① Nonspecific vaginitis: the vulva and vagina have a burning sensation, a large number of vaginal epithelium falls off, and the vaginal mucosa is congested and tender. In severe cases, general weakness, abdominal discomfort, excessive leucorrhea, purulent or serous, and the outflow of leucorrhea stimulates the urethral orifice, which may lead to frequent urination and painful urination.
② Mycotic vaginitis: also known as vaginal candidiasis. The prominent symptoms are increased leucorrhea, pruritus of vulva and vagina. In severe cases, fidgeting, unbearable pain, frequent urination, painful urination and painful sexual intercourse may occur. Leucorrhea is like thick white bean dregs. The vaginal membrane is highly edematous, and there is a white membrane adhesion, which is easy to peel off. Below it, there is an erosive base or superficial ulcer of the damaged mucosa. Severe cases can leave ecchymosis, which is a typical symptom of this disease. Another patient's leucorrhea is watery or purulent, with no white flake, moderate swelling of vaginal mucosa, no severe itching and burning sensation, and only vulva is moist. The incidence of fungal vaginitis is second only to trichomonal vaginitis, which is mainly caused by candida albicans infection. It is generally believed that Candida albicans is mainly caused by anal infection and has nothing to do with tinea of hands, feet and feet. Of course, fungal vaginitis can also be transmitted through sexual intercourse. According to statistics, about 10% of non-pregnant women and 30% of pregnant women have this parasite in their vaginas without obvious symptoms.
Candida can exist in human oral cavity, intestinal tract and vaginal mucosa without causing symptoms, and candida in these three parts can infect each other. In the case of suitable local conditions or poor hygiene habits, long-term use of antibiotics is likely to cause changes in vaginal pH, make candida multiply and cause infection.
Patients with fungal vaginitis mainly show pruritus and burning pain in vulva, and severe pain is unbearable; Some patients also have symptoms of urinary tract irritation and sexual pain; Leucorrhea increased in acute stage, showing white thick bean dregs. If you find the above situation, you should seek medical advice in time, and it is easy to make a diagnosis after examination and testing. Treatment must be carried out in strict accordance with the doctor's advice.
③ Trichomonal vaginitis: leucorrhea is increased and yellow-white, occasionally yellow-green purulent, often with foam and stench, and when the lesion is serious, it will be mixed with blood; Followed by backache, frequent micturition, dysuria, pruritus vulvae and dull pain in the lower abdomen. Vaginal mucosa is red and swollen, with scattered bleeding spots or strawberry-like protrusions, and occasionally there is pain during sexual intercourse.
④ Senile vaginitis: leucorrhea increases, showing yellow water sample. When the infection is serious, the secretion can turn into purulent and smelly, and occasionally there are symptoms of blood drop. Have vaginal burning sensation, abdominal discomfort, frequent urination, and dysuria. Vaginal mucosa is red, with mild edema and tenderness, scattered punctate or flaky bleeding spots of different sizes, and sometimes accompanied by superficial ulcers.
Diagnosis:
① Take the secretion of nonspecific vaginitis as smear, and common pathogenic bacteria can be found by Gram staining microscopy, but there are no molds and trichomonads.
② The secretion of fungal vaginitis was smeared and Gram stained. Under the microscope, we can see a group of oval cells stained with Gram-positive, or we can see that pseudohyphae are connected with budding cells in a chain or branched way. The most reliable method is to check the mold culture.
③ The secretion of trichomonal vaginitis was mixed with a small amount of warm normal saline dripping on the glass and examined under a microscope. Movable trichomonas vaginalis can be seen. Under special circumstances, if trichomonas can't be found, the culture method can be used to check, and the accuracy of the results is high.
④ The secretion examination of senile vaginitis should be differentiated from trichomonal vaginitis and fungal vaginitis. Pay attention to the size and shape of cervix and uterus, the source of bleeding and the results of vaginal cytology, and do cervical or endometrial biopsy if necessary to rule out the possibility of uterine cancer.
Treatment:
Dietotherapy and medication can be used. In drug therapy:
① Nonspecific vaginitis: The treatment principle lies in correcting vaginal pH and local application of antibiotics.
② Mycotic vaginitis: We should treat related inducements, such as diabetes, and stop using broad-spectrum antibiotics or hormones in time.
③ Trichomonal vaginitis: There are two methods: systemic medication and local medication.
④ Senile vaginitis: The treatment principle is to supplement a small amount of estrogen, increase vaginal resistance and inhibit bacterial growth.
Prevention:
① Nonspecific vaginitis: strengthen exercise and enhance physical fitness. Actively treat the causes, such as vaginal injury, pelvic inflammatory disease, uterine bleeding, etc. To reduce the growth and reproduction of pathogenic bacteria.
