Pharmacological Management of Vaginitis

Abstract

The paper focuses on the characteristics of vaginitis, the nursing implications of the disease, and its treatment with the application of anti-infectives. The essential idea behind the text is that, in order to treat vaginitis properly, it is necessary to determine its type and symptoms. Depending on the type of pathogen the disease is provoked by, vaginitis is divided into specific and non-specific.

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Specific vaginitis is caused by gonococci, trichomonads, fungi, and other infections. According to the initial localization of an infectious focus, vaginitis can be divided into primary, when the process is just developing in the vagina; secondary, which occurs in cases of contact with infectious agents from other places (ascending – from the surface of the vulva and downward – from the uterus). The disease can appear in the following forms: slow disease vaginitis; acute vaginitis; chronic vaginitis; subacute vaginitis; latent (hidden) vaginitis; vaginitis asymptomatic. Separately, there is also isolated vaginitis senile, or atrophic (which is connected with the woman’s age).

Keywords: vaginitis, nursing implications, antiinfectives, pharmacological management, patients.

Introduction

One of the most common illnesses females suffer from is vaginitis. This disease mainly affects women of childbearing age, but it frequently occurs among young girls and post-menopausal women. In order not to miss the development of vaginitis, every woman should know the symptoms to begin treatment immediately. However, it is important to remember that no diseases, especially ones of infectious nature similar to vaginitis, should be treated in domestic conditions. It is important to consult a doctor immediately. Therefore, this paper will focus on the pharmacological management of vaginitis with the help of anti-infectives and nursing implications.

Vaginal Flora

Normally, the vaginal microflora of healthy women of childbearing age consists of 95% – 98% lactic acid bacteria or Doderlein’s bacillus (Kale & Ubgade, 2013). Doderlein’s bacillus cleave glycogen, which is obtained from the exfoliated epithelial surface layer of the vaginal mucosa cells. Upon cleavage of glycogen, lactic acid is formed, by which the pH of the vaginal environment is shifted to the acid side (4.5 or less). The acidic vaginal environment is a kind of defense against pathogenic microbes, many of which are not able to grow and reproduce in these conditions.

The lactic acid bacteria also form hydrogen peroxide and a number of substances similar to antibiotics that strengthen the protection and prevent the colonization of the vagina by unwanted microorganisms. Additionally, Lactobacillus coexists with bifidobacteria, which protect the vagina from infection control. The ability to live and the number of lactic acid bacteria depend on the production of estrogen (Bilardi et al., 2013).

Therefore, beginning with the premenopausal period, estrogen production declines. It thins the vaginal mucosa and decreases the number of lactic acid bacteria. This process is known to lead to the development of age-vaginitis. Combined with various other conditions that lead to a decrease in lactobacilli in healthy and young women. Afterward, the vagina is very quickly populated by ‘invaders’ – pathogens. Moreover, bifidobacteria and Lactobacillus in the vagina are present in small amounts along with other organisms: Streptococcus; enterococci; peptococcus; staphylococci; Bacteroides; fungi genus Candida, and others.

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Causes of Vaginitis

As it has already been noted, the disease is caused by increases in vaginal pathogens quantity or activation of opportunistic pathogens. Conditionally pathogenic flora is represented by the microbes, which in the state of immunity are in equilibrium with normal flora, However, the balance is very fragile (Bilardi et al., 2013). If a woman weakens her immunity, the flora of this woman goes into the category of pathogenic.

The causative agents of vaginitis are represented by the following microorganisms: treatment of symptoms of the trichomoniasis vaginitis; fungi genus Candida; cytomegalovirus; Mycoplasma and Ureaplasma; numerous intestinal flora; Proteus; Staphylococci; Streptococci; Corynebacterium; Gonococci; Chlamydia; Tubercle bacillus, and others. In girls, vaginitis can be caused by childhood infections that enter the vagina with the blood flow (secondary vaginitis) (Bilardi et al., 2013). It can be agents of measles, diphtheria, scarlet fever, etc.

