Vaginal Infections: Causes, Symptoms, and Treatments

Vaginitis, fungal issues?

Hello Doctor, I would like to ask you a few questions.
I have previously undergone a liver transplant, and since getting married several years ago, I have experienced vaginal itching at least once a year.
However, I have not had any vaginal itching in the last two to three years.
Last year, the itching returned, and I was found to have three types of bacteria during one of my visits: a fungus, Escherichia coli, and a type of bacteria that the doctor said is normally found on the skin.
I wonder if my skin itching and scratching could be related to the vaginal itching.

On January 6th of this year, I started feeling itchy again and noticed some cottage cheese-like discharge.
I visited the doctor on January 10th, who performed a bacterial culture and prescribed a five-day course of suppositories.
On January 17th, I returned for the results, and I still felt itchy.
The doctor performed an internal examination and said everything looked fine.
However, the report indicated the presence of fungus, E.
coli, and a rare respiratory bacterium.
I was prescribed a five-day course of antibiotics and additional suppositories for three days, which I used until Friday night.
I took the antibiotics from the evening of January 17th until Saturday morning but forgot to take them on Saturday morning, so I resumed taking them in the afternoon and evening.
1.
Will the E.
coli in my vagina develop antibiotic resistance due to this treatment? I still feel itching in the vulvar area.
On January 26th, I visited a gynecologist again, who performed another internal examination and said everything looked clean, with no redness or swelling in the vulvar area.
However, the vulvar area appeared drier, possibly causing the itching.
The doctor prescribed a topical cream for me to apply to the vulvar area.

Recently, I started feeling a specific itch at the vaginal opening, occurring about once or twice a day.
Yesterday, while straining during a bowel movement, I noticed a small amount of greenish discharge mixed with clear discharge.
Today, I experienced a bit of green and clear discharge again while straining during a bowel movement.

2.
Should I use a suppository preemptively?
3.
Does excessive flatulence increase the risk of E.
coli reaching the vagina?
4.
I have been wiping after bowel movements and washing my buttocks with body wash, but I do not wash my vagina with body wash.
Could this lead to vaginal inflammation?
5.
I recently purchased a feminine hygiene foam specifically for washing the vulvar area.
Is it safe to use this daily while showering?
6.
Given the recent humid weather, is it advisable to use a hairdryer to dry my underwear before wearing them?
7.
I have seen other doctors recommend lactic acid suppositories and lactic acid bacteria supplements.
Can these be used regularly?
Thank you for your help, Doctor.

Wenwen, 40~49 year old female. Ask Date: 2022/01/30

Dr. Wu Xianghui reply Obstetrics and Gynecology

"Vaginal infections" can cause abnormal discharge, perineal itching, odor, burning sensation during urination, frequent urination, and bleeding.
In more severe cases, it may lead to abdominal pain or fever.
"Treatment methods" vary depending on the symptoms and require proper health education.
It is recommended to visit an outpatient clinic for examination and evaluation by a specialist in obstetrics and gynecology.

Reply Date: 2022/01/30

More Info

Understanding vaginal infections is crucial for maintaining reproductive health, especially for individuals with a history of medical conditions such as liver transplants. Vaginal infections can arise from various causes, including bacterial, fungal, and viral pathogens. The symptoms often include itching, burning, unusual discharge, and discomfort during intercourse.
In your case, it seems you have experienced recurrent vaginal itching and infections over the years, with recent tests indicating the presence of Candida (a type of yeast), Escherichia coli (E. coli), and a rare respiratory bacterium. The presence of these pathogens can lead to symptoms such as itching and abnormal discharge, which you have described.

Causes of Vaginal Infections
1. Fungal Infections: These are often caused by an overgrowth of Candida species, leading to symptoms like itching and a thick, white discharge resembling cottage cheese. Factors such as antibiotic use, hormonal changes, and a weakened immune system can predispose individuals to these infections.

2. Bacterial Infections: Bacterial vaginosis is a common condition caused by an imbalance of normal vaginal bacteria. E. coli, typically found in the intestines, can also cause urinary tract infections that may lead to vaginal symptoms.

3. Skin Bacteria: The skin flora can sometimes lead to infections if there is a break in the skin barrier or if the bacteria migrate to the vaginal area.

Symptoms and Diagnosis
The symptoms you are experiencing, including itching and unusual discharge, warrant a thorough evaluation. The greenish discharge you mentioned could indicate a bacterial infection or a possible recurrence of a yeast infection. It is essential to differentiate between these conditions, as treatments vary significantly.

Treatment Options
1. Antifungal Medications: If a yeast infection is confirmed, antifungal treatments such as topical creams or oral medications (like fluconazole) are effective.
2. Antibiotics: For bacterial infections, antibiotics are prescribed. However, overuse can lead to antibiotic resistance, which is a concern with E. coli.

3. Topical Treatments: Creams like hydrocortisone can help alleviate itching and inflammation, while moisturizers can address dryness.

4. Probiotics: Lactobacillus supplements or vaginal probiotics can help restore the natural flora of the vagina, potentially preventing future infections.

Preventive Measures
1. Hygiene Practices: It’s good that you are cautious about hygiene. Using mild soap for external washing and avoiding harsh products in the vaginal area is advisable. Over-washing or using scented products can disrupt the natural balance.

2. Clothing Choices: Wearing breathable cotton underwear and avoiding tight clothing can help reduce moisture and prevent infections.

3. Diet and Lifestyle: A balanced diet, staying hydrated, and managing stress can support your immune system, which is crucial for preventing infections.

4. Avoiding Irritants: Be cautious with products like feminine washes or douches, as they can disrupt the natural vaginal flora.

Addressing Your Specific Questions
1. Antibiotic Resistance: The risk of developing antibiotic resistance with E. coli is real, especially with repeated courses of antibiotics. It's essential to use them judiciously and only when necessary.

2. Self-Treatment: If you suspect a recurrence of a yeast infection, using an over-the-counter antifungal treatment may be appropriate, but consulting a healthcare provider is ideal.

3. Bacterial Migration: While flatulence itself does not directly cause E. coli to migrate to the vagina, poor hygiene practices can facilitate this.

4. Washing Practices: Using mild soap for external cleaning is fine, but avoid washing the vagina internally with soap, as it can disrupt the natural pH balance.

5. Feminine Hygiene Products: Using a gentle feminine wash can be beneficial, but ensure it is free from irritants.

6. Drying Underwear: Using a blow dryer on low heat can help dry underwear, but ensure it’s not too hot to avoid fabric damage.

7. Probiotics: Lactobacillus supplements can be beneficial for maintaining vaginal health and can be used regularly, especially after antibiotic treatment.

In conclusion, it’s essential to work closely with your healthcare provider to manage your symptoms effectively and to address any underlying issues contributing to recurrent infections. Regular check-ups and open communication about your symptoms will help in tailoring the best treatment plan for your needs.

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