Bacterial vaginosis is the most common cause of pathological vaginal discharge in women of reproductive age.

• According to Centers for Disease Control and Prevention (CDC) in the united states, The prevalence of bacterial vaginosis is estimated to be 21.2 million (29.2%) among women ages 14–49. In addition, non-white women have higher rates (African-American 51%, Mexican Americans 32%) than white women (23%) do.
• According to a study published in International Journal of Microbiology, the prevalence of bacterial vaginosis is considered high and was affected by personal hygiene.
• According to a study published in Indian Journal of Medical Research and Pharmaceutical Sciences, bacterial vaginitis was found to be maximum in the 20-29 age group. Poor education and agriculture occupation present a significant risk to contribute to vaginitis.

Vaginitis is an inflammation of the vagina that can be caused by several causes and germs.

Types of vaginitis including bacterial vaginosis that caused by bacteria, vulvovaginal candidiasis that caused by a type of yeast, trichomoniasis that caused by a type of parasite, atrophic vaginitis which is mostly seen when reduction of female hormone levels occurs, viral vaginitis that caused by a virus, and noninfectious vaginitis that is mostly caused by an allergic reaction.

Several infections and irritants can cause vaginitis infections including infection or excessive proliferation of specific types of bacteria and other pathogens, fistula formation between bladder and rectum, vaginal injury, having an inflammatory disease, dryness, and allergic reaction.

Risk factors that increase the possibility of having the disease including certain hormonal changes, lifetime frequency of sexual activity, taking certain medications such as antibiotics, having a weakened immune system, and frequent douching.

A normal vaginal pH of 3.5 to 4.6 is maintained by metabolizing of glucose to lactic acid by Lactobacilli acidophilus that lives normally in the vagina. In bacterial vaginosis, an abnormal change in pH facilities the replication of organisms that are normally suppressed, such as Gardnerella vaginalis and Mycoplasma hominis, resulting in infection and inflammation.

Signs and symptoms that associated with vaginitis including an abnormal vaginal discharge, pain when urinating or during sexual intercourse, light bleeding or spotting, and appearing of lesions called satellite lesions.

Physicians diagnose vaginitis by reviewing patient’s medical history, performing a physical examination to check the vagina, performing a microscopic examination to test vaginal discharge in the laboratory, and by PH testing.

Speaking of a treatment for vaginitis, an antibiotic called metronidazole is used to treat bacterial vaginosis while over-the-counter antifungal cream or suppository are usually used to treat yeast infections. Moreover, almost any nitroimidazole drug can be used to treat trichomoniasis, while estrogen can be used to manage both atrophic vaginitis and noninfectious vaginitis.

If not managed properly, vaginitis can lead to various complications such as developing the pelvic inflammatory disease (PID) and catching sexually transmitted infections. In addition, getting vaginitis in pregnancy may lead to complications such as premature birth, miscarriage, and early breaking of the amniotic sac.

Some preventive measures that may be helpful in decreasing the risk of developing the disease include the avoidance of garments that hold in heat and moisture, avoidance of vaginal sprays and repeated douching.

Bacterial vaginosis may resolve without treatment. However, the relapse of the disease within three months of successful treatment has been seen in many cases.

Vaginitis, also called vulvovaginitis, is an inflammation, swelling, or infection in the vagina that can be attributed to various causes and germs. Vaginitis is a term that can refer to a spectrum of conditions that can generate several vaginal symptoms, such as burning, itching, irritation, odor, and vaginal discharge.

There are several types of vaginitis, including:

• Bacterial vaginosis (BV): This type accounts for the most cases of vaginal discharge that occurs in childbearing age and is mainly resulted from an imbalance of the bacteria normally present in the vagina.
• Vulvovaginal candidiasis: A naturally occurring fungus called Candida albicans causes this type. Candida is a type of yeast, which is a type of fungus present in the vagina.
• Trichomoniasis: Trichomoniasis also called trich, is caused by parasitic protozoa called Trichomonas vaginalis and is considered a common, curable sexually transmitted infection (STI).
•  Atrophic vaginitis: Atrophic vaginitis is not related to any infection but can cause vaginal discharge and irritation. This type is mostly seen when reduction of female hormone levels occurs, such as during breastfeeding and after menopause.
• Viral vaginitis: Viruses can cause vaginitis in many cases. One form is called “herpes” infection which caused by herpes simplex virus (HSV).
• Noninfectious vaginitis: This type is not related to any infection but can lead to vaginal irritation and is mostly caused by an allergic reaction to vaginal sprays, douches or spermicidal products.

