Vaginitis is a common condition, but it can return even after the same treatment has been repeated. In most cases it recurs because it was treated the same way without identifying which organism was behind it.
Candida, bacterial and trichomonas vaginitis look alike in their symptoms, yet the cause and the direction of treatment are entirely different. Confirming the organism, and where necessary testing for sexually transmitted infection and assessing the structure of the labia as well, is what reduces recurrence.
Why does the organism behind recurring vaginitis have to be identified?
Vaginitis may look similar in its symptoms, such as discharge or itching, but it is in fact caused by different organisms. Candida vaginitis appears when candida overgrows, bacterial vaginitis develops as lactobacilli decline and anaerobic bacteria come to dominate, and trichomonas vaginitis appears through transmission by sexual contact, so everything from the cause to the medication used differs considerably.
Where the same antifungal or antibiotic is used again and again, the symptoms may not settle or may return quickly if the organism has changed, or if a different organism was behind it from the start. When recurrence is frequent, testing should confirm which organism it is first, and repeating the same medication on your own should be avoided.
- Candida vaginitis — develops when candida overgrows, with thick white discharge and itching as its features, and is treated with an antifungal
- Bacterial vaginitis — arises as lactobacilli decline and anaerobic bacteria come to dominate, accompanied by pale grey discharge and a characteristic odour
- Trichomonas vaginitis — a parasitic infection that can be passed on through sexual contact, so a partner needs to be treated as well
If vaginitis keeps returning, is testing for sexually transmitted infection needed?
Candida vaginitis and bacterial vaginitis can develop whenever the balance in the body is disturbed, quite apart from sexual contact, so there is no need to suspect a sexually transmitted infection straight away. Even so, cases such as trichomonas vaginitis that are transmitted are mixed in among them, and separating out the cause means testing for sexually transmitted infection as well.
If an organism transmitted by sexual contact is confirmed, treating yourself alone leaves room for it to be passed back, so a partner has to be tested and treated too for recurrence to be prevented. Assuming the cause without testing risks missing the organism, allowing the inflammation to spread and leading to complications such as pelvic inflammatory disease.
Can the structure of the body, rather than an organism, be the cause?
When the labia minora are enlarged, friction with underwear becomes more frequent and discharge cannot drain properly from between the folds, so it tends to collect there. That area then turns into a warm, damp environment, favourable for candida and anaerobic bacteria to multiply, and vaginitis can reappear even after the same treatment has been repeated.
Where a structural cause is present, removing the organisms with medication still leaves the environment that produces the recurrence, so the effect of treatment often proves temporary. Assessment of the structure of the labia is therefore needed alongside testing for the organism, and where necessary treatment to improve the structure can be considered.
- Trapped discharge — discharge cannot escape from between the folds, creating an environment in which bacteria and fungi multiply easily
- Friction and irritation — repeated friction against underwear weakens the skin barrier, making it easier for organisms to penetrate
- Difficulty washing — the overlapping skin is hard to clean between, so discharge and sweat tend to remain even when hygiene is kept up
