Pregnant women with untreated gonorrhoea risk having blind babies – Gynaecologist - Punch Newspapers

A United Kingdom-based gynaecologist and robotic surgeon, Dr Olumide Ofinran, discusses common vaginal infections and other common sexually-transmitted diseases in this interview with ALEXANDER OKERE

What is a vaginal infection?

A vaginal infection is a condition in the vagina that results from an infection caused by organisms such as bacteria, yeast, or viruses. Doctors generally refer to the various conditions that cause infection or inflammation of the vagina as vaginitis.

What are the types of vaginal infections?

Vaginitis normally results from an infection and some of the most common types of vaginal infections are bacterial vaginosis, chlamydia, gonorrhoea, trichomoniasis, genital thrush (candidiasis/yeast infection), genital herpes and genital warts. Other causes of vaginitis include hormone changes from menopause, breastfeeding, some types of contraception or irritation or allergy. Bacterial vaginosis, usually referred to as BV, is a condition caused by a change in the natural balance of bacteria in the vagina.

While BV is not a sexually-transmitted infection, it can increase the risk of getting an STI such as chlamydia. BV can be brought about by sex especially with a new partner. Symptoms may include a greyish-white, thin, and watery discharge with a strong fishy smell, particularly after sex. Half of the women with BV may not have any symptoms at all. The condition is not usually serious, but there's a need to be treated with antibiotics if the infection is present. It's also important to seek treatment if one is pregnant as there's a small chance that BV can cause complications with pregnancy such as premature birth or miscarriage.

Can you shed more light on chlamydia?

Chlamydia is one of the most common STIs, which affects both men and women. It is a bacterial infection, and it is passed on through unprotected sex (sex without a condom), and it is particularly common in sexually active teenagers and young adults. Many people with this infection may not have any symptoms and so may not know they have it, but they can still pass it onto others.

The symptoms however include unusual discharge from the vagina or penis, pain during peeing, tummy pain, bleeding after sex or in between menstrual periods in women or pain, tenderness and swelling of the testicles in men. Effective treatment with a short course of antibiotics is available. Anyone who has or suspects they have chlamydia must get tested and treated as soon as possible. If the test shows they have chlamydia, it is important their current partners and any other recent partners are also tested and treated. This is called contact tracing.

How serious is this type of infection in men and women?

Chlamydia can be serious if it's not treated early, especially in women. In women, untreated chlamydia can cause inflammation of the pelvic reproductive organs called pelvic inflammatory disease, ectopic pregnancy and infertility. In men, in rare cases, chlamydia can spread to the testicles and epididymis (tubes that carry sperm from the testicles), causing them to become painful and swollen. This is known as epididymitis or epididymo-orchitis (inflammation of the testicles). It can also sometimes cause reactive arthritis in men and women.

Gonorrhoea is another very common sexually-transmitted infection. It used to be known as the 'clap' and it is caused by the bacteria, Neisseria gonorrhoeae or gonococcus. Many people with gonorrhoea don't have any symptoms but those who do often experience a burning sensation during peeing, a thick green, or yellow discharge from the penis or vagina; pain, swelling or inflammation in the testicles or bleeding between menstrual periods. Gonorrhoea is usually easily cured with antibiotics, but if it is not treated early enough, it can lead to more serious health problems like PID or infertility in the future. The infection can also be passed from a pregnant woman to her baby. If a woman is pregnant and suspects she may have gonorrhoea, it's important to get tested and treated before the baby is born. Without treatment, gonorrhoea can cause permanent blindness in a newborn baby. People who test positive for gonorrhoea should also have contact tracing.

Trichomoniasis or "trich" is another very common sexually-transmitted infection and it is caused by the parasite called Trichomonas vaginalis. Although symptoms of the infection vary, up to half of those who have the infection cannot tell they are infected, but can still pass it onto others. The symptoms are like those of the other STIs and include abnormal yellow-green thin or foamy discharge with an unpleasant fishy smell, itching and soreness around the vagina and, sometimes, inner thighs; soreness and swelling around the head of the penis, pain when peeing or having sex or needing to pee more frequently than usual.

Trichomoniasis is effectively treated with antibiotics so it's important to seek medical advice if you suspect any of these symptoms. Current and recent partners of those that test positive for this infection also need to be tested and treated. Trichomoniasis, like other STIs, is spread by unprotected sexual intercourse. Untreated trichomoniasis in pregnancy may cause the baby to be born prematurely.

Genital thrush, also known as yeast infection, is an infection of the vagina or penis with a fungus called candida, which is normally harmless. It affects both men and women and, in most cases, it develops for no apparent reason. However, certain conditions affect the balance of bacteria that helps to defend the vagina from candida infection and other infections. These conditions include the use of antibiotics, weakened immune system (because of chemotherapy or HIV infection), hormone treatment or pregnancy. Symptoms of thrush could include thick, white vaginal discharge, which doesn't usually smell, itching or irritation around the vagina or the head of the penis, soreness during sex or peeing.

Can thrush affect other areas of the body?

Thrush can affect other areas of the skin, like the armpits, groins or between the fingers. Sometimes, thrush does not cause any symptoms. The treatment of thrush is with antifungal medicine, which could be a tablet you swallow or insert into the vagina (called a pessary), or a cream to apply to the affected area. Partners don't need to be treated unless they have symptoms. Some women keep getting thrush more than four times in one year (recurring thrush) and might need longer treatment. It's important to see a doctor to be checked out.

