Vaginal infections are frequent causes of distress and discomfort in many women.

Such
infections are usually accompanied by vaginitis, an inflammation of the vagina characterized
by vaginal discharge, irritation, odor and/or itching.

Many effective drugs can treat vaginal infections. However, the cause is hard to pinpoint. Any
women with symptoms of vaginitis should see her doctor for testing and not treat herself For a
correct diagnosis, a doctor does laboratory tests, including microscopic evaluation of vaginal
fluid.

Some vaginal infections are passed from one person to another through sexual contact, but
others, such as yeast infections, usually are not. Most vaginal infections are due to bacterial
vaginosis, trichomoniasis or yeast infections, yet there also may be other causes of rapid
inflammation. These causes may include allergies and vaginal irritations or other sexually
transmitted diseases (STDs).

Allergy symptoms can be caused by exposure to spermicides, vaginal hygiene products,

detergents and fabric softeners. Cervical infections also are often associated with abnormal
vaginal discharge, but these infections can be distinguished from true vaginal infections by
tests.

Research is trying to determine factors that promote the growth and disease-causing potential
of vaginal microbes. No longer considered merely a harmless annoyance, vaginitis is the
object of serious investigation as scientists attempt to clarify its role in such conditions as
pelvic inflammatory disease and pregnancy-related complications.

Vaginal yeast infection

Vaginal yeast infection, sometimes referred to as vulvovaginal candidiasis, candidal vaginitis

or monilial infection, is a common cause of vaginal irritation. Doctors believe about 75 percent
of all women experience at least one symptomatic yeast infection during their lifetime.

Yeast is normally present in the vagina in small numbers. A vaginal yeast infection is caused
by an overabundance or overgrowth of yeast cells (primarily candida albicans) that normally
colonize the vagina. Major factors that increase the risk of vaginal yeast infections include
pregnancy, uncontrolled diabetes and the use of birth control pills or antibiotics.

Other factors that may increase the incidence of yeast infections are the use of douches,
perfumed feminine hygiene sprays, topical antimicrobial agents and tight, poorly ventilated
clothing and underwear. Whether or not yeast infections can be transmitted sexually is
unknown. HIV-infected women may have severe yeast infections that are hard to treat.

Because specific signs and symptoms are uncommon, this condition cannot be diagnosed by
the patient's history and physical examination. An accurate diagnosis is important before
beginning treatment. See your doctor to be sure your symptoms are caused by a yeast
infection.

Common symptoms Diagnosis Treatment If you have a male

partner
Itching, burning and Microscopic Anti-fungal medicines. Symptoms are rare.
irritation of the vagina examination of Both creams and pills
vaginal secretionscan be purchased over A transient rash and
Painful urination for evidence of the counter. burning sensation of the
yeast forms penis may occur after
Pain with intercourse Oral antifungal drugs intercourse if condoms
(A home screening are used for chronic or were not used.
test may become recurring yeast
Vaginal discharge - the
available.) infections. Because yeast infections
thick, whitish-gray
discharge is typically are not sexually
described as cottage- transmitted, there is
cheese-like in nature, usually no treatment of
although it can vary from male partners.
watery to thick in
consistency.

Sometimes there are no

symptoms.
Bacterial vaginosis

Bacterial vaginosis is an infection that is the most common cause of vaginitis symptoms
among women of childbearing age. Bacterial vaginosis is caused by changes in the balance of
the kinds of normal bacteria living in a woman's vagina. Instead of the normal predominance
of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis,
Bacteroides, Mobiluncus and Mycoplasma hominis are found in the vagina in women with
vaginosis.

The role of sexual activity in causing bacterial vaginosis is not understood. An infection can be
transmitted during sex but also can occur in women who are not having sex. Having an IUD, a
change in sexual partners and douching may increase a woman's chances of getting bacterial
vaginosis. Although the effects of vaginosis are unknown, some evidence indicates it may
cause problems in pregnancy such as premature birth and low-birth-weight infants.

