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Chronic Vaginal Issues
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An_245429 posted:
StitchedPigeon, same here. Its been 18 months in my case.

Ms. Jane, Before I start writing to you I appreciate the expertise, sincerity and kindness with which you answer. I have been following you for a while now.

I have two doubts after reading your answer to StitchedPigeon.

1. My urine culture found me positive for Klebsiella Pneumoniae during March, '11. I was treated (My Gynac said that the counts was very lessfor that but was not prescribed a culture again. Do I have to go for one again?

2. Please read the following paras and tell me if I have to go for any treatments.

My last vaginal swab during Nov. '11 showed 'scanty growth of streptococcus sp' and vagianl smear cytology read, 'Smear shows benign squamous epithelial cells of all the stages with karyolysis. There are numerous tropozoites of Trichomonas Vaginalis. I was prescribed Bactrim for 5 days.

My last Pap (in March, '12) said, no malignant cells, no fungi, no parasites, no viral inclusions(no koilocytosis),no clue cells and endocervical cells show squamous metaplasia. My Gynac said I was fine.

As of now I take no medicines. My last treatment which concluded before two months was one capsule of Canditral 200 on the first day of my period for 6 months. That is, I am in the first mensturation cycle without Canditral. Since this problem started I have been watching it subsiding very very slowly. Now I have stinging and itching. I don't have the itching on all the days of my cycle. Its on and off. I don'thave the urgency to pass urine always. My husband complaints about a burning/irritation kind of discomfort after intercourse. Its on and off again. He talked about that 2 months back and that was when I went for this last Pap which I talked about.

What do I do now ?
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Jane Harrison Hohner, RN, RNP responded:
Dear An: Let's start with the urine question first, OK? It sounds like you were prescribed an antibiotic for the Klebsiella Pneumoniae despite the bacteria being in lower amounts (ie low count of Klebsiella in the sample). If the bacteria at that time were sensitive to the antibiotic prescribed antibiotic prescribed, a follow up ("test of cure") may not be needed. However if you are currently having urinary symptoms then a current urinalysis with urine culture would be suggested. Klebsiella is a very common cause of UTIs, second only to E. Coli.

With the vaginal culture of six months ago, you had low numbers of strep. Group B strep, E. Coli, and Staph aureus (normal skin bacteria) were frequently cultured in a group of 631 women, many of whom had no symptoms (Donder, 2002). In a study of 141 GYN surgical patients, Group B strep was found in the vaginal secretions of 20% (Song, 1999). This suggests that many types of bacteria can be a part of the"normal" vaginal ecology.

By contrast, the presence of the protozoan trichomoniads (also known as the STD "trich") is not normal and they are usually treated with a dose of metronidazole ("Flagyl"). Bactrim can be used but, metronidazole and tinidazole are considered the drugs of choice and are probably more effective. Your sexual partner should have been treated too so he could not give the trich back to you.

The PAP of March did not report any trich--other other concerning findings. If you are having stinging and itching it may be wise to have a microscope exam ("wet mount") to look specifically for yeast, increased numbers of the beneficial lactobacilli, and any evidence of surviving trich. The best time to have the exam is when your symptoms are the worst. There is an increased chance of finding any pathogens.

Yours,
Jane
 
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Alven replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

Thank you for the quick reply. Shall talk to my Gynec.

Love,
Alven.
 
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An_245429 replied to Alven's response:
Dear Jane,

I went for

1. Urine routine(I'll be going for a culture) - Normal

Pus - 1-3

Epi - 4-6 and

2. Wet mount

Trichomonas Vaginalis - Not seen

Pus - 50-75/HPF

EPI - 7-10/HPF

I was prescribed

Dalacin C - 8 1-0-1
Microdox - 8 1-0-1
Candid cl suppository for 3 nights
Omez - 4 1-0-0

She said I would have to go for another wet mount after that course of medicines.

She saw an yellowish discharge. But, whatever very little that came out once, day before, was white and not smelly. This happened before, too. When I was on and off to her office, she said the samething couple three times but I didn't see that kind.

Is there any do's and don'ts to prevent this issue getting recurrent - by diet and by hygiene?

Will this prolonged issue bring out anyother side effects?

With all the treatments the symptoms subside but I have never felt I got rid off those in full. After any particular course gets over, it shows up again with reason (more frequency in intercourse, outings etc) and even without any reason. Previously, I was on Ecoflora twice a day for 2 months before I was started on Canditral.

Love,
Alven.
 
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Jane Harrison Hohner, RN, RNP replied to An_245429's response:
Dear Alven: Your GYN is breaking out the "big guns," probably because of the increased number of white blood cells (pus cells 50-75 per high powered field when only 7-10 normal vaginal epithelial skin cells were seen in the same space). You have been put on both doxycyclin and clindamycin, with the addition of omeprazole (for the stomach) and a medicine suppository for vaginal yeast (because of the antibiotics).