Candida vaginitis is a common form of the disease caused by hormonal changes common after childbirth and during breastfeeding. Quite often it can form in the first six months after childbirth. It is associated with decreased immunity, high pressure on physical fitness and emotional state, and stress (Lowe, Neal, & Ryan-Wenger, 2009). The fungi genus Candida, which provokes thrush, lives on the mucous membranes of the vagina (Bilardi et al., 2013).

However, if there is a disruption of the microbial balance of the vagina and the resistance of the organism reduces, they activate and actively proliferate (Coleman, Gaydos, & Witter, 2013). Contrary to the popular belief, a fungal infection is not transmitted sexually, although intimacy without a condom can promote its activation due to the entry of foreign flora into the mucus of women.

Symptoms and Signs

To find out the main principles of vaginitis pharmacological management, it is necessary to study its symptoms and signs (Bilardi et al., 2013). The clinical picture of the disease is quite varied and is largely determined by the type of pathogen and the form of the disease (Bilardi et al., 2013). The main symptoms of vaginitis are burning and itching in the vagina; aching or dragging pain in the abdomen; pain during intercourse; the violation of urination (frequent and painful urination); temperature increase; etc. The amount of vaginal discharge increased significantly. Its nature varies and can be cheesy, pus-like, homogeneous milk, foaming, or blood mixed with blood. The allocation has an unpleasant odor and may exhibit redness and swelling of the labia minora.

In the case of acute vaginitis, the symptoms may include the following: burning and itching, the gravity of the lower abdomen, and problems with internal organs (Farage, Miller, & Ledger, 2008). In the course of the severe form of the disease, a significant increase in temperature to 38 degrees and above may take place (Lowe, Neal, & Ryan-Wenger, 2009). As a rule, such situations are typical for specific forms of vaginitis (gonorrhea or Trichomonas).

Vaginitis (or nonspecific vaginitis, as it is frequently referred to as) in women is inflammation inside the vagina (Coleman, Gaydos, & Witter, 2013). Typically, it causes a decrease in immunity after delivery, during breastfeeding, a general weakening of the body, or activation of conditionally pathogenic microbes that are a permanent part of vaginal microflora (Bilardi et al., 2013). The most common causative agents of vaginitis during breastfeeding are staphylo- or streptococci, escherichia coli, Haemophilus influenzae, and fungi thrush (candidiasis).

Normally, inflammation occurs in the acute form with all of its manifestations clearly and sharply defined. In such circumstances, there can be discomfort and isolation (Lowe, Neal, & Ryan-Wenger, 2009). However, if the pathology is treated wrong, especially if a woman engages in self-treatment, it can transform into a chronic and sluggish form in which the symptoms are aggravated by other illnesses, such as the common cold, as well as fatigue, intimacy, and changing hygiene (Coleman, Gaydos, & Witter, 2013).

Usually, vaginitis in the form of yeast occurs during nursing or is caused by the intimate contact after unprotected sexual intercourse, the infection of Trichomonas, gonococci, or other sensitive infections (Farage, Miller, & Ledger, 2008). During this period of life, a woman’s body is particularly susceptible to infections because of the unstable hormonal levels. Mothers who have been through difficult childbirths suffer from chronic disease, or inflammations in the uterus or appendages are most susceptible to vaginitis.

 

Nursing Implications

If the cause of vaginitis was pathogenic microbes, its manifestations will largely depend on what specific kind of microbe it was (Peters et al., 2014). The most rational regimen for patients is the anti-infectives complex treatment (Farage, Miller, & Ledger, 2008). It is aimed at suppressing and eliminating pathogens, detoxificating and correcting hemostasis disorders, promoting the general stimulation of the body and improving its defensive abilities, keeping the functions of vital organs, and decreasing catabolic and anabolic processes (Farage, Miller, & Ledger, 2008).