Various infections and irritants can cause vaginitis including:

• Thrush, which is a common yeast infection that affects most females at some point in their lives.
• Infection or excessive proliferation of bacteria, yeast, or parasite.
• Tumors, injury, or infection that can cause fistula formation from the bladder draining urine or from the rectum leaking feces.
• Vaginal injury, particularly after childbirth, sexual intercourse, sexual assault, trauma or surgery.
• Inflammatory disease such as desquamative vaginitis in which the lining of the vagina desquamates or peels away.
• Benign or malignant tumor of the womb (endometrium).
• Allergic reaction such as allergy to rubber condom.
• Pelvic inflammatory disease due to sexually transmitted infection.
• Chemical irritation that may result from perfumed soap, bubble bath, or from spermicide that kills sperm and which sometimes used on condoms.
• Getting sexually transmitted infection such as chlamydia , gonorrhea , or genital herpes.
• Vaginal dryness, itching or discomfort (especially during sex).
• Presence of a foreign body within the vagina.
• Pinworm infection, which is an intestinal worm infection, especially in young girls.

Factors that increase the risk of developing vaginitis include:

• Hormonal changes such as those which occur during pregnancy; birth control pills or menopause,
• Lifetime frequency of sexual activity,
• Having a history of sexually transmitted infection,
• Medications, such as antibiotics and steroids,
• Use of spermicides or intrauterine device (IUD)  for birth control,
• Uncontrolled diabetes,
• Use of hygiene products such as bubble bath; vaginal spray or vaginal deodorant,
• Wearing damp or tightfitting clothing,
• Having a new sex partner,
• Practicing sex with more than one partner,
• Being a pregnant,
• Having a weakened immune system such as from HIV,
• Diet high in refined sugars,
• Low socioeconomic status,
• Unprotected sexual intercourse,
• Homosexual relationships,
• Illicit drug use,
• Oophorectomy; the removal of an ovary or ovaries,
• Radiation therapy,
• Chemotherapy,
• Immunologic disorders,
• Premature ovarian failure; the loss of normal function of ovaries before age 40,
• Endocrine disorders,
• Antiestrogen medication,
• Menopause,
• Douching,
• Smoking.

Normally, a dynamic interrelationship exists in the vaginal environment between a bacterium called Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH, and pathogens. The vaginal environment can be affected by many factors including sexual intercourse, antibiotics, douching, contraceptives, stress, and hormones, which may eventually allow pathogens to grow.

A normal vaginal pH of 3.5 to 4.6 is maintained by metabolizing of glucose to lactic acid by Lactobacilli. In addition, a chemical compound called hydrogen peroxide is produced by Lactobacilli, which acts as a bactericidal.

In bacterial vaginosis, an abnormal change in pH facilities the replication of organisms that are normally suppressed, such as Gardnerella vaginalis and Mycoplasma hominis. This abnormal change is believed to result from some events that can cause a reduction in the number of Lactobacillus acidophilus organisms that normally produce hydrogen peroxide. Similarly, germination of yeast can be facilitated by adherence of Candida albicans to vaginal epithelial cells, which may result from increasing in glycogen production in pregnancy or from oral contraceptives that cause altered estrogen and progesterone levels.

Signs and symptoms of vaginitis may include:

• An abnormal vaginal discharge, which manifests in bacterial vaginosis as a grayish-white, foul-smelling discharge. In yeast infections, the discharge resembles cottage cheese, while in trichomoniasis it appears as a greenish-yellow, sometimes frothy discharge.
• Satellite lesions that spread to the thighs and anus and take the shape of red, tender, pus-filled bumps.
• Pain when urinating or during sexual intercourse.
• Itching around the outside of the vagina.
• Vaginal irritation or itching.
• Light bleeding or spotting.
• Discomfort during sexual intercourse.
• Odor.

To diagnose vaginitis, a physician may perform certain diagnostic methods including:

• Medical history: By doing this step, a physician may review the patient’s history of previous vaginal or sexually transmitted infections, In addition to investigating current symptoms and their duration, and asking questions concerning previous diagnosis or previous therapies.
• Physical examination: A physician may use an instrument called speculum to perform a pelvic exam. A physician uses a speculum to look inside the vagina to detect swelling, inflammation or abnormal discharge. Vaginal discharge should be carefully examined for color, volume, consistency, and adherence to the vaginal walls.
• Microscopic examination: The microscopic examination is performed by collecting a sample of the cervical or vaginal discharge and send it to the laboratory to confirm the kind of vaginitis present.
• PH Testing: PH is a scale used to specify the degree of acidity or basicity. A physician measures vaginal pH by applying a pH test stick or pH paper to the wall of the vagina. Bacterial vaginosis, trichomoniasis, and atrophic vaginitis are all associated with an elevated pH level. 

In clinical practice, the presence of three out of four Amsel criteria can indicate bacterial vaginosis. Amsel criteria include:

• Presence of vaginal discharge that is thin and homogenous.
• Presence of vaginal pH that exceeds 4.5.
• Positive whiff test, which is fishy amine odor that formed when adding 10% potassium hydroxide solution to the vaginal discharge.
• Presence of at least 20 % clue cells, which are known as vaginal epithelial cells with ambiguous borders due to adherent coccobacilli on gram stain.