Researchers have also shown an association between vaginosis and pelvic inflammatory
disease (PID), which can cause infertility and tubal (ectopic) pregnancy. Therefore, the
Centers for Disease Control and Prevention recommends doctors check for vaginosis in all
pregnant women who previously have delivered a premature baby, whether or not the women
have symptoms. If these women have vaginosis, they should be treated with oral
metronidazole or oral clindamycin. A pregnant woman who has not delivered a premature
baby should be treated if she has symptoms and laboratory evidence of vaginosis. Bacterial
vaginosis is also associated with increased risk of gonorrhea and HIV infection.

Unfortunately, many women with vaginosis symptoms do not see a doctor, and many women
who don't have symptoms decline treatment. The infection does not go away on its own. For
some women, bacterial vaginosis is chronic.

Common symptoms Diagnosis Treatment If you have a male

partner
Abnormal vaginal Laboratory testing No treatment is needed.
discharge with a fishy odor of vaginal fluid for Antibiotics such as
that is noticeable "clue cells" (vaginal metronidazole or The role of sexual
especially after intercourse lining cells that are clindamycin activity and vaginosis is
coated with G. undefined.
Aching pain in the lower vaginalis and other
abdomen bacterial vaginosis
organisms)
Often there are no
symptoms Decreased acidity of
vaginal fluid or
change in pH of
vaginal fluid

Trichomoniasis

Trichomoniasis (trik-o-mo-ni-a-sis) is a common STD that affects 2 to 3 million Americans

yearly. It is caused by a single-celled protozoan parasite called Trichomonas vaginalis.
Trichomoniasis is primarily an infection of the urogenital tract. The urethra is the most
common site of infection in men, and the vagina is the most common site of infection in
women.

Common symptoms Diagnosis Treatment If you have a male

partner
Frequently none. Microscopic Drugs called 5- Male partners must be
examination of notroimidazoles treated, even if no
Heavy vaginal discharge sample fluid from symptoms are present.
vagina for evidence Do not use alcohol
of the parasite; in while taking this drug. Usually no symptoms.
Vaginal itching
some cases it can
be detected on a
Heavy, yellow-green or Thin, whitish discharge
Pap smear.
gray vaginal discharge from the penis

For men, a sample

Painful urination Painful or difficult
of fluid from the
penis may be taken
Discomfort during to test for the urination
intercourse parasite.
Can cause urinary
Vaginal odor infection in men

In rare cases, lower When properly used,

abdominal pain latex condoms offer
very good protection.

Spermicides offer some

protection.

If symptoms occur, they usually appear within four to 20 days of exposure, although
symptoms can appear years after infection.

Although trichomoniasis was not thought to cause any important complications, recent studies
have linked it to two serious health problems. Data suggest trichomoniasis may increase the
risk of transmission of HIV, the virus that causes AIDS, and may cause delivery of low-birth-
weight or premature infants. More research is under way.

Preventing trichomoniasis

Condoms and diaphragms may help prevent the spread of trichomoniasis. Some laboratory
evidence says spermicides can kill STD organisms, but scientists are still evaluating the
usefulness of spermicides in preventing STDs. Some studies have found that frequent use of
spermicides (more than three times a week) may cause vaginal inflammation.

External Sources

National Women's Health Information Center (800-994-9662)

National Institute of Child Health and Human Development

National Institute of Allergy & Infectious Diseases

American College of Obstetricians and Gynecologists (ACOG)

National Vaginitis Association

This article was reviewed April 2004, by Simeon Margolis, M.D., Ph.D., Professor of Medicine,
Endocrinology, and Biologic Chemistry, The Johns Hopkins University School of Medicine,
Baltimore, MD.

Return to the previous page

Gonorrhea
WHAT IS GONORRHEA?

Gonorrhea is a curable sexually transmitted infection (STI) caused by a

bacterium called Neisseria gonorrhoeae. These bacteria can infect the genital
tract, the mouth, and the rectum. In women, the opening to the uterus, the cervix,
is the first place of infection.

The disease however can spread into the uterus and fallopian tubes, resulting in pelvic
inflammatory disease (PID). PID affects more than 1 million women in this country every year
and can cause infertility in as many as 10 percent of infected women and tubal (ectopic)
pregnancy.
In 2000, 358,995 cases of gonorrhea were reported to the U.S. Centers for Disease Control
and Prevention (CDC). In the United States, approximately 75 percent of all reported cases of
gonorrhea is found in younger persons aged 15 to 29 years. The highest rates of infection are
usually found in 15- to 19-year old women and 20- to 24-year-old men. Health economists
estimate that the annual cost of gonorrhea and its complications is close to $1.1 billion.