Generally speaking there are no specific, well established regimens of diet or hygiene to to prevent vaginal or bladder infections except the very general (wipe front to back, monogamy, etc). The most important thing is to have a definitive diagnosis. You should be getting that from both the pending urine culture and your earlier vaginal culture. It is good that she is going to have you return for another vaginal discharge wet mount microscope test to see if the high number of white blood cells are reduced.

In terms of prevention, one of the best is to try and increase the beneficial hydrogen peroxide producing lactobacilli bacteria. These are the "good bacteria" of the vagina. According to a WEB MD site on probiotics:

Treating vaginal infections caused by bacteria (bacterial vaginosis). Clinical research shows certain strains of Lactobacillus might help treat bacterial vaginosis when applied inside the vagina. Researchers have found Lactobacillus acidophilus suppositories (Vivag, Pharma Vinci A/S, Denmark) and vaginal tablets (Gynoflor, Medinova, Switzerland) may be effective. Researchers also found that vaginal capsules Lactobacillus gasseri and Lactobacillus rhamnosus, seem to lengthen the time between infections.

Here is the link for more information:

http://www.webmd.com/vitamins-supplements/ingredientmono-790-Probiotics%20%28LACTOBACILLUS%29.aspx?activeIngredientId=790&activeIngredientName=Probiotics%20%28LACTOBACILLUS%29

Yours,
Jane
 
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Alven replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

Thanks.

I live in India. I'll talk to my GYN about Vaginal LB. Hope it is available here.

Actually, I didn't use the CL suppositories yet, as I was expecting my periods. I'll start it today.

I'll get back to you with the urine culture and the second wet mount results.

Sorry to bother you with so many questions. What would you have prescribed in the above case?

Love,
Alven.
 
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Jane Harrison Hohner, RN, RNP replied to Alven's response:
Dear Alven: You have a lot of white blood cells/WBC (suggestive of inflammation or infection) in your vaginal secretions. Conditions associated with increased vaginal discharge WBCs can include: chlamydia, gonorrhea, trich, desquamative vaginitis (now thought to be a variant of the autoimmune disorder lichen planus), and atrophic vaginits (present where there is low estrogen/menopause). There are likely other organisms which we have not even identified yet. For example, chlamydia was not fully recognized until the 1970s, but I am sure it had been around for a long time.

What would I prescribe? I am assuming that you and your partner are monogamous. If all your STD cultures were negative I might try doxycycline (covers chlamydia). Clindamycin covers for organisms thought to be linked to desquamative vaginitis. They may also have been using this combo of antibiotics because of the prior UTI.

In terms of the lactobacilli as a probiotic, the use of natural yogurt on a tampon or as a douche has not been shown to be the same as vaginal lactobacilli. The vaginal type produces the hydrogen peroxide; the vaginal type has better adherence to superficial epithelial cells in the vagina.

Medicine is a collaborative effort between the standards of care for certain conditions and the woman's specific history. It is hard to second guess what I would have done--unless I did a history and physical as well. As always, the best thing is to get a "for sure" diagnosis if possible.

Gosh, thanks for writing from INDIA! The internet has made us one family of women.

Namaste,
Jane

PS Here, from New Zealand, is more about desquamative vaginitis:

http://dermnetnz.org/site-age-specific/desquamative-vaginitis.html
 
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Alven replied to Jane Harrison Hohner, RN, RNP's response:
Namaste Jane. Good to hear the Indian kind of greeting from you !

Thank you for throwing more light into this issue. I did go thru the link provided by you.

You are right. We are monogamous and I am commented by my husband as, "born to stay hygienic".

We lived in the US for a few years and came back for good 3 years back. I wish I was there now. Basically, there are either healthy women or ignorant ones here and so no full fledged diagnosis available, to the most part. After seeing the wet mount results I asked my GYN why there was a single mention about trich and no other things. She just talked about KOH that her lab was missing which was used to find out one more thing. Please tell me about all the investigations which I can go for. This issue is getting too much. Do I have to avoid intercourse till I get rid off this?

I will get my urine culture results tomorrow and will be going for the wet mount, too. Shall write to you.

Love,
Alven.
 
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Alven replied to Alven's response:
Dear Jane,

My urine culture came out normal. I couldn't go for the wet mount as there was a very less secretion. The slides dried up so quick.

My GYN's final advice: Ignore. (She just prescribed a vaginal wash to be used once a day.) I still have the same old symptoms; very mild itching(mostly felt in the nights) and burning sensation(felt only while cleaning the vagina) and a very occasional stinging.

I reminded her back that I had very mild symptoms when the first wet mount showed up so many pus cells. She said it was only pus cells and asked me to keep cool.

Sometime back another GYN told the samething, "You have very mild symptoms. So just ignore".

Is it ok to ignore? At the sametime, I have an idea of searching out the next GYN(so far, 3 of them) as well. Suffering, you know.

Unfortunately, there is no vaginal lactobacillus available in India.