The treatment of nonspecific vaginitis includes general and local therapy. Local treatment is the rehabilitation of the external genitalia and the vagina (douching wash and antiseptic solutions) (Coleman, Gaydos, & Witter, 2013). In addition, the introduction of antiinfective vaginal suppositories and tablets into the vagina is very efficient.

The structure of the complex treatment for patients with complicated forms of HB includes antibiotic and anti-infective therapy, which is used for the general and local impact that allows creating an effective antibiotic and anti-infective concentration for the required time (Lowe, Neal, & Ryan-Wenger, 2009). Given some pathogens’ resistance to antibiotics, topical application of the latter in the form of solutions and emulsions is appropriate only in the presence of acute sensitivity to the pathogen and the treatment should be short (Bilardi et al., 2013). Hence, the anti-infective approach to vaginitis management is an essential point in treating the disease.

Regardless of the significant advances of modern technology in the sphere of clinical microbiology and pharmacology of modern antibacterial drugs, vaginitis continues to occupy a leading place in the structure of obstetric and gynecological diseases. Hence, vaginitis treatment is to be based mainly on the anti-infective therapy, which is known to be effective at eliminating the predisposing factors for the development of the disease, based on clinical manifestations (Amaya-Guio et al., 2015). The anti-infective therapy is prescribed only after determining the sensitivity of the pathogen to antibiotics. Many drugs have contraindications in cases of pregnancy and lactation.

The treatment that includes anti-infectives should be directed at eliminating the reasons causing vaginitis. Therefore, the drug should be administered on a case by case basis, because the development and adherence to a conventional scheme will not lead to success. In addition to this, due to the bacterial environment which causes the disease, the anti-infectives serve as the basis for the disease to stop its spread.

A great variety of anti-infective drugs is used in gynecology for the treatment of inflammatory diseases of genitals. For the best effect and comprehensive treatment of vaginitis, doctors prescribe the use of drugs from different groups of anti-infectives. The local application antiinfectives and disinfectants are used to alleviate the symptoms of vaginitis when a diagnosis is confirmed.

One of the major reasons why the treatment of vaginitis is important is the appointment of local anti-infective therapy, aimed at the destruction of pathogenic microorganisms and suppression of their activity. In the first 3 – 4 days, doctors should recommend douching with antiseptic solution (chlorhexidine, sodium bicarbonate, potassium permanganate) and / or a decoction of herbs (calendula, chamomile, lemon balm, sage). At the same time, anti-inflammatory suppositories are administered by douching of the anti-infectives.

The treatment of inflammatory diseases (both vaginitis and those of any other kind) that target internal genitals require the usage of anti-infective agents. Along with intravenous infusions of antibiotics, suppositories are assigned for adnexitis, endometritis, and so on. The treatment of endometritis and adnexitis has several objectives. Rectal anti-infectives are suppositories, the main components of which is a non-steroidal anti-inflammatory drug (NSAIDs). NSAID has a number of effects including the anti-inflammatory, anesthetic, and antipyretic ones.

The nursing implications in the course of vaginitis are applied in several stages. First of all, when a case of vaginitis is suspected, it is necessary to consult a gynecologist (Bilardi et al., 2013). Because the inflammation inspection process can be difficult, the doctor has to perform an external inspection of the vagina as the nature of changes can help determine a diagnosis (Best, 2012). However, it is necessary to determine the nature of the infection (Farage, Miller & Ledger, 2008). This is conducted by means of a sampling swab, which is then examined under a microscope or through PCR pathogen diagnostics.

The nursing implications should include colposcopy to rule out cervical lesion, as well as bacteriological crop discharge from the vagina flora, and the determination of its sensitivity to antibiotics (Bilardi et al., 2013). All the data is supplemented by a pelvic ultrasound and a general analysis of blood and urine if the patient is a lactating mother.