Gonorrhea is spread during sexual intercourse. Infected women also can pass gonorrhea to
their newborn infants during delivery, causing eye infections in their babies. This complication
is rare because newborn babies receive eye medicine to prevent infection. When the infection
occurs in the genital tract, mouth, or rectum of a child, it is due most commonly to sexual
abuse.

WHAT ARE THE SYMPTOMS OF GONORRHEA?

The early symptoms of gonorrhea often are mild. Symptoms usually appear
within 2 to 10 days after sexual contact with an infected partner. A small number
of people may be infected for several months without showing symptoms.

When women have symptoms, the first ones may include

 Bleeding associated with vaginal intercourse

 Painful or burning sensations when urinating
 Vaginal discharge that is yellow or bloody

More advanced symptoms, which may indicate development of PID, include cramps and pain,
bleeding between menstrual periods, vomiting, or fever.

Men have symptoms more often than women, including

 Pus from the penis and pain

 Burning sensations during urination that may be severe

Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel
movements with fresh blood on the feces.

HOW IS GONORRHEA DIAGNOSED?

Doctors or other health care workers usually use three laboratory techniques to
diagnose gonorrhea: staining samples directly for the bacterium, detection of
bacterial genes or DNA in urine, and growing the bacteria in laboratory cultures.
Many doctors prefer to use more than one test to increase the chance of an
accurate diagnosis.

The staining test involves placing a smear of the discharge from the penis or the cervix on a
slide and staining the smear with a dye. Then the doctor uses a microscope to look for
bacteria on the slide. You usually can get the test results while in the office or clinic. This test
is quite accurate for men but is not good in women. Only one in two women with gonorrhea
have a positive stain.

More often, doctors use urine or cervical swabs for a new test that detects the genes of the
bacteria. These tests are as accurate or more so than culturing the bacteria, and many doctors
use them.

The culture test involves placing a sample of the discharge onto a culture plate and incubating
it up to 2 days to allow the bacteria to grow. The sensitivity of this test depends on the site
from which the sample is taken. Cultures of cervical samples detect infection approximately 90
percent of the time. The doctor also can take a culture to detect gonorrhea in the throat.
Culture allows testing for drug-resistant bacteria.

HOW IS GONORRHEA TREATED?

Doctors usually prescribe a single dose of one of the following antibiotics to treat
gonorrhea:
  Cefixime
 Ceftriaxone
 Ciprofloxacin
 Ofloxacin
 Levofloxacin

If you have gonorrhea and are pregnant or are younger than 18 years old, you should not
take ciprofloxacin or ofloxacin. Your doctor can prescribe the best and safest antibiotic for you.

Gonorrhea and chlamydial infection, another common STI, often infect people at the same
time. Therefore, doctors usually prescribe a combination of antibiotics, such as ceftriaxone and
doxycycline or azithromycin, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if
infected, whether or not they have symptoms of infection.

WHAT CAN HAPPEN IF GONORRHEA IS NOT TREATED?

In untreated gonorrhea infections, the bacteria can spread up into the

reproductive tract, or more rarely, can spread through the blood stream and infect
the joints, heart valves, or the brain.

The most common result of untreated gonorrhea is PID, a serious infection of the female
reproductive tract. Gonococcal PID often appears immediately after the menstrual period. PID
causes scar tissue to form in the fallopian tubes. If the tube is partially scarred, the fertilized
egg may not be able to pass into the uterus. If this happens, the embryo may implant in the
tube causing a tubal (ectopic) pregnancy. This serious complication may result in a
miscarriage and can cause death of the mother.

Rarely, untreated gonorrhea can spread through the blood to the joints. This can cause an
inflammation of the joints which is very serious.

If you are infected with gonorrhea, your risk of getting HIV infection increases (HIV, human
immunodeficiency virus, causes AIDS). Therefore, it is extremely important for you to either
prevent yourself from getting gonorrhea or get treated early if you already are infected with it.

CAN GONORRHEA AFFECT A NEWBORN BABY?

