irritation, discharge, and odor - symptoms highly common to vaginal infections. But even among infections, causes vary, and treatments differ as well. That's why it's important both to know the differences between various vaginal infections and to spot the indications early. "That way, you can ease symptoms more quickly and prevent any complications," Pascale says.

Common vaginal infections

Here, Pascale describes the most prevalent vaginal infections as well as their causes and treatment approaches.

Bacterial vaginosis (BV). The most common vaginal infection - affecting up to half of women with vaginal symptoms - BV results from an imbalance of normal bacteria in the vagina. It's not a sexually transmitted infection (STI), but it is more common in sexually active women.

"What stands out about BV is itch or irritation and often a fishy odor," she says. Treatment involves antibiotics. But it's important to detect it early, since untreated BV can make you more vulnerable to STIs, along with pregnancy complications.

Yeast infection. Caused by an overgrowth of the fungus Candida - which can live naturally in the vagina in small amounts - yeast infections trigger a thick, white, cottage cheese–like vaginal discharge as well as intense itching, redness, and swelling around the vulva. You might also feel burning during urination or sex.

Yeast infections stem from a variety of causes, including antibiotic use (even if antibiotics are taken as prescribed), hormonal changes, uncontrolled diabetes, and wearing damp, constricting clothing. They're highly common, affecting up to 39% of women who seek care for vaginal symptoms. They require treatment with an antifungal medication. "In severe cases," Pascale says, "you can have a swollen vulva or fissuring" - that is, tiny cracks or tears in the vulvar or vaginal tissue.

Trichomoniasis. Caused by the parasite Trichomonas vaginalis, trichomoniasis is an STI that can be spread orally or through any unprotected genital contact (men can also get it). Many people don't notice symptoms, but trichomoniasis can lead to itching, pain during urination, and a foamy, yellow, or greenish vaginal discharge in women. Antibiotics are needed to clear the infection, and all sexual partners must be treated to prevent reinfection.

Herpes simplex virus (HSV-2). A highly contagious STI, HSV-2 causes recurring outbreaks of painful fluid-filled sores or blisters in and around the vagina - symptoms often preceded by fever, swollen lymph nodes, or headache. There's no cure for the infection itself, but antiviral medications can minimize outbreaks.

"A herpes infection can show up with itching and burning around the vulva," Pascale says, "but you can have a mild herpes outbreak and not know it."

Chlamydia and gonorrhea. Chlamydia can be mild or symptomless, but it can also cause profuse vaginal discharge, pelvic pain, irregular vaginal bleeding, and pain or burning during urination. Gonorrhea, which can involve similar symptoms, is less common than chlamydia, but has been increasingly prevalent in recent years. Both of these STIs can raise a woman's odds of pelvic inflammatory disease - an infection of the reproductive organs - as well as infertility or ectopic pregnancy (a life-threatening complication in which an embryo attaches outside the uterus).

Key features to watch

While it's wise to know the symptoms of various vaginal infections, you shouldn't self-diagnose, Pascale warns. Even recurring, recognizable infections warrant a call to your health care provider to prescribe or guide treatment.

Most vaginal infections require prescription antibiotics, but yeast infections can be treated with over-the-counter antifungal remedies. If your yeast infection doesn't abate after two courses, however, you should see your doctor, Pascale says.

When you call for an appointment, you can help your provider by describing

• the location of symptoms, whether inside or outside the vagina, or only around the vulva
• any vaginal discharge
• any urinary symptoms.

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