Vaginitis: What Your Doctor Isn’t Telling You

If you’ve seen our TikTok video on ureaplasma and mycoplasma (and judging from the video’s 10.9K views, most of you have!), there have been a lot of questions about the specific vaginal infection. 

What is it? 

When do we test for it?

How is it treated, and what symptoms does it cause? 

Don’t have time to read this post? Watch the video here instead!

So vaginitis is an infection in the vagina and genitals, which can cause burning, itching, pain, discharge, sexual pain, and burning with urination. All these symptoms are caused by any number of different infections — but most vaginitis is covered by one of two organisms: yeast and gardnerella (or bacterial vaginosis), which we covered extensively in this video here

Number one on the list of usual suspects is bacterial vaginosis (also known as Gardnerella). Most of the time when there is a discharge, it’s grey with a fishy odor. When bacterial vaginosis is the cause, it’s simply treated with either a vaginal or an oral medication called metronidazole or Flagyl™. Recurrent episodes (or resistant bacterial vaginosis) may require treatment with Candizole™ or boric acid — but if it is recurrent, definitely see your doctor to rule out other infections. 

Next step is yeast (or Candida). This typically causes a white curd-like discharge and itching, but typically no odor. This is more common in patients with diabetes or autoimmune conditions or systemic immunosuppression like HIV. In cases of recurrent candidiasis, those other conditions should be ruled out. Most yeast infections can be treated with an over-the-counter vaginal suppository or a prescribed oral medicine in some recurrent cases. We also use boric acid to treat yeast. In any case, if over-the-counter treatments are not improving the symptoms, you need to see your doctor to rule out other causes of discharge, which are commonly gonorrhea, chlamydia, and trichomonas (which are all treated with antibiotics).

And yet there are some cases where all of those tests for all those organisms are negative, and there are still signs of discharge and burning with urination.

This can be caused by an organism called ureaplasma or mycoplasma. Now these organisms can actually be very common — up to 40% prevalence in the urogenital tract for both men and women. And so most of the time, you’ll have these bacteria and they’re asymptomatic. So we don’t test for these organisms because most of the time, they’re just an asymptomatic colonizer in the urogenital tract. Both ureaplasma and mycoplasma are sexually transmitted. In some circumstances — when there’s a high bacterial load — they CAN cause symptoms like burning with urination, pelvic pain, sexual discomfort, and discharge. And when all the other organisms have been ruled out, we’ll do a separate panel to test for these organisms to see if they’re present. If they are present, they’re treated with doxycycline or a macrolide like erythromycin or azithromycin. 

And if all of these tests are negative, there are other rare conditions — cancer, fistulas, foreign bodies — things that require a comprehensive workout by your medical provider. So don’t put this off. 

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