② Mycotic vaginitis: Pay attention to the rational use of broad-spectrum antibiotics and hormones. Diabetic patients should pay special attention to the cleanliness of skin and vulva. Vaginal mold often coexists or cross-infects with molds in other parts, such as itchy skin and scratching with hands to make nails with mold; Patients with perianal itching may have intestinal infection with mold. The disease can also be transmitted through sexual life, so sexual life should be avoided during treatment, and husband and wife should be diagnosed and treated at the same time when necessary.
③ Trichomonas vaginitis: Trichomonas can maintain a certain vitality during freeze-drying, and at the same time, it has a strong resistance in different concentrations of soapy water, so it is easy to be spread. First, the source of infection must be eliminated. Regular screening and treatment should be carried out, and the lover of trichomonas patients should also be diagnosed and treated. Second, eliminate the route of infection. Advocate shower, change the sitting toilet to squat, and don't rent swimsuits and towels.
④ Senile vaginitis: Enhance the defensive function of vagina, and commonly use acid or acid-producing drugs.
Drug treatment of leucorrhea
Healthy women's vagina will secrete some leucorrhea. Mental and psychological factors and physical decline will lead to an increase in leucorrhea, which will gradually return to normal after conditioning. If it is leucorrhea caused by gynecological infectious diseases, doctors must find out the reason, use drugs according to the condition and control the infection, so as to cure leucorrhea radically. Leucorrhea is mostly caused by trichomonal vaginitis, fungal vaginitis and chronic cervicitis.
The incidence of trichomonal vaginitis is very high, especially in areas with relatively poor sanitary conditions. The main symptoms of trichomonal vaginitis are pruritus and tingling of vulva, or crawling sensation, a large amount of leucorrhea and yellow-white foam, and a sour smell. At present, metronidazole (metronidazole) is its first choice for treatment, which can kill trichomonas. Take 200mg each time, three times a day, 7 days as a course of treatment. After the first course of treatment is completed, you can go to the hospital for trichomoniasis. If it is not completely killed, it is necessary to kill the trichomonas with another course of treatment to prevent repeated infection in the future.
Mycotic vaginitis is mostly transmitted through contact, and mold can be diagnosed from leucorrhea. Leucorrhea caused by fungal vaginitis, its typical symptoms are unbearable vulvar itching, more leucorrhea, especially milky white blood clots. Gynecological examination showed that the vaginal wall was severely congested and tingling. The treatment should start with killing mold, and the commonly used drug is nystatin suppository, which is inserted into the deep vagina every night 1 granule (10000 units) for 10 days as a course of treatment. After a course of treatment, you still need to go to the hospital for reexamination to decide whether you need to continue taking the medicine. For some patients with severe congestion or small area ulceration of vaginal wall, a long cotton swab can be dipped in 1% methyl violet solution.
Leucorrhea caused by chronic cervicitis is difficult to cure in a short time, and patients with cervical erosion can't heal after a long illness. Only by curing cervical lesions can the problem of leucorrhea be solved. The symptoms of this leucorrhea are more serious. Leucorrhea is yellow pus-like, sticky, smelly and bloodshot. The patient has long-term abdominal pain, backache, low back pain, poor constitution and great pain. If long-term drug treatment is ineffective, radical surgery can be performed.
Related reference: genital candidiasis || trichomoniasis
98 cases of vaginitis treated by washing and collecting method
Zhang Xiulan Guojianshan Fenyang Rehabilitation Hospital 032200 China Folk Therapy 1999 Vol.7 No.8 1999-05- 10
Vaginitis is a common disease in women. From1June, 1997 to1September, 1998, the author treated 98 cases of this disease with Baiqin Kushen decoction, metronidazole, nystatin and diethylstilbestrol, and achieved satisfactory results. Now the report is as follows.
general specification
The age of this group is 19 ~ 62 years old; All of them had clinical manifestations of vaginitis and were diagnosed by gynecological examination and vaginal secretion microscopy. There were 59 cases of trichomonal vaginitis, 27 cases of fungal vaginitis and 0/2 cases of senile vaginitis.
therapeutic method
Scutellaria baicalensis Georgi 15g, Cortex Phellodendri 15g, Radix Sophorae Flavescentis 30g, Fructus Cnidii 30g, Stemonae 15g, Herba Artemisiae Scopariae 15g, Fructus Zanthoxyli 12g, and Radix Glycyrrhizae 9g, which are decocted with water every day. The patient started treatment on the third day after menstruation. Before going to bed, wash the vulva and around the vaginal orifice with warm boiled water, and then add a proper amount of boiled water to the decoction for external washing of traditional Chinese medicine to fumigate and wash the vulva. When the temperature is suitable, the patient takes a sitz bath. After bathing, take 1 tablet and put it into the deep vagina (metronidazole for trichomonal vaginitis, nystatin for fungal vaginitis and diethylstilbestrol for senile vaginitis). Continuous medication for 7 days is 1 course of treatment.
