SPONSORED SYMPOSIUM
VAGINAL INFECTIONS: EPIDEMIOLOGY AND RISK FACTORS
Tempera G
Dept. Microbiological/Gynaecological Sciences, University of Catania - Italy

Vaginitis (infection of the vagina) is the most common gynaecologic condition encountered by physicians in the office. The actual frequency of vaginitis is difficult to ascertain, due to numerous confounding factors, such as a high asymptomatic rate, inaccurate self-diagnosis and treatment, and population dependence. In the USA, the reported rate at general gynaecologic clinics is 5-15%, while for STD clinics, reported rates range from 32% to as high as 64%. International rates are uncertain but probably are similar to those in the United States.
Vaginitis affects all races, but the highest incidence is in African Americans and the lowest incidence is in Asians. All age groups are affected, even if the highest incidence is noted among young, sexually active women.
Bacterial vaginosis (BV), vaginal candidiasis, and T. vaginalis infection are thought to cause approximately 90% of all vaginal infections. From a worldwide perspective, BV continues to be the leading variety of vaginal infection even if the incidence of candidiasis has increased dramatically during the last decade, with an increase in the percentage of non-albicans Candida strains, while T.vaginalis infection showed an approximate 40% decrease.
Recently, Donders proposed the term ' aerobic vaginitis' to define a ''new'' vaginal pathology (that is neither classifiable as specific vaginitis nor as BV) characterised by pH values above 5, yellowish and foul smelling secretions (though negative at the KOH test), and inflammatory and dyspareunia manifestations. From the microbiological point of view, this is different from BV because of the lack of increase in anaerobic microrganisms and the presence of aerobic bacteria from the rectal reservoir (especially E.coli). It is therefore indicative of an alteration of the vaginal homeostasis with a consequent increase of enteric bacteria vaginal colonization.
A complex and intricate balance of microorganisms maintains the normal vaginal flora. Important organisms include lactobacilli, corynebacteria, and yeast. Hormones further influence this microenvironment. A state of decreased estrogens, as occurs in prepuberty and post menopause and following oophorectomy, can result in an altered risk of infection.
The normal postmenarchal and premenopausal vaginal pH is 3.8-4.2. At this pH, growth of pathogenic organisms usually is inhibited.
Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of pathogens.
Factors that alter vaginal environment include feminine hygiene products, contraceptives, vaginal medications, antibiotics, sexually transmitted diseases (STDs), sexual intercourse, and stress.
 

questa pagina è aggiornata al 10/05/2005