If you are pregnant and have gonorrhea, you may give the infection to your baby
as it passes through the birth canal during delivery. A doctor can prevent infection
of your baby's eyes by applying silver nitrate or other medications to the eyes
immediately after birth. Because of the risks from gonococcal infection to both
you and your baby, doctors recommend that pregnant women have at least one
test for gonorrhea during pregnancy.

HOW CAN I PREVENT GETTING INFECTED WITH GONORRHEA?

By using latex condoms correctly and consistently during vaginal or rectal sexual
activity, you can reduce your risk of getting gonorrhea and its complications.

RESEARCH

The National Institute of Allergy and Infectious Diseases (NIAID) continues to

support a comprehensive, multidisciplinary program of research on N.
gonorrhoeae (gonoccoci). Researchers are trying to understand how gonoccoci
infect cells while evading human immune defenses (immune response). Studies
are ongoing to determine
1. How this bacterium attaches to host cells
2. How it gets inside them
3. Gonococcal surface structures and how they can change
 4. Human response to infection by gonococci

All of these efforts, together, will eventually lead to development of an effective vaccine
against gonorrhea. They also have led to, and will lead to further, improvements in diagnosis
and treatment of gonorrhea.

Another important area of gonorrhea research concerns antibiotic resistance. This is

particularly important because strains of N. gonorrhoeae that are resistant to recommended
antibiotic therapies have spread from Southeast Asia to Hawaii and are now starting to appear
on the West Coast. These events add urgency to NIAID efforts to develop effective
microbicides (antimicrobial preparations that can be applied inside the vagina) to prevent
infections.

Recently, scientists have determined the sequence of the N. gonorrhoeae genome. They are
using this information to find promising new leads to help us better understand how the
organism causes disease and becomes resistant to antibiotics.

MORE INFORMATION

National Institute of Allergy and Infectious Diseases

National Institutes of Health
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov

National Library of Medicine

MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-888-FIND-NLM (1-888-346-3656)
301-594-5983
http://medlineplus.gov

National STD and AIDS Hotline

1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)

American Social Health Association

P.O. Box 13827
Research Triangle Park, NC 27709-9940
www.ashastd.org

NIAID is a component of the National Institutes of Health (NIH), which is an agency

of the Department of Health and Human Services. NIAID supports basic and applied
research to prevent, diagnose, and treat infectious and immune-mediated illnesses,
including HIV/AIDS and other sexually transmitted diseases, illness from potential
agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and
allergies.

News releases, fact sheets and other NIAID-related materials are available
on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Chlamydial Infection
What is Chlamydial Infection?
Chlamydial ("kla-MID-ee-uhl") infection is a curable sexually transmitted infection
(STI), which is caused by a bacterium called Chlamydia trachomatis. You can get
genital chlamydial infection during oral, vaginal, or anal sexual contact with an
infected partner. It can cause serious problems in men and women as well as in
newborn babies of infected mothers.

Chlamydial infection is one of the most widespread bacterial STIs in the United States. The
U.S. Centers for Disease Control and Prevention (CDC) estimates that more than 4 million
people are infected each year. Health economists estimate that chlamydial infections and the
other problems they cause cost Americans more than $2 billion a year.

What Are the Symptoms of This STI?

Because chlamydial infection does not make most people sick, you can have it
and not know it. Those who do have symptoms may have an abnormal discharge
(mucus or pus) from the vagina or penis or pain while urinating. These early
symptoms may be very mild. Symptoms usually appear within one to three
weeks after being infected. Because the symptoms may be mild or not exist at
all, you might not seek care and get treated.

The infection may move inside the body if it is not treated. There, it can cause pelvic
inflammatory disease (PID) in women and epidydimitis in men, two very serious illnesses.

C. trachomatis can cause inflamed rectum and inflammation of the lining of the eye ("pink
eye"). The bacteria also can infect the throat from oral sexual contact with an infected partner.

How Does the Doctor Diagnose Chlamydial Infection?

Chlamydial infection is easily confused with gonorrhea because the symptoms of

both diseases are similar and the diseases can occur together, though rarely.

The most reliable ways to find out whether the infection is chlamydial are through laboratory
tests. Usually, a doctor or other health care worker will send a sample of pus from the vagina
or penis to a laboratory that will look for the bacteria.

