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How to treat vaginal infections and maintain a healthy vagina

Vaginal infections (Vaginitis) occur in most women during their lifetime and can be extremely uncomfortable and at times feel embarrassing.

Mr Mahantesh Karoshi is a leading women’s health expert and consultant gynaecologist. We recently sat and spoke with him to discuss vaginal infections, symptoms, causes, treatment options, prevention tips and one of the most widely believed misconceptions about vagina maintenance.


What causes vaginal infections?

Vaginal infections (vaginitis) can be caused by a change in its microbial environment. In every woman’s vagina there are good bacteria and bad bacteria. In a completely healthy woman, the good bacteria outnumber the bad bacteria (briefly put, there is a yin and yang balance).

Sometimes a change in its balance can be a cause of a vaginal infection such as bad bacteria outnumbering good bacteria. Systemic infection, a weak immune system, or a severe cough, cold or fever can all affect the bacterial microbial environment and make you more prone to a vaginal infection.

Taking antibiotics for sore throat, chest infection and UTIs can all cause an imbalance in the vaginal microbial environment. This can also make you more prone to a vaginal infection. In other words, vaginal infections are not always due to sexual intercourse. In older women, senile vaginitis (also known as atrophic vaginitis), can be secondary to hormonal deficiency. If a woman doesn’t produce enough female sex hormones (oestrogen) it can cause the vaginal skin to become thin and prone to infection.

Vaginal infection can also occur due to sexual contact. If a woman has changed her sexual partner, her vagina may become sensitive to different bodily fluids. It can make her prone to repeated infection because of a drop in the bodies’ tolerance to different fluids.

In summary, vaginal infections may be caused by:

  • A change in microbial bacteria

  • Hormonal levels, usually post menopause

  • Multiple sexual partners

When patients Google vaginal discharge, Google gives answers from a patient’s perspective and usually just suggests one infection. Vaginal infections are usually polymicrobial, it’s rarely one organism. It may be a combination of something like bacterial vaginitis, mycoplasma, candidiasis or human papillomavirus. Once the vaginal defence goes down, it’s susceptible for different organisms to attack at a different cellular level.

The problem with self-diagnosis is that many times you’ll end up buying over the counter medication and the treatment she takes may be directed to one particular organism, where in fact, she may be suffering from a polymicrobial infection.

My advice to women trying over the counter medications is, if your attempt to self-treat has not resolved the problem, then you need medical assessment. Continued repeated incorrect self-administration of medication may end up with a protracted condition with temporary relief, frustration and a waste of money. It can even make the infection harder to treat later.

What are the many types of vaginal infections?

Some of the most common infections include:

  • Thrush (Candidiasis)

  • Bacterial vaginosis –a polymicrobial condition

  • Inflammatory conditions (senile vaginitis)

  • STDs such as mycoplasma, gonorrhoea, chlamydia, syphilis and herpes.

What symptoms are more serious than others?

  • Chlamydia infection-causing cervicitis and urethritis have the ability to damage the tubes’ lifelong subfertility.

  • Recurrent bacterial vaginosis is also associated with susceptibility to different infections. This may occur due to a weak immune system.

  • Genital herpes is associated with painful lesions, they usually last about 3 to 4 days. Once you catch genital herpes, in some women, it can be a recurrent problem

  • Recurrent BV in some women can be challenging to cure, to control the symptoms and treat the attacks. Thrush can also be recurrent.

How can vaginal infections be prevented?

The most important thing I would say in this discussion is never use a vaginal douche, it’s a misconception that this helps. Every woman has an inbuilt self-cleaning system, so vaginal douching is unnecessary.

Understand each condition and try to reduce over the counter medication. If the infection doesn´t get any better, you will most definitely need professional help to treat the infection accordingly. Minimise the number of partners and if you think you have an infection seek help.

Most common methods to treat a vaginal infection?

It depends on clinical suspicion, however, treatment options are usually as follows:

Thrush - With thrush, for example, you use anti-fungal medications. A pessary is used if there are ‘cottage cheese’ like discharge from the vaginas. If the dominant symptoms are itching then a anti-thrush cream is usually recommended.

Bacterial Vaginitis (BV) - metronidazole oral tablets are usually recommended to be taken for seven days. If it doesn’t work, a vaginal pessary is suggested.

Herpes – Anti viral medication acyclovir would be suggested.

Mycoplasma - Doxcycline for one to two weeks. Senile vaginitis (or atrophic vaginitis) – Oestrogen pessaries if there are no contraindications.

Swabs can be cultured or analysed through a PCR, a polymerase chain reaction (PCR) this technology looks for protein molecules of seven different organisms including mycoplasma, and chlamydia.

Some of the infections you can’t culture. I always compare PCR to being as though you’re in the jungle, you see some footprints that look like an elephant’s and you investigate to see if it was indeed an elephant. PCR is very much like this, we spot the symptoms (the footprints) and then PCR investigates further to find out what it is.

PCR testing has been around for a few years now. Before you’d only suspect what you have but now you can confidently say what a patient has got.

Are all vaginal infections curable?

It's a myth. In some yes, in the majority, they’re known for recurrence. All are treatable and controllable. Genetic susceptibility or lifestyle choices make some people more prone than others.

If you’re currently suffering from vaginal infection symptoms, we recommend booking an appointment with a leading specialist such as Mr Mahantesh Karoshi. Book an appointment with him via his Top Doctor’s profile today.


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© 2020 by Mahantesh Karoshi.