Colpitis

Classification according to ICD-10
N76.0	Acute colpitis
N76.1	Subacute and chronic colpitis
ICD-10 online (WHO version 2019)

As vaginitis ( lat. ) Or vaginitis ( Greek. ) Refers to an inflammation of the vagina (lat. Vagina , Greek. Kolpos ).

to form

• Dysbiosis : If there is an imbalance in the frequency of individual germs in the vagina, but there are no signs of infection, it is called dysbiosis. This can degenerate into an infection.
• Primary colpitis: This occurs when a considerable amount of germs get into the vagina and disturb the existing germ balance there. As a result, the lining of the vagina becomes inflamed.
• Secondary colpitis: If the environment in the vagina is disturbed and an infection develops on the basis of this disturbance, it is called secondary colpitis.
• Atrophic colpitis or senile colpitis : special form of secondary colpitis. As a result of the loss of hormone production (here especially estrogen ), there is a reduced local defense against bacteria or fungi. This can lead to more frequent vaginal infections.
• Non-inflammatory vaginal infections: These include infections with human papillomavirus (HPV) or other viruses such as infection with the herpes simplex virus  2 ( genital herpes ).

meaning

The dysbiosis is harmless at first. However, it favors the rise of further germs (including chlamydia ) via the cervix ( cervicitis ) and the uterus into the fallopian tubes and ovaries up to the abdomen. Such an advanced infection can lead to massive inflammation of the abdomen, also known as pelvic inflammatory disease in English , and to infertility as a result of the inflammation of the fallopian tubes . Therefore, during routine gynecological examinations, the pH value should be measured regularly and a microbiological native preparation should be created in order to detect inflammation at an early stage. An infection by the human papillomavirus (HPV) can lead to the formation of condylomas ( Condylomata acuminata ), and if certain types of the virus, especially types 16 and 18, are persistent, it can increase the risk of developing cervical cancer. A genital infection with the herpes virus type II usually leads to a so-called superinfection of the cold sore. This bacterial or fungal infection of the vesicles can cause significant pain and slow wounds to heal.

Pathogen

Usually there is a mixed form of different pathogens. Nevertheless there is a frequency distribution.

The most common germ found is Gardnerella vaginalis (40% of cases). The colpitids that u. a. caused by Gardnerella - mostly a mixed flora - are called bacterial vaginoses . In the meantime, however, the bacterium Atopobium vaginae, along with G. vaginalis, is regarded as an indicator germ for bacterial vaginosis. In second place are various mushrooms with 20% of the frequency . They are also visible in the vaginal swab. Trichomonas vaginalis , which can be seen alive in the native preparation under the microscope (a mobile flagellate) is in third place in terms of frequency with around 10% of the causer . The portio (the vaginal part of the cervix) appears blotchy. Chlamydia is also relatively common with 10% incidence in sexually active women. The remaining 20% ​​are spread over mixed infections of all the possibilities mentioned. HPV infections are a special case. HPV is also transmitted through sexual intercourse. There are now over 80  genetically differentiable subtypes. Types 16 and 18 contain two oncogenes in their DNA and are largely responsible for the development of cervical carcinoma .

Other subgroups (6, 11) produce the condylomata acuminata (genital warts), which are small, pointed, hard warts.

Herpes simplex type II can occur on the outside of the vulva , but also in the vagina. It shows small, itchy blisters .

Symptoms

Symptoms depend on the type of infection.

• In the case of a classic infection with the most common germ Gardnerella vaginalis, the patients complain of discomfort and increased wetness in the vagina or a grayish to yellowish discharge with a fishy odor (amine odor) in the case of bacterial vaginosis, which can intensify especially after unprotected intercourse (due to the alkaline Prostate secretions ).
• With a simple bacterial infection, there is usually also a discomfort, pain during intercourse and a different, often yellowish-green discharge.
• When infected with trichomonads, the discharge is often yellowish, foamy, and women feel a considerable burning sensation in the vagina.
• With a fungal infection, the discharge is often crumbly, odorless and white-yellowish. The main symptom is usually the z. T. unbearable itching.
• With a chlamydial or mycoplasma infection, the discharge is usually (if changed at all) whitish-glassy, ​​odorless. The symptoms are varied and not typical of any infection.
• When infected with herpes viruses, small grouped vesicles appear at the vaginal entrance. These often cause stabbing pain before they become visible.

In addition, all infections can cause itching and pain during sexual intercourse ( dyspareunia ).

HPV infection will only cause symptoms if it is infection of the subtypes that cause the condylomas. These can occur after a certain period of infection and sometimes cause, before they become visible, pulling and stabbing discomfort in the area where the condylomas later appear.

