Location
Suwanee, GA
Start Date
11-5-2023 1:00 PM
End Date
11-5-2023 4:00 PM
Description
Background:
Recurrent Vaginitis is defined as having three or more confirmed episodes within a year. Recurrence rates of vaginitis have been reported in up to 60% of previously infected women. The most common bacterial cause is due to Gardnerella vaginalis, while Candida albicans is the most common fungal cause; both microorganisms can cause opportunistic infections when imbalances occur in the vaginal environment. Commonly known risk factors include multiple sex partners, unprotected sex, douching, recent antibiotic use, and estrogen therapy.
Case Presentation:
A healthy 34-year-old female is complaining of recurrent episodes of vaginitis since the birth of her son two years ago. Vaginal irritation is typically accompanied by thick off-white vaginal discharge. She attributes her recurring symptoms to her intrauterine device (IUD) placed six-weeks postpartum. Symptoms occur after sexual intercourse, approximately once or twice a month. Her husband has incorporated oral sex into their routine sexual practice to help counteract the reduced libido she developed since having their son. She is married and monogamous with her husband. She has no prior history of sexually transmitted infection. She denies fevers, unintentional weight change, menstrual irregularity, rash or genital lesions, dyspareunia, or urinary complaints.
Her vital signs are within normal range. A pelvic exam reveals mild suprapubic tenderness, erythema of the vaginal introitus, and thick off-white vaginal discharge with slight odor. No abnormal masses or cervical motion tenderness are noted on the bimanual exam. Urinalysis shows leukocyte esterase. Urine pregnancy test is negative. Vaginal swabs for gonorrhea and chlamydia are negative. Clue cells are seen on saline wet mount, and pseudohyphae with budding yeast are noted on potassium hydroxide preparation. For her concurrent bacterial vaginosis and Candidal vaginitis, she is prescribed a week of oral metronidazole 500 mg twice daily, and one dose of oral fluconazole 150 mg, respectively. Additionally, her husband is advised to thoroughly gargle with mouthwash prior to engaging in oral sex. On follow-up, the patient reports no further postcoital vaginitis episodes.
Discussion:
Current data is inconsistent regarding whether oral sex is considered a risk factor for recurrent vaginitis. The lack of research in this area could be due to the sensitive nature of discussing detailed sexual practices with patients, but these discussions provide a significant part of a patient’s history. Anecdotal evidence from our patient case prompted further investigation into the interactions between oral sex and recurrent vaginitis. An extensive literature review suggests that dysbiosis in vaginal flora resulting in vaginitis may be due to the direct inoculation of oral microbes, or the indirect effects of their byproducts. Furthermore, studies have shown that the use of mouthwash can effectively eliminate oral flora known to impact the vaginal microbiota. We plan to conduct a meta-analysis to further investigate the effects of varying vaginal and oral flora compositions on many aspects of the vaginal environment. A future case-control study can also be done to investigate the effectiveness of using mouthwash prior to oral sex for the prevention of recurrent vaginitis.
Embargo Period
6-14-2023
Included in
An investigation of oral sex as a risk factor for recurrent vaginitis: a case study
Suwanee, GA
Background:
Recurrent Vaginitis is defined as having three or more confirmed episodes within a year. Recurrence rates of vaginitis have been reported in up to 60% of previously infected women. The most common bacterial cause is due to Gardnerella vaginalis, while Candida albicans is the most common fungal cause; both microorganisms can cause opportunistic infections when imbalances occur in the vaginal environment. Commonly known risk factors include multiple sex partners, unprotected sex, douching, recent antibiotic use, and estrogen therapy.
Case Presentation:
A healthy 34-year-old female is complaining of recurrent episodes of vaginitis since the birth of her son two years ago. Vaginal irritation is typically accompanied by thick off-white vaginal discharge. She attributes her recurring symptoms to her intrauterine device (IUD) placed six-weeks postpartum. Symptoms occur after sexual intercourse, approximately once or twice a month. Her husband has incorporated oral sex into their routine sexual practice to help counteract the reduced libido she developed since having their son. She is married and monogamous with her husband. She has no prior history of sexually transmitted infection. She denies fevers, unintentional weight change, menstrual irregularity, rash or genital lesions, dyspareunia, or urinary complaints.
Her vital signs are within normal range. A pelvic exam reveals mild suprapubic tenderness, erythema of the vaginal introitus, and thick off-white vaginal discharge with slight odor. No abnormal masses or cervical motion tenderness are noted on the bimanual exam. Urinalysis shows leukocyte esterase. Urine pregnancy test is negative. Vaginal swabs for gonorrhea and chlamydia are negative. Clue cells are seen on saline wet mount, and pseudohyphae with budding yeast are noted on potassium hydroxide preparation. For her concurrent bacterial vaginosis and Candidal vaginitis, she is prescribed a week of oral metronidazole 500 mg twice daily, and one dose of oral fluconazole 150 mg, respectively. Additionally, her husband is advised to thoroughly gargle with mouthwash prior to engaging in oral sex. On follow-up, the patient reports no further postcoital vaginitis episodes.
Discussion:
Current data is inconsistent regarding whether oral sex is considered a risk factor for recurrent vaginitis. The lack of research in this area could be due to the sensitive nature of discussing detailed sexual practices with patients, but these discussions provide a significant part of a patient’s history. Anecdotal evidence from our patient case prompted further investigation into the interactions between oral sex and recurrent vaginitis. An extensive literature review suggests that dysbiosis in vaginal flora resulting in vaginitis may be due to the direct inoculation of oral microbes, or the indirect effects of their byproducts. Furthermore, studies have shown that the use of mouthwash can effectively eliminate oral flora known to impact the vaginal microbiota. We plan to conduct a meta-analysis to further investigate the effects of varying vaginal and oral flora compositions on many aspects of the vaginal environment. A future case-control study can also be done to investigate the effectiveness of using mouthwash prior to oral sex for the prevention of recurrent vaginitis.