Genital herpes is a common STI caused by the herpes simplex virus. Sexual contact is the main way that the virus is passed on and this includes oral sex. After the initial infection, the virus lies quiet and inactive in the body and can reactivate several times a year. Genital herpes can cause pain, tingling, itching, blisters, and sores in the genital area but there may be no signs or symptoms. Symptoms clear up on their own but can come back. If infected, one can pass on the infection even if there are no visible sores. There's no cure for genital herpes, but medications can ease symptoms and reduce the risk of infecting others.

Correctly used condoms also can help prevent the spread of genital herpes as well as avoiding intercourse if either partner has an outbreak of herpes in the genital area or anywhere else. If a woman is pregnant and she knows she has genital herpes, she should tell her doctor. If one thinks they might have genital herpes, they should ask to be tested for it. A doctor may recommend the use of herpes antiviral medications late in pregnancy to try to prevent an outbreak around the time of delivery. If a pregnant woman has an outbreak when they go into labour, her doctor might suggest a caesarean section to reduce the risk of passing the virus to her baby.

Genital warts are fleshy growths that develop around the genitals or anus. They are common sexually-transmitted infections caused by the human papillomavirus and they can appear in various sizes and shapes. It is possible to spread or get these warts even when you cannot see them. Of the over 100 types of HPV, only a few can cause genital warts. Some HPV types can cause cervical cancer, other types can cause anal cancer, cancer of the penis, or mouth and throat cancer. One could get more than one type of HPV. There is no cure for HPV. The infection often goes away on its own. Unless that happens, warts can come back even after treatment.

Can one have more than one of these infections at the same time?

Yes, it is possible to have more than one vaginal infection at the same time and these would need specific treatments for the relevant infection. For this reason, diagnosis can sometimes be tricky, especially when there are no symptoms.

The commonest vaginal infections are bacterial vaginosis and genital thrush, and this is because they are caused by certain things that lead to changes in the natural defences and balance of the bacteria and yeast in the vagina. These include female hormone level changes, taking antibiotics, pregnancy, or sex.

Why do females with vaginal infections find it difficult to have sex?

Infections cause inflammation or swelling of the vagina and the vulva, which could cause sex to be painful.

Are there certain products that cause allergies in women with vaginal infections?

Some symptoms of vulval or vaginal itching can happen from using products that irritate the sensitive area around the private parts, and these may include menstrual pads, underwear with certain irritating materials, underwear washed with scented laundry detergent, creams, soaps, or lotions, especially scented brands, fragrances in deodorants.

Vaginal douching is when a woman uses a mixture of fluids to wash the vagina with the intention to eliminate odours and 'clean' the vagina. Doctors do not recommend using products to clean the vagina. The vagina cleans itself. Douches and other vaginal cleaning products can cause irritation and impair its ability to clean itself. Latex condoms can also cause allergic reactions in some women. The itching will usually go away after the person stops using the products, and latex-free condoms are also available. Fragrance-free and unscented products are also less likely to cause irritation.

Can a female who suspects they may have a vaginal infection self-diagnose?

A woman may suspect that she has a vaginal infection if she notices any of the symptoms mentioned above.

At what point should a person with a vaginal infection see a doctor?

If a woman experiences any of the signs and symptoms mentioned above, she may have a vaginal infection which, if left untreated, can lead to health complications. The health care provider will carry out an assessment, which includes questions about her symptoms, personal habits and sexual history; physical examination and tests. These are necessary to help arrive at a diagnosis and to determine the underlying cause to help guide treatment.

How best can an infected person prepare for a diagnosis?

One thing to note is that the various treatments for vaginal infections are generally very effective. The proper diagnosis, however, will make sure that you receive the right treatment. If you have any new or concerning symptoms, always speak to a doctor to ensure you get the right treatment. It is usually advised that the person avoids sex until confirmation of diagnosis and the infection has cleared up.

How are suspected cases of a vaginal infection diagnosed?

Successful treatment of vaginal infections depends on the accurate diagnosis of the cause. The clinical picture, through a correct account of patient signs and symptoms and appropriate genital examination, will usually reveal the cause, but diagnosis can be confirmed by tests such as swabs from open sores, the vagina and the cervix. Urine or blood tests may sometimes be necessary.

Is the diagnosis the same for an infected male?

The diagnosis of infections is similar in men and women. While swabs are taken from the vagina and cervix in women, they are taken from the tip of the penis in men.

Vaginal infections caused by bacteria are generally easier to treat, while viral infections can be managed but are not always curable. A mild thrush infection may go away on its own, but this is rare. It is always a good idea to treat thrush even if it is mild because if it isn't treated properly, it is more likely to return and will most likely get worse.

How best can the sexual infections be treated for females and males?

The key to treating infections is getting the right diagnosis. Treatment depends on the cause of the infection. Antibiotics may be prescribed for bacterial infection while antifungal medication may be prescribed for thrush. Viral infection can be treated with antiviral medication but while this medication doesn't kill the virus, it can decrease the pain and shorten the length of the outbreak of the infection.

If you test positive, you should not have sex until you and your current sexual partner have finished your treatment. It is very important that your current sexual partner and any other sexual partners you have had during the last six months are also tested and treated to help stop the spread of the infection.

Are over-the-counter drugs helpful?

Most medications for vaginal infections are prescription-only; they must be prescribed by a qualified health care provider and are not licensed for sale to the general public. They are not available over-the-counter, and because they have side effects and can interact negatively with other medications and medical conditions, it is important that you meet with a doctor to ensure they are safe for you to take.

Medication for thrush can be purchased over-the-counter while there are some over-the-counter antiviral creams available to relieve the symptoms of genital herpes. It's better to see your doctor before you try over-the-counter medications, even if you're pretty sure you know what you have.

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