During the treatment, avoid sexual intercourse, pregnant women and unmarried people only use lotion, not vaginal drugs.
Treatment effect
Curative effect standard: recovery: the conscious symptoms disappeared, and there was no abnormality in gynecological examination, vaginal secretion appearance and microscopic examination; Remarkable results: the symptoms disappeared, and gynecological examination, leucorrhea appearance and microscopic examination were improved.
After treatment, all patients were effective, among which 94 cases were cured and 4 cases were markedly effective.
typical case
Zhou, female, 28 years old, was first diagnosed on June 28th, 1998. The patient complained that leucorrhea increased over the past year, showing yellow or pus-like appearance, and severe cases included red leucorrhea, local itching and burning pain. The diagnosis showed that the tongue was red, the tongue coating was yellow and greasy, and the pulse was thin. The vaginal secretion smear was examined under microscope, and trichomonas was found, which was diagnosed as trichomonal vaginitis. After 1 course of treatment, all the symptoms disappeared and vaginal secretions were normal under microscope. He was told to keep local cleanliness and pay attention to sexual hygiene. Follow-up for half a year showed no recurrence.
Learn from experience
Traditional Chinese medicine believes that vaginitis is mostly caused by local impurity, and sexual intercourse does not pay attention to hygiene, so that damp-heat insects invade. Scutellaria baicalensis Georgi, Cortex Phellodendri and Radix Sophorae Flavescentis in Baiqin Kushen Decoction are bitter in taste, cold in nature, clearing heat and drying dampness; Fructus Cnidii, Radix Stemonae and Fructus Zanthoxyli are wet, killing insects and relieving itching; Yinchen clears away heat and promotes diuresis, and the fragrance turns turbid; Glycyrrhiza uralensis Fisch purges fire and detoxifies. Metronidazole is an effective drug to kill trichomonas, nystatin can inhibit and kill mold, and diethylstilbestrol is a kind of estrogen, which can increase the storage of glycogen in epithelial cells, enhance resistance and reduce pathogenic infection. This method combines traditional Chinese and western medicine, washing and harvesting, and has quick effect.
Are fungal vaginitis and trichomonal vaginitis sexually transmitted diseases?
Specifically, fungal vaginitis and trichomonal vaginitis are not sexually transmitted diseases. These two kinds of vaginitis are the most common vaginitis in women from adolescence to menopause. From the last article, we can know that these two kinds of vaginitis can be infected through many ways, but because they can be transmitted through sexual behavior, the World Health Organization lists them as sexually transmitted diseases. The concepts of sexually transmitted diseases and sexually transmitted diseases are different. The concept of sexually transmitted diseases is much broader than that of sexually transmitted diseases. All diseases that can be transmitted through sexual behavior are classified as sexually transmitted diseases, including not only sexually transmitted diseases, but also hepatitis B, crabs, tinea cruris and scabies that we are familiar with. Sexually transmitted diseases refer to diseases with sexual life as the main route of transmission. Although some sexually transmitted diseases can be transmitted through sexual behavior, sexual transmission is not necessarily the main mode of transmission.
In China, only eight diseases are classified as sexually transmitted diseases. They are: AIDS, gonorrhea, syphilis, condyloma acuminatum, genital herpes, nongonococcal urethritis, chancre and sexually transmitted lymphogranuloma.
Vaginitis is very common, the main symptom is abnormal increase of leucorrhea, accompanied by pudendal itching, often vaginal burning, pain and sexual pain, and sometimes frequent urination and pain. The most common pathogens are Trichomonas vaginalis, mold (Candida albicans) and common pyogenic bacteria, and others are Neisseria gonorrhoeae and viruses (pre-bubble virus, cytomegalovirus). The typical leucorrhea of trichomonal vaginitis is yellow watery leucorrhea or purulent foamy leucorrhea. The leucorrhea of fungal vaginitis is white dry thick bean dregs or cheese leucorrhea, often accompanied by strange itching. Typical leucorrhea is easy to identify.
Prevention and treatment of vaginitis;
1, pay attention to personal hygiene. Vaginitis is spread directly or indirectly through sexual intercourse, bathtub (footbath), bath towel (foot cloth), public bathhouse, toilet, clothes, etc. Therefore, patients' footbath, foot cloth, bath towel and underwear should not only be washed, disinfected and used exclusively, but also should not go to public bathhouse or swimming pool during illness.