Diagnosis

A measurement of the pH value almost always gives values ​​in the weakly acidic range; d. H. a pH <5.5 (normal would be pH 3.8-4.5). A disruption of normal settlement is therefore already certain. The basic diagnosis includes a smear for the microscopic examination of the vaginal secretions. This can be used to distinguish inflammation caused by bacteria, fungi, trichomonads and especially Gardnerella vaginalis . However, these investigations are not certain. Herpes infection is almost always diagnosed by eye diagnosis. A chlamydial infection is diagnosed with a special smear. Rapid tests are offered for practice and considerably better ones for laboratories. An HPV infection can be recognized by the condyloma or not at all. In the meantime, however, there are also meaningful laboratory tests for this. A positive or negative result is currently of no significance in terms of treatment, as there is not yet any, but enables the patient to be categorized. In the case of high-risk HPV infections, a follow-up examination is carried out more closely.

therapy

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

In the case of bacterial vaginosis, the Center for Disease Control and Prevention recommends:

• Metronidazole 2 × 500 mg daily for 7 days or
• Metronidazole 0.75% gel 5 g each in the vagina before sleep, for 5 days or
• Clindamycin 2% cream 5 g each in the vagina before bed for 7 days

Alternatives:

• Tinidazole 2 g daily orally for 2 days or
• Tinidazole 1 g orally daily for 5 days or
• Clindamycin 300 mg twice daily orally for 7 days or
• Clindamycin Ovula 100 mg in the vagina at bedtime for 3 days

In case of desquamative inflammatory vaginitis (with purulent discharge), the following are recommended:

• Clindamycin 2% cream in the vagina before going to sleep for 1 - 3 weeks, possibly continued 1 - 2 × per week for 2–6 months and
• Local glucocorticoids:

Hydrocortisone 300–500 mg in the vagina before going to sleep for 3 weeks, possibly continued 1–2 times per week for 2–6 months or

Put Clobetasol Propionate into the vagina for 1 week at each sleep

Additional recommendation:

Fluconazole 150 mg orally, once a week as maintenance therapy

intravaginal estrogens twice a week (have the indication checked by a gynecologist! Is absorbed into the bloodstream.)

Bacterial infection:

• Use of antibiotics . For Gardnerella vaginalis and trichomonads, partner treatment is compulsory.

Fungal infection:

• Locally effective remedy for a fungal infection. So-called combination preparations are usually used: suppositories for the vagina and a cream for the intimate area. Treatment over three days is standard. A partner treatment is not absolutely necessary, except in the case of complaints or persistent infection without improvement.

Chlamydia and Ureaplasma:

• Use of antibiotics, preferably tetracyclines .

Herpes infection:

• If the infection is healing, only local disinfection in order to avoid a second infection with bacteria or fungi.
• In the case of very fresh blisters, either locally with a cream or as tablets, a treatment with a so-called antiviral agent, a means that stops the virus from multiplying. One example is acyclovir.

Condylomas :

• Look there.

HPV:

• None, observation. Exceptions: condylomas or cell changes on the cervix, the dysplasia .

source

• Kaiser et al .: Textbook of Gynecology. 16th edition. Georg Thieme Publishing House.

See also

• Vulvovaginitis

Web links

• Preventing vaginal infections - diseases of the female intimate zone at Vital

Individual evidence

1. ↑ CS Bradshaw, SN Tabrizi, CK Fairley, AN Morton, E. Rudland, SM Garland: The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. In: The Journal of Infectious Diseases. Volume 194, Number 6, September 2006, pp. 828-836, ISSN  0022-1899 . doi: 10.1086 / 506621 . PMID 16941351 .
2. ↑ Andreas Schwiertz, David Taras, Kerstin Rusch, Volker Rusch: Throwing the dice for the diagnosis of vaginal complaints? In: Annals of Clinical Microbiology and Antimicrobials. 5, p. 4, doi: 10.1186 / 1476-0711-5-4 .
3. ↑ Kimberly A. Workowski, Gail A. Bolan, Centers for Disease Control and Prevention: Sexually transmitted diseases treatment guidelines, 2015 . In: MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports . tape 64 , RR-03, June 5, 2015, ISSN  1545-8601 , p. 1-137 , PMID 26042815 , PMC 5885289 (free full text).
4. ↑ Orna Reichman, Jack Sobel: Desquamative inflammatory vaginitis . In: Best Practice & Research Clinical Obstetrics & Gynaecology . tape 28 , no. 7 , October 2014, p. 1042-1050 , doi : 10.1016 / j.bpobgyn.2014.07.003 ( elsevier.com [accessed on February 16, 2019]).
5. ↑ Jorma Paavonen, Robert C. Brunham: Bacterial Vaginosis and Desquamative Inflammatory Vaginitis . In: New England Journal of Medicine . tape 379 , no. 23 , December 6, 2018, ISSN  0028-4793 , p. 2246–2254 , doi : 10.1056 / NEJMra1808418 ( nejm.org [accessed February 16, 2019]).

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !