Treatment of scabies

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Causes, treatment and prevention of ringworm

Itching of the vagina (sometimes there may be clots) is the result of infectious or non-infectious inflammation of the mucous membrane of the vagina (vaginitis), often accompanied by inflammation of the vulva (vulvovaginitis). Symptoms may also include itching, burning, redness, and sometimes dysuria and dyspareunia. Symptoms of vaginitis are the most common part of gynecological complaints.

 

Pathophysiology of pruritus

A small amount of vaginal discharge is normal, especially if estrogen levels are high. High estrogen levels are observed in the following cases:

 

• A few days before ovulation
• During the first 2 weeks of life (because the mother's estrogen is transferred to the child before birth)
• A few months before the first period and during pregnancy (when estrogen production increases)
• When using drugs that contain estrogen or increase the production of estrogen (for example, some fertility drugs)

In such cases, irritation, burning sensation and itching should not be accompanied by a lump.

Normally, Lactobacillus bacteria are a major component of the normal vaginal flora in women of reproductive age. These bacteria keep the vaginal pH at a normal level (3.8-4.2), thereby preventing the growth of pathogenic bacteria. Also, the high level of estrogen acts as a local protection and ensures the normal thickness of the vaginal mucosa.

Factors that tend to increase bacterial vaginal pathogens:

 

• Antibiotics (can reduce the number of lactobacilli)
• Menstruation Violation of alkaline vaginal pH due to decreased blood, sperm, or lactobacilli.
• Poor personal hygiene
• Too much washing
• Pregnancy
• Diabetes mellitus
• Foreign objects inside the vagina (for example, a forgotten tampon)

 

The origin of pruritus

 

- In children

Vaginitis usually develops due to an infection of the intestinal flora. In girls aged 2 to 6 years, this may be due to improper vaginal hygiene (for example, wiping in the direction of the vagina after ejaculation, not washing hands after pooping).

Chemicals in foam or soap can cause inflammation and itching of the vulva. Foreign bodies in the vagina can cause nonspecific vaginitis, and in rare cases, bleeding can occur.

 

— In women of reproductive age

Vaginitis is usually contagious. The most common types:

• bacterial vaginosis,
• candidal vaginosis
• trichomoniasis vaginosis (usually sexually transmitted)

Sometimes other infections (for example, gonorrhea, chlamydial infection) can cause heavy discharge. These infections often cause pelvic inflammatory disease.

In some cases, genital herpes also causes vaginal itching, but usually this disease causes pain and ulcers.

Vaginitis can also be caused by foreign bodies (a forgotten tampon). Non-infectious inflammatory vaginitis is very rare.

 

 

- Vaginal itching in climactic women:

Atrophic vaginitis is a common cause in women of climactic age.

Other causes include vaginal cancer, cervical cancer, endometrial cancer, and chemically induced vulvitis in women with incontinence or in bedridden patients.

 

— In women of all ages vaginal itching:

Conditions that are predisposed to vaginal and vulvar infections at any age include:

• Fistulas between the intestines and genitals (causes the mixing of intestinal and vaginal microflora)
• Pelvic tumors or radiation (harmful tissues and procedures that weaken the body's immune defenses)
• A fistula is usually caused by trauma during childbirth or an infection during an episiotomy, but sometimes it occurs as a complication of inflammatory bowel disease or a pelvic tumor or pelvic surgery. (eg hysterectomy, rectal surgery).

Non-infectious vulvitis accounts for 30% of vulvovaginitis patients. It can be caused by hypersensitivity or reactions to various substances, including toilet sprays, perfumes, soaps, bleach, fabric softeners, and sometimes spermicides, vaginal creams or lubricants, latex condoms, contraceptive vaginal rings, and diaphragms.

 

Check for shingles

history

This medical history includes symptoms (itching, burning, pain, swelling), their duration and intensity. In the presence of vaginal discharge, the patient should be asked about the color and smell of the discharge and about the factors that lead to the exacerbation or weakening of the above symptoms (especially related to menstruation and sexual intercourse). Also asked about the use of hygiene sprays or perfumes, spermicides, vaginal creams or lubricants, latex condoms, vaginal contraceptive rings and diaphragms.

An examination of body systems should include looking for symptoms that may indicate the cause of the disease, including:

 

• Fever or chills, abdominal or stomach pain: pelvic inflammation of the organs disease or cystitis
• Polyuria and polydipsia: Newly diagnosed diabetes

Also, the medical anamnesis should contain information about risk factors associated with the following conditions:

• Candida infection (eg, recent antibiotic use, diabetes, HIV infection, other immunosuppressive diseases)
• Clots for various reasons (eg, Crohn's disease, peptic ulcer or gastrointestinal cancer, pelvic or rectal surgery, birth trauma)
• Sexually transmitted diseases (eg unprotected sex, having sex with multiple partners)

 

Objective examination

Physical examination focuses on the pelvic organs.

The external genitalia are examined to determine the presence of erythema, injury and swelling. The cervix is ​​examined for inflammation (for example, trichomoniasis) and clots. Vaginal pH is measured and stool samples are taken for analysis. A bimanual examination is performed to determine the sensitivity of the uterus.