The nursing implications should also focus on the prevention of complications. The vaginitis complications include the spread of infection in the cervix and its body. These complications can be aggravated by cervical erosion, development of endometritis, and the duration of treatment (Harbison, Polly, & Musselman, 2015). The currently known vaginitis complications can lead to infertility and the development of complications during pregnancy (Coleman, Gaydos & Witter, 2013). The process of breastfeeding in the course of vaginitis is not affected. The prognosis of treatment is favorable, as almost all types of vaginitis respond well to treatment.

The local anti-infectives treatment of female patients can be applied at home. It consists of cleaning the genital area with antiseptic solutions, the decoction of chamomile, or a slightly pink solution of potassium permanganate. It is important to wear breathable cotton underwear only and avoid the use of panty liners or narrow underwear because it hinders skin respiration. It is important to have good nutrition and decrease the number of carbohydrates in a patient’s diet in favor of plant and dairy food. At the time of treatment, it is necessary to have adhered to strict sexual celibacy.

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After receiving the results of diagnostics, a doctor chooses a local treatment in the form of douching with anti-infective solutions, the use of suppositories and vaginal capsules, tablets, antibiotics, and drugs for the normalization of the normal microbial flora of the vagina after a complete readjustment. The physiotherapy methods, immune stimulation methods, and careful selection of resources can be involved in the infection persists. Systemic antibiotics are not desirable while breastfeeding, and they should be used only in the presence of sexually transmitted infections, such as gonorrhea and trichomoniasis. General treatment is necessary if a woman has a hormonal disorder connected to metabolism, immune disorders, or comorbidities.

The anti-infectives are applied to deal with the Candida vaginitis, a special type of inflammation of the vagina, which provokes active reproduction of the fungus Candida. This fungus causes thrush, decreases the body’s resistance, and changes hormonal levels, especially among pregnant or breastfeeding women. Fungi live permanently on the skin and mucous membranes without causing harm or deterring immunity and normal vaginal flora (Bastani et al., 2012). If there is a change of flora, the woman is often sick, has a weakened immune system, or her body produces too much estrogen after the activation of the infection.

In the chronic form, all manifestations of Candida vaginitis are expressed softly. Frequently enough, they only concern the change in the number of isolation and periods of itching, skin irritation, and discomfort during sexual intercourse. The basis for diagnosis and disease management is a manifestation of typical symptoms. However, herein, it is necessary to be sure to check the vagina and cervix in a mirror. It is important to confirm the diagnosis based on the microscopy of swabs taken from the walls of the vagina and cervix, as well as through additional methods of diagnosis in complex cases (Bilardi et al., 2013). If there is a fungal infection in smears, it is important to detect the fungus or its spores. If chronic infection discharge from the vagina is sown on nutrient media, it helps the definition of the sensitivity of fungi to drugs for treatment.

Major complications include the development of an inflammatory process in the cervix and its body against the background of the development of fungal infection layers of microbial inflammation (Bilardi et al., 2013). Additionally, the dangerous transition to a chronic form of infection with periods of exacerbation is difficult to cure.

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When applying the anti-infectives to breastfeeding patients, it is not necessary to self-medicate. However, it threatens complications of the transition to the chronic form of infection (Amaya-Guio et al., 2015). It is important to pay attention to diet, drastically reducing the number of sweet, fatty, and spicy foods, while adding more greens, fermented milk products, and vitamins. It is necessary to perform perineal hygiene, wear cotton clothes, and use a genital decoction of herbs or antiseptic solutions for irrigation.

Conclusion

The paper discussed the pharmacological management of vaginitis using anti-infectives and its nursing implications. In order to avoid vaginitis, women need to adopt a number of preventive measures, namely strictly observe hygiene of the genitals, select means of intimate hygiene, etc. It is also necessary to use barrier methods of contraception during sexual contacts, especially in cases of lowered immunity. It is important to regularly visit a doctor and conduct inspections, control smears, and maintain a healthy lifestyle. It has also been found that all types and symptoms of vaginitis can be treated using the anti-infectives and certain forms of nursing implications.

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