The urine test does not require a pelvic exam or swabbing of the penis. Results from the urine
test are available within 24 hours.

How is Chlamydial Infection Treated?

If you are infected with C. trachomatis, your doctor or other health care worker
will probably give you a prescription for an antibiotic such as azithromycin (taken
for one day only) or doxycycline (taken for seven days) to treat people with
chlamydial infection. Or, you might get a prescription for another antibiotic such
as erythromycin or ofloxacin.

Doctors may treat pregnant women with azithromycin or erythromycin, or sometimes, with
amoxicillin. Penicillin, which doctors often use to treat some other STIs, won't cure chlamydial
infections.

If you have chlamydial infection:

 Take all of the prescribed medicine, even after symptoms disappear.

 If the symptoms do not disappear within one to two weeks after finishing
the medicine, go to your doctor or clinic again.
 It is very important to tell your sex partners that you have chlamydial
infection so that they can be tested and treated.

What Can Happen if the Infection is Not Treated?

In women, untreated chlamydial infections can lead to PID. In men, untreated
chlamydial infections may lead to pain or swelling in the scrotal area, which is a
sign of inflammation of a part of the male reproductive system located near the
testicles known as the epididymis. Left untreated, these complications can
prevent people from having children.

Each year up to 1 million women in the United States develop PID, a serious infection of the
reproductive organs. As many as half of all cases of PID may be due to chlamydial infection,
and many of these don't have symptoms. PID can cause scarring of the fallopian tubes, which
can block the tubes and prevent fertilization from taking place. Researchers estimate that
100,000 women each year become infertile because of PID.

In other cases, scarring may interfere with the passage of the fertilized egg to the uterus
during pregnancy. When this happens, the egg may attach itself to the fallopian tube. This is
called ectopic or tubal pregnancy. This very serious condition results in a miscarriage and can
cause death of the mother.

Can Chlamydial Infection Affect a Newborn Baby?

A baby who is exposed to C. trachomatis in the birth canal during delivery may
develop an eye infection or pneumonia. Symptoms of conjunctivitis or "pink eye,"
which include discharge and swollen eyelids, usually develop within the first 10
days of life.

Symptoms of pneumonia, including a cough that gets steadily worse and congestion, most
often develop within three to six weeks of birth. Doctors can treat both conditions successfully
with antibiotics. Because of these risks to the newborn, many doctors recommend that all
pregnant women get tested for chlamydial infection.

How Can I Prevent Getting Chlamydial Infection?

You can reduce your chances of getting chlamydia or of giving it to your partner
by using male latex condoms correctly every time you have sexual intercourse.

If you are infected but have no symptoms, you may pass the bacteria to your sex partners
without knowing it. Therefore, any doctors recommend that anyone who has more than one
sex partner, especially women under 25 years of age, be tested for chlamydial infection
regularly, even if they don't have symptoms.

What Research is Going On?

Scientists are looking for better ways to diagnose, treat, and prevent chlamydial
infections. NIAID-supported scientists recently completed sequencing the
genome for C. trachomatis. The sequence represents an encyclopedia of
information about the organism. This accomplishment will give scientists
important information as they try to develop a safe and effective vaccine.
Developing topical microbicides (preparations that can be inserted into the
vagina to prevent infection) that are effective and easy for women to use is also a
major research focus.

For More Information About Chlamydial Infection Contact:

National Institute of Allergy and Infectious Diseases

National Institutes of Health
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov

National Library of Medicine

MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://medlineplus.gov

Centers for Disease Control and Prevention

1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.cdc.gov

National STD and AIDS Hotline

1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)

American Social Health Association

P.O. Box 13827
Research Triangle Park, NC 27709-9940
http://www.ashastd.org

NIAID is a component of the National Institutes of Health (NIH), which is an agency

of the Department of Health and Human Services. NIAID supports basic and applied
research to prevent, diagnose, and treat infectious and immune-mediated illnesses,
including HIV/AIDS and other sexually transmitted diseases, illness from potential
agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and
allergies.

News releases, fact sheets and other NIAID-related materials are available
on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Department of Health National Institutes of Health (NIH)

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Last Updated June 05, 2003 (cvr)