 

Symptoms of hives

The following symptoms are dangerous:

• Trichomoniasis vaginitis in children (refers to sexual violence)
• Faecal discharge (even if it is not visible, it indicates the presence of fistulas)
• Pelvic pain and fever
• Bleeding in women of climactic age

 

Interpreting the results of shingles itching

Vaginal discharge in children may indicate the presence of a foreign body in the vagina.

In the presence of vaginal fistula and cervicitis, it is necessary to check for sexually transmitted diseases. Non-specific vulvovaginitis - when all the above diagnoses are not found.

In women of reproductive age, vaginitis should be distinguished from normal clots:

• Vaginal discharge is usually milky white or slimy, odorless and non-irritating; can wet underwear.
• In bacterial vaginosis, there is a liquid, gray discharge with a fishy odor.
• In trichomoniasis infection, there is a foamy, yellow-green vaginal discharge and irritation.
• Candidal vaginitis is a white, curd-like discharge that often worsens in the week before menstruation and worsens after intercourse.
• In allergic reactions, there is a significant irritation with a relatively small amount of mucus, which causes inflammation.

Fistulas due to cervicitis (due to pelvic infection) can be similar to vaginitis. Abdominal pain, pain when moving the cervix and inflammation of the cervix indicate an infectious disease of the pelvic organs.

Vaginal itching and vaginal discharge can occur in women of all ages as a result of skin conditions (eg, psoriasis, eczema), which are usually easy to find through history and skin examination.

Watery and bloody discharge can be caused by cancer of the vulva, cancer of the vagina, or cancer of the cervix; cancer can be distinguished from vaginitis by tests and biopsy.

In atrophic vaginitis, the discharge is scanty and can be watery and transparent or thick and yellowish. Dyspareunia develops quickly, and the vaginal tissues become thin and dry.

 

Analyzes in shingles itching

All patients should undergo the following tests:

• pH
• Preparation of wet anatomical specimen
• Potassium hydroxide (KOH) test

Testing for gonorrhea and chlamydia is done when non-infectious causes (eg, allergy, foreign body) are not clear.

Vaginal pH, analyzed using a pH indicator paper, ranges from 4,0 to 6,0 pH, with a pH range of 0,2. Then, put the material on 2 bottles with a cotton swab; in one bottle, the material is dissolved with 0,9% sodium chloride (wet preparation in saline solution), and in the other - 10% KOH (KOH test).

Using the KOH test, the origin of the "fish" smell is determined, which indicates the presence of amines formed in trichomoniasis vaginitis and bacterial vaginosis. Medicines are examined with a microscope; KOH dissolves most materials except fungal hyphae and facilitates identification.

The material is examined under a microscope in a physiological solution, in which motile trichomoniasis can be detected, which quickly become immobile and difficult to detect after a few minutes of smearing.

 

Treatment of scabies

All the diseases mentioned above should be treated.

It is necessary to observe hygiene and keep the genitals clean. Avoid using soap and unnecessary topical preparations. If necessary, hypoallergenic soap should be used. Occasional use of ice packs or warm baths (with or without baking soda) can relieve pain and itching. If the cause of chronic inflammation of the vulva is incontinence or bed disease, hygiene is the best therapy.

If the symptoms are moderate or severe and the measures listed above are ineffective, medication is necessary. Antipruritic corticosteroids (eg, 2% hydrocortisone twice daily as needed) may be applied to the vulva, but not to the vagina. Antihistamines relieve itching and induce drowsiness, helping patients to fall asleep.

Adolescent girls should be taught the basics of vaginal hygiene (eg, how to properly wipe the vagina from front to back after bowel movements and urination, washing hands, avoiding touching the vagina).

 

Vaginal itching in older women

— In climactic women, a significant decrease in estrogen levels leads to thinning of the vaginal mucosa (atrophic vaginitis), increased susceptibility to infection and inflammation. Other common causes of low estrogen levels in older women include oophorectomy, pelvic radiation, and certain chemotherapy drugs.

 

— In atrophic vaginitis, the inflammation often results in an abnormal, scanty discharge, which may be watery and clear or thick and yellowish. Dyspareunia often develops, and the vaginal tissues become thin and dry.

 

— Poor hygiene (eg, in patients with incontinence) can cause chronic inflammation of the vulva due to chemical irritants in the urine or feces.

 

— Bacterial vaginosis, candidal vaginitis, and trichomoniasis vaginitis are rare in climacteric women, but may occur in patients with risk factors.

 

— After menopause, the risk of developing cancer increases, so bloody or watery discharge can often indicate the presence of cancer; therefore, any vaginal discharge should be checked in postmenopausal women.

 

Main results

• Complaints are often specific.
• The causes of vaginal itching and burning sensation vary depending on the age of the patient.
• Most patients require vaginal pH measurement and microscopic examination of clots; if necessary, a bacterial analysis is performed for the presence of sexually transmitted diseases.
• Any vaginal discharge in climacteric women should be investigated immediately.

source: msdmanuals.com