Ask the Pharmacist

Q: I was told I have vaginitis. Is that another term for a yeast infection? What are the usual signs and symptoms, what else might it be, and can a pharmacist help treat it?

A: Many ailments that end in “itis” describe an inflammation; thus, vaginitis is best defined as an inflammation of the vaginal tissue. It can result in vaginal and/or vulvar (the external female genital organs) itching, irritation, burning, odour and/or discharge.

Vaginitis is common, especially for women who are in their reproductive years, and may occur when there is a change in their vaginal ecosystem.

There are four main causes of vaginitis:
 

• Bacterial vaginosis (40-50 per cent)
• Sexually-transmitted infections, such as Trichomoniasis, Chlamydia, Gonorrhea (15-20 per cent)
• Non-infectious (five to 10 per cent), such as allergic, atrophic, or irritant
• Vaginal candidiasis (20-25 per cent)

We will describe each type of vaginitis in more detail, as well as when you should seek medical attention and when a pharmacist can prescribe a treatment.

Bacterial vaginosis

Up to 50 per cent of women with bacterial vaginosis may not experience any symptoms but for those women who do, it would be a thin, consistent, malodorous (fishy) discharge with a grayish white or yellowish colour.

Vaginal pain or vulvar irritation is not common; however, itching may be present. With bacterial vaginosis, the vaginal pH is usually elevated at greater than, or equal to, pH5. Pharmacists are not able to prescribe any treatments for this and, therefore, another health-care practitioner should be sought.

Sexually-transmitted infections
 

• Trichomoniasis
  • Trichomoniasis is the most prevalent, non-viral sexually-transmitted infection that is seen globally. What makes it challenging is up to 50 per cent of people with trichomoniasis may not have symptoms. Those that do, may have a malodorous and profuse amount of frothy discharge which may be gray, yellow or green with vaginal pain and irritation along with painful urination (20 per cent), itching (25 per cent) and post-coital bleeding. The vaginal pH is usually elevated at greater than or equal to pH6.
• Chlamydia/Gonorrhea
  • Chlamydia or Gonorrhea may include excessive vaginal discharge, redness, fever or abdominal tenderness. The abdominal tenderness would indicate there might be an upper genital tract infection, such as pelvic inflammatory disease.

Pharmacists are also not able to prescribe for these sexually-transmitted diseases and, therefore, it is recommended to seek medical treatment from another health-care provider.

Non-infectious conditions

Non-infectious conditions are often a result of an allergic reaction or irritation. Some examples include:
 

• Foreign body – a tampon or a condom are the most common foreign body objects that are, unintentionally, left in the vagina and can create a very malodorous discharge.
• Poor hygiene – when wiping after toileting, always wipe from front to back
• Atrophic vaginitis – associated with low estrogen, and symptoms can include vaginal dryness, itching, abnormal bleeding, or painful intercourse.
• Contact dermatitis – usually caused from a recent bubble bath, douching, using feminine hygiene sprays, coloured or scented products such as toilet paper, panty liners and latex.
• Psoriasis
• Lichen planus
• Lichen sclerosis

Once again, pharmacists are unable to prescribe for these non-infectious vaginal conditions.

Vaginal candidiasis

Vaginal candidiasis, also widely-termed as a vaginal yeast infection, often presents itself with a thick, white, curdy discharge resembling cottage cheese. There is often itching, discomfort, burning, redness, and/or swelling of the vaginal tissues and vulvar area. There may also be painful urination and painful intercourse.

Vaginal candidiasis can be classified as either uncomplicated (less than four episodes per year and/or mild to moderate symptoms) or complicated (four or more episodes per year and/or severe symptoms and/or are immuno-compromised or pregnant).

Some risk factors that increase your chances of acquiring a vaginal yeast infection include:
 

• Having a reduced immune function
• Having poorly-controlled diabetes
• Peri-menopause or menopause
• Certain medications, such as antibiotics, corticosteroids, and specific diabetes medications, such as canagliflozin (Invokana) or empagliflozin (Jardiance), among others

As with many conditions, prevention is the best form of treatment. In the case of vaginal candidiasis, it is important to practise good genital hygiene (wipe front to back, avoid scented feminine hygiene products, avoid vaginal douching and other genital hygiene products), avoid tight clothing and synthetic underwear, and promptly change out of wet clothes or bathing suits.

In regard to treating vaginal yeast infections, products vary anywhere from one day to seven days of treatment. It is interesting to note that the one-day treatment is as effective as the seven-day treatment but bear in mind that the one day does NOT work any faster, it is perhaps just more convenient. However, the one-day treatments are more potent and, therefore, have an increased chance of local side effects.

Pharmacists are allowed to prescribe for many, but not all, vaginal candidiasis infections. There are treatments available that do not require a prescription and, therefore, are easily accessed without any consultation. You may, however, decide you want a consult to confirm your diagnosis or to listen to helpful tips to reduce your symptoms or you have a drug plan that you hope the prescribed medications might be covered for you. If you think you are experiencing symptoms of vaginal candidiasis, contact your pharmacist to see if he/she is willing, and able, to help you.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/