I know, I am bugging you. Please bear with me and repIy. I have been looking forward to your answer for my previous post, too.

Love,
Alven.
 
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Jane Harrison Hohner, RN, RNP replied to Alven's response:
Dear Alven: Given that you are not at risk for any STDs (including trich or chlamydia), AND that you have been given a course of powerful antibiotics, that should cover most infectious etiologies. As we discussed above, increased WBCs can also arise with atrophic/low estrogen changes, and desquamative vaginitis which is not thought to be an infection.

The itching/burning/stinging (now that yeast has been ruled out) could be an over groth of the hydrogen-peroxide producing "beneficial" bacteria--or even irritation from all the varied treatments.

Bottom line, it is probably OK to watch and wait to see if the symptoms resolve on their own. This usually does happen if no infection is involved. If the symptoms persist then you can try another GYN and ask specifically about desquamative vaginitis/lichen planus as a cause. You do not have to suspend intercourse.

Your comments about GYN care were fascinating. We have so much focus on technology and testing in the US that I have often wondered if I would be able to practice outside my usual parameters.

In Support,
Jane
 
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Alven replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

Thanks a million for your constant support.

Everytime after a course of treatment, the symptoms would slowly increase. But, this time immediately after the last course got over, I started using 'V-Wash' twice a day and that seems to help a bit. Hoping for the best.

I can very well understand your last para for I lived there for a few years.

Thanks again for being there.

Love,
Alven.
 
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Alven replied to Alven's response:
Dear Jane,

Happy new year!

Just thought of discussing with you what I am going thru' now. Its been 8 months after I wrote to you. My symptoms were like nothing more and nothing less for a while. Indeed, no treatment. Then slowly the stinging which I got only around 7 to 8 times a cycle went sharper. Then for two cycles, before ovulation and periods I got more of white discharge. So, I consulted my GYN and used just one suppository of Zalain (sertaconazole).

After that the stinging is not that sharp. But, it is only back to square one. Please read my first post to you.

My skin bas been very sensitive. I would get facial rashes (which was never too much but with some basic care it would go off) whenever I was exposed to sun. Recently, I got severe itching on my face. My eye lashes got a bit reddish and swollen. It went off on its own. My ear canal got itchy. So, I consulted an ENT. She prescribed a 5 day course of some medicines. Well. I didn't tell her about my facial problem thinking that it was something which was always there. But, I noticed the rashes on my face vanished. At the sametime, my ears got alright too. So, I started wondering about my vaginal issue, guessing it can go off with some dermatological treatment. Are the vaginal treatment and dermatology treatment same? Please throw some light.

Love,
Alven.
 
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Jane Harrison Hohner, RN, RNP replied to Alven's response:
Dear Alven: We usually tell women that if they have a genital skin lesion, or vulvar condition, they have a good chance of getting an excellent diagnosis from a general dermatologist. There are some skin conditions which can appear in/on the genitals as well as other parts of the body:

1. Lichen planus---an autoimmune condition which can be seen in the oral mucosa (dentists will diagnose it) and in the lower 1/3 of the vaginal canal.

2. Psoriasis--another autoimmune skin disorder which is most commonly seen as scaly plaques on elbows, knees, behind ears, but can be found on the vulva.

I am not familiar with any dermatology issues which are confined to just the face and vagina.

You mentioned that the medications (sounds like systemic steroids???) given by the ENT seemed to clear up things all over the body. Topical steroids (eg rectal suppositories cut into a smaller dose) can be used inside the vagina for very inflamed, or autoimmune, conditions. The next time you see your GYN let her know the name of the meds given by the ENT. That may help focus a diagnosis of the recurring vaginal symptoms.

Yours,
Jane
 
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Alven replied to Jane Harrison Hohner, RN, RNP's response:
Thanks Jane.


Those medicines relieved me off my facial symptoms but not the vaginal ones and they were back in 5 days. It was a course of 10 days. Then, when I started getting rashes on my face which was itchy, it extended to the ear, too.

I consulted my GYN yesterday. She ruled out LP or any other skin conditions. She repeated telling me not to worry about all those symptoms.
I would like to write to you about the list of medicines that I took.
Betnesol inj 1CC - 1Candid - O - ear drops - 2 drops twice a day
Azimax 500 - 0 0 1 - 3Xyzal - 1 0 1 - 20Zerodal - 0 0 1 - 5Betnesol - 0 0 1 - 10
I got to see your answer to KZWL 1982 (Discussion - Chronic Yeast). There was a mention about vaginal boric capsules. Thats the only thing left for me to try. Shall I go for that?
There was another reply from a member to the discussion. She said that it was found out that she was allergic to yeast infection and that treatment was fruitful. How to diagnose that?
In the near future, If you come across anything regarding this problem please write to me.
LoveAlven

 
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Alven replied to Alven's response:
Dear Jane,

My GYN called me yesterday and said that I could use Xysal around the period when my symptoms get more, for couple three days and recommended candid cream for topical use.

Love
Alven


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