There are several common vaginal infections that may also be associated with sexual intercourse, including trichomoniasis, hemophilus, bacterial vaginosis, and candidiasis. All of these may cause a vaginal discharge, vulvar itching, and irritation and/or vaginal odor.
Trichomoniasis (trick-oh-mun-NYE-iss-sis; also called trich, or TV) is a form of vaginitis that is caused by Trichomonas vaginalis. Women can contract trichomoniasis from an infected man or woman, whereas a man usually contracts it only from an infected woman. Even though the actual number of women seeking healthcare visits for trichomoniasis is fairly low (see Table 15.1), experts estimate that there are 7.4 million new cases of trichomoniasis every year (Centers for Disease Control and Prevention, 2005). The organism is acquired through sexual activity, and symptoms usually appear anywhere from 3 to 28 days after infection.
The most common symptom for women is an increase in vaginal discharge, which may be yellowish or green-yellow, frothy, and foul-smelling; it may cause a burning or itching sensation in the vagina. Some women are asymptomatic or have minimal symptoms (Centers for Disease Control and Prevention, 2002a). In men, the most common site of infection is the urethra, although trichomoniasis infection is often asymptomatic. If there are symptoms, there may be a slight increase in burning on the tip of the penis, mild discharge, or slight burning after urination or ejaculation.
The most common treatment for trichomoniasis is metronidazole (Flagyl), which can cause side effects such as nausea, headaches, loss of appetite, diarrhea, cramping, and a metallic taste in the mouth. Anyone taking this medication should not drink alcohol until 24 hours after treatment. It is recommended that all partners should be treated, and sex should be avoided until after treatment.
Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age (Schwebke, 2000). Symptoms may include an increase in vaginal discharge and a fishy odor to the discharge. However, approximately half of infected women are asymptomatic. BV occurs when there is an overabundance of certain types of bacteria that are present normally in the vagina (Holzman et al., 2001). Overall, multiple sex partners, douching, and low concentrations of beneficial vaginal bacteria have been found to increase a woman’s susceptibility to BV. In addition, research has found that occurrences of BV are more common in the first week of the menstrual cycle (Keane et al., 1997). Bacterial vaginosis rates vary by race and ethnicity—from 6% in Asians, 9% in Caucasians, 16% in Hispanics, and 23% in African Americans (Centers for Disease Control and Prevention, 2005d).
Women with BV have been found to have an increased risk of endometriosis and PID. Treatment is generally metronidazole or clindamycin, either orally or vaginally. As we discussed earlier, alcohol should be avoided during the course of treatment. Treatment of male sex partners has not been found to be beneficial in the treatment of BV.
Vulvovaginal candiasis (can-DIE-ass-sis; yeast infections, also called moniliasis or candidiasis) can be very troubling to women who are prone to them. Yeast infections can be difficult to get rid of, and recurrences are common. The infections are caused by a variety of different fungi, but one of the most common is Candida albicans. This fungus is normally present in the vagina, but it multiplies when the pH balance of the vagina is disturbed because of antibiotics, regular douching, pregnancy, oral contraceptive use, diabetes, or careless wiping after defecation (yeast is present in fecal material, and so it is important to make sure it does not come into contact with the vulva). Although yeast infections are not sexually transmitted, if a woman experiences multiple infections, her partner should be evaluated and treated with topical antifungal creams (Wilson, 2005). Men are less likely to have problems with yeast infections because the penis does not provide the warm and moist environment that the vagina does.
A yeast infection often causes burning, itching, and an increase in vaginal discharge. The discharge may be white, thin, and watery, and may include thick white chunks. It is estimated that 75% of women will experience a yeast infection at least once in their life, and 40% to 45% will have two or more yeast infections (Wilson, 2005).
Treatment includes either an antifungal prescription or over-the-counter drugs (such as Monistat, Gyne-Lotrim, or Mycelex), which are applied topically on the vulva and are inserted into the vagina. However, research has shown that a widespread use of these over-the-counter antifungal medications has caused a large increase in recurrent infections (MacNeill & Carey, 2001). Perhaps this is because many women misdiagnose their symptoms; one study found that 67% of women who thought they had a yeast infection were wrong (Crow, 1999). Misuse of over-the-counter drugs can contribute to medication-resistant strains of yeast.
Plain yogurt may provide relief to women suffering from a yeast infection. The yogurt can be applied to the outside of the vulva, and a tampon can be dipped into the yogurt and inserted into the vagina. Eating one cup of yogurt daily can also sometimes reduce recurrences. Lactobacillus, a type of “good” bacteria found in the vagina of healthy women, is also present in yogurt and can help the vagina to produce more of it.
Question: I have a vaginal discharge that is yellowish white, but there is no odor. I think it’s a yeast infection because it’s kind of itchy. Should I use an over-the-counter cream?
Remember that having a discharge doesn’t always mean that you have a vaginal infection. Normal vaginal discharge can range from white to slightly yellow, and it varies throughout the menstrual cycle. If it is thick, chunky, clearly yellow to green, or smells fishy, get it checked out by your healthcare provider. Many women mistake bacterial vaginosis for a yeast infection. Like a yeast infection, bacterial vaginosis can sometimes be triggered by the use of antibiotics or the use of feminine hygiene products. Over-the-counter medications for yeast infections, which fight fungus, are ineffective against bacterial vaginosis.