2. Patients with trichomonal vaginitis generally take metronidazole orally (200mg, three times a day) together with vaginal medication (200mg 1 tablet every night, stuffed into the deep vagina), and 7 ~ 10 days is a course of treatment, together with acidic solution (such as 1: 5000 potassium permanganate solution, or 6500).
3, fungal vaginitis commonly used nystatin (1 0 ~ 200,000 units, capsules or tablets into the vagina, 1 one night), 3% clotrimazole ointment applied to the vagina, or 1% gentian violet liquid applied to the vagina,1one night,/kloc-0. And use alkaline solution (such as 2 ~ 4% sodium bicarbonate solution) to wash vagina or sitz bath.
4. Generally, pyogenic fungal vaginitis can be filled with antibiotics (such as oxytetracycline 250 mg 1 time/night) and diethylstilbestrol tablets (1 mg 1 time/night), and the vagina can be washed with acidic solution.
Precautions for prevention and treatment of vaginitis;
1. If vaginitis lasts for a long time, it is necessary to further check whether there are pathogens such as viruses (such as herpes virus and cytomegalovirus) for targeted treatment.
2. The author of trichomonal vaginitis has repeated attacks, and his spouse should also check whether there is trichomonal infection.
3. Stubborn patients with fungal vaginitis should check urine sugar and blood sugar, because the treatment of fungal vaginitis in diabetic patients is difficult to be effective if diabetes is not controlled.
4, the treatment of fungal vaginitis, it is not appropriate to use broad-spectrum antibiotics and estrogen, otherwise it will only increase the difficulty of treatment.
5. If vaginitis or fungal vaginitis such as pemphigus virus and cytomegalovirus is found during pregnancy, it should be thoroughly treated as far as possible, because the former can cause fetal malformation, neonatal infection or death, and the latter can cause neonatal fungal infection (thrush, etc.). ).
6. The concentration of liquid medicine used for vaginal washing or sitz bath should not be too high, so as not to cause chemical burns to local skin and mucosa.
7. It is best not to use metronidazole in the early pregnancy (within the first 3 months) because the possibility of fetal teratogenesis has not been ruled out.
How do women with vaginitis give birth to babies?
Vaginitis is a common and frequently-occurring disease in gynecology, with many causes, among which trichomonas vaginitis and fungal vaginitis are the most common.
Trichomonas vaginitis refers to the infection caused by Trichomonas vaginalis. Generally, it is transmitted indirectly by carriers or patients through bathhouses, swimming pools, public toilets and medical devices that are not completely disinfected, and it can also be transmitted through sexual behavior. It has been proved that live trichomonas can devour sperm, which is directly related to infertility. Trichomonas can also consume glycogen in vagina and hinder the production of lactic acid, thus changing the pH of vagina, destroying the self-defense mechanism of vagina, promoting secondary bacterial infection and increasing leucorrhea. The change of vaginal pH and excessive leucorrhea will hinder the vitality of sperm and increase the possibility of infertility.
Mycotic vaginitis is caused by Candida albicans infection. Candida albicans can exist in human oral cavity, intestine, perianal region and vaginal mucosa without causing symptoms. However, under the following circumstances, the local resistance of the body or vagina decreases, which can cause disease: ① when the glycogen of vagina increases and the acidity increases; ② A large number of estrogen drugs were used; ③ Long-term application of antibiotics can change the distribution of vaginal flora; ④ Vitamin deficiency caused by serious infectious diseases and other consumptive diseases. The endocrine changes caused by pregnancy are equivalent to taking a large number of contraceptives, and the level of estrogen in the body increases, which stimulates the increase of glycogen content in vaginal epithelial cells and enhances vaginal acidity, thus accelerating the growth and reproduction of Candida. This also explains why fungal vaginitis is more common in pregnant women.
No matter what kind of vaginitis, the incidence of intrauterine infection and neonatal infection in patients with vaginitis is higher than that in normal women, because the vagina is closely connected with the uterus, and the vagina is the first non-uterine environment that the fetus comes into contact with at birth. Therefore, women suffering from vaginitis should be actively treated before pregnancy, and it is best to plan pregnancy in the case of recovery. If it is an infection during pregnancy, the corresponding pathogenic microorganism treatment can be carried out after 3 months of pregnancy. At the same time of active treatment, measures should be taken during sexual life, such as using condoms to avoid repeated infections and raise a healthy and intelligent baby.
