Texts for Translation 2008:
  Sexual Health

VAGINAL HEALTH

The vagina is actually very good at taking care of itself – if left to its own devices!  It contains a healthy population of bacteria (called lactobacilli) which keeps the environment slightly acidic.  Things can go wrong if anything happened to disrupt this normal, healthy balance – common causes include antibiotics, over washing, douching or the use of strong soaps, shower gels and vaginal deodorants.  It is normal for women to have a variable amount of vaginal discharge, which is usually white or clear.  This may increase just before a period or during pregnancy.  There are a number of common minor infections, which can cause a change from the normal type of discharge – it may become more strong smelling, yellow of frothy.  The discharge may occur with some external soreness, itching, burning or cracks in the skin.  Genito-urinary medicine and Sexual health clinics can offer IMMEDIATE AND ACCURATE DIAGNOSIS of all vaginal infections.  The commonest vaginal infections are;

Vaginal Candidiasis (thrush)
Bacterial vaginosis
Trichomoniasis (TV)

VAGINAL CANDIDIASIS

This is caused by yeast which 10% of all women carry in the vagina.  Most of the time, it causes no problems, but under certain conditions (and in small group of women who seem to get troublesome, recurrent thrush for no apparent reason) the yeast multiplies in the vagina and causes symptoms.  Although your male partner may experience some soreness on his penis if you have very active thrush, sexual transmission is not thought to be important in causing thrush in women.

Symptoms
Itching, Burning, soreness and occasionally swelling around the vulval area.  Vaginal discharge (sometimes).

Diagnosis
A sample is taken gently from the side wall of the vagina and examined under the microscope whilst you are in the clinic – this allows an immediate diagnosis and treatment can be started without delay.  Another swab will be sent off to the laboratory for culture confirmation, the result of which comes back in 3-7 days.

Treatment
There are various options – usually a single-dose pessary or concentrated vaginal cream is used.  Sometimes a weaker antifungal cream is also given to soothe the skin externally.  Some women choose to take tablets by mouth to clear the infection.  It is best to stop using soap for a while and to wear loose cool clothing – or no underwear at all.  Treatment of your sexual partner is not required, unless they have symptoms.  For the small group of women who experience very frequently recurring vaginal candidasis, there are particular approaches which have been shown to help, including regular use of antifungal pessareis to prevent recurrences

BACTERIAL VAGINOSIS

This is almost as common as thrush, but often goes unrecognised.  It is cause by a change in the balance of bacteria in the vagina.  Bacteria which are usually present in small numbers multiply and take over from the healthy lactobacilli.  It tends to occur in women who are in sexual relationships, but is not thought to cause any problems for partners.  Current research is studying the effects of this common infection in pregnancy – some evidence suggests that it may be associated with premature labour.

Symptoms
Grey, watery discharge with an offensive odour
NO soreness or itching usually

Diagnosis
A sample of the discharge is taken and its acidity measured.  It is then examined under the microscope whilst you are still in the clinic – this allows immediate confirmation of the diagnosis and treatment can be started.

Treatment
There are several options.  A single-dose of the antibiotic (usually Metronidaxole) can be given, this is about 85% effective.  Other options are a week’s course of antibiotics given either in tablet form by mouth or sometimes a vaginal cream – these options are over 95% effective.  Your partner does not need treatment.

TRICHOMONIASIS (TV)
This is an infection caused by a small parasite.  It may also cause infection in the urethra (water passage) in both women and men.  It is usually sexually transmitted.

Symptoms
There may be no symptoms
Thin, yellow, frothy discharge
Irritation and soreness around the vaginal area
Pain on passing urine.

Diagnosis
A sample of the discharge is examined under the microscope (called a wetmount preparation) this again allows an instant diagnosis and treatment.

Treatment
This is usually a single dose of Metronidaxole, an antibiotic.  If you suspect you may be pregnant, tell your doctor before accepting this treatment.  Your partner should also be treated and you should both go back for a repeat examination about a week later.

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