Vaginitis is caused by a variety of organisms and conditions, so treatment targets the specific cause:

• Bacterial vaginosis: A physician may prescribe an antibiotic called metronidazole that taken orally or metronidazole gel or clindamycin cream that applied to the vagina.
• Vulvovaginal candidiasis: Usually, over-the-counter antifungal cream or suppository are used to treat yeast infections.These medications may include such tioconazole, miconazole, clotrimazole, and butoconazole. However, a prescription oral antifungal medication, such as fluconazole may treat yeast infections as well.
• Trichomoniasis: In many cases, almost any nitroimidazole drug may seem helpful in treating the condition when given orally in a single dose or over a longer period.
• Atrophic vaginitis: This type can be managed with estrogen, which can be taken orally or applied as a vaginal cream. During the sexual intercourse, a water-soluble lubricant may be useful.
• Noninfectious vaginitis: Treatment of this type depends greatly on the cause but it generally includes oral estrogen tablets or creams that are helpful in restoring lubrication and decreasing irritation and soreness of the vagina.However, if the cause is attributed to a reaction to an irritant, the irritant should be avoided.

If not properly managed, symptoms of vaginitis can worsen and can lead to various complications including:

• Pregnancy complications: These might include:

• Premature birth, in which the baby is born before completing the 37th week of gestation.
• Miscarriage, which is a loss of an embryo or fetus during the first 23 weeks of gestation.
• The early breaking of the amniotic sac, which is the bag of fluid where an unborn baby develops.
• Chorioamnionitis, that refers to an infection of the chorion and amnion membranes that make up the amniotic sac, and infection of the amniotic fluid that surrounds the fetus.
• Postpartum endometritis, which is an infection and swelling of the womb lining after giving birth that mostly develops after a cesarean section. 
• Sexually transmitted infections: Having bacterial vaginosis increases the risk of catching sexually transmitted infections (STIs), such as chlamydia.
• Pelvic inflammatory disease (PID): This serious disease damages a woman's reproductive organs including the womb, fallopian tubes, and ovaries. In addition, PID can lead to infertility in many cases.
• Recurrent Bacterial vaginosis: It is relatively common for Bacterial vaginosis to recur after treatment with antibiotics.

Certain things can be carried out to decrease the risk of getting vaginitis, such as:

• Avoid garments that hold in heat and moisture: It is advisable to avoid clothes that hold in heat and moisture, such as tight jeans, pantyhose without a cotton lining, or nylon panties.
• Taking yogurt and probiotics containing lactobacillus: Specialists consultation is important before taking yogurt and probiotics containing lactobacillus because of poor scientific evidence that supports the effectiveness of such method in preventing the disease.
• Limiting sugary foods: To prevent the growth of yeast, some suggest limiting sugary foods. However, physician consultation is important before doing this step.
• Avoid vaginal sprays: Such sprays can kill "good" bacteria and cause vaginal irritation, so most physicians suggest less use of vaginal sprays or heavily perfumed soaps for cleansing this area.
• Avoid repeated douching: Repeated douching may cause irritation and can hide a vaginal infection.
• Safe sexual practices: Using of condoms and performing safe sexual practices is important to prevent the passing of diseases between partners.
• Pre-menopause preparation: Women are encouraged to discuss with their physician the use of hormone pills or creams to keep the vagina lubricated and healthy in case they are approaching menopause, had ovaries removal surgery, or have low levels of estrogen for any reason.

Vaginitis is common in women of all ages. At least one form of vaginitis exists in one-third of women at some time during their lives. Bacterial vaginosis may resolve without treatment. However, the relapse of the disease within three months of successful treatment has been seen in many cases.

The likelihood of catching HIV infection is increased among women with vaginitis. So quick and effective treatment of vaginitis is important. During pregnancy, yeast infections occur twice as often due to hormone fluctuations.

Bacterial vaginosis is the most common cause of pathological vaginal discharge in women of reproductive age.

• According to Centers for Disease Control and Prevention (CDC) in the united states, The prevalence of bacterial vaginosis is estimated to be 21.2 million (29.2%) among women ages 14–49. In addition, non-white women have higher rates (African-American 51%, Mexican Americans 32%) than white women (23%) do.
• According to a study published in International Journal of Microbiology, the prevalence of bacterial vaginosis is considered high and was affected by personal hygiene.
• According to a study published in Indian Journal of Medical Research and Pharmaceutical Sciences, bacterial vaginitis was found to be maximum in the 20-29 age group. Poor education and agriculture occupation present a significant risk to contribute to vaginitis.