Candidal vaginitis is a kind of fungal vaginitis. Its symptoms are:
1, leucorrhea increases: leucorrhea is white or yellow water-like or pus-like, containing white curd-like or tofu-like residue, slightly smelly, or bloodshot under leucorrhea.
2, vulva and vaginal irritation symptoms: manifested as severe itching, affecting sleep and work, symptoms generally range from mild to unbearable, patients often scratch unconsciously, leading to vulva swelling, flushing, and even redness, ulceration, burning sensation.
Because the recurrence rate of fungal vaginitis is particularly high, we must take strict precautions: (1) Mold can be transmitted through sex, so both men and women should pay attention to it. (2) Don't abuse antibiotics, because antibiotics can kill normal bacteria in vagina, resulting in flora imbalance, which is beneficial to mold growth. (3) beriberi and onychomycosis are important sources of infection. Someone in the family got this disease, and once it spread to the vagina, it became fungal vaginitis. (4) At home, shoes, socks and other clothes must not be washed in a basin, nor can they be washed together in the washing machine. Should be washed separately to avoid fungal vaginitis.
The treatment drug is "Spirits", and patients can basically recover after taking it for one week under the guidance of a specialist. But in treatment, it should be treated by husband and wife together. And to determine the clinical efficacy, we should observe it for three months and check it once a month. If it is negative, it can be said that it is completely cured.
What is trichomonal vaginitis?
Trichomonas vaginalis in women with trichomonas vaginitis is mostly parasitic in vagina, urethra, vestibular gland and bladder. Vestibular gland involvement is rare. Trichomonas vaginalis is a flagellate body, much larger than polymorphonuclear leukocytes, pear-shaped, with four flagella at the top and a shaft column protruding from the tail. It can be parasitic in human body and will not cause clinical symptoms. Some bacteria can induce trichomonas to be active and produce symptoms, but antibodies in the body can spread directly or indirectly, mainly through baths, bathhouses, swimming pools or medical devices that are not thoroughly disinfected. Direct transmission can be through sexual intercourse, from male urinary system, and urine and feces of patients may also be the source of infection.
What is trichomonal vaginitis caused by?
Trichomonas vaginalis is mostly parasitic in vagina, urethra, vestibular gland and bladder. Vestibular gland involvement is rare. Trichomonas vaginalis is a flagellate, which is much larger than polymorphonuclear leukocytes. It is pear-shaped, with four flagellates at the top and a shaft column protruding from the tail. It can be parasitic in human body and will not cause clinical symptoms. Some bacteria can induce trichomonas to be active and produce symptoms, but antibodies in the body can spread directly or indirectly, mainly through baths, bathhouses, swimming pools or medical devices that are not thoroughly disinfected. Direct transmission can be through sexual intercourse, from male urinary system, and urine and feces of patients may also be the source of infection.
What are the symptoms of trichomonal vaginitis?
The incubation period is 4 ~ 28 days, and there are small red particles or petechiae in the vaginal mucosa. The pH value is higher than normal. Vagina has a large amount of yellow-green or gray foam secretion, which smells fishy, sometimes mixed with a little blood or pus, and the secretion stimulates the vulva and has an itchy feeling. Redness of vulva and even inflammatory ulcers, some of which are caused by dampness and abrasion, can spread to genital thigh folds. Pain during sexual intercourse, and symptoms such as dysuria and frequent urination may occur.
What tests does trichomonal vaginitis need to do?
It is not difficult to diagnose according to symptoms and signs, and the diagnosis can only be made if trichomonas vaginalis is found. Vaginal secretion was examined by hanging drop method, and movable trichomonas could be found under microscope and stained smear. Culture can be carried out if necessary. When trichomonas infection affects vaginal cells, it should be differentiated from malignant tumors, and vaginal cytology can be done after treatment if necessary.
How to treat
Oral metronidazole 200mg, 3 times a day, 7 to 10 days. The side effects are small, and some cases may have nausea, diarrhea, dizziness, headache, rash and granular leukopenia after taking the medicine. After stopping the drug, these side effects disappeared.
Can use 1% lactic acid or acetic acid solution to locally scrub vulva and rinse vagina; Then put it in the vagina with arsenic, diweijing or mucomycin for 7 ~ 10 days as a course of treatment.
External Chinese medicine lotion; 30g of crane louse, 65438 05g of Sophora flavescens, 65438 05g of Stellera chamaejasme, 65438 05g of Fructus Cnidii, Radix Angelicae Sinensis and Radix Clematidis, decocted in water, smoked and washed, and taken in a sitz bath. During the treatment, pay attention to keep the local clean. Underwear and utensils touching vulva should be boiled and disinfected to prevent re-staining.