Gynecology / Women's Health Expert Forum
Chronic vaginitis
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Chronic vaginitis

Dear Doctor,

I´ve had vaginal discharge and burning in the vulvar vestibule (probably due to the discharge) for about 2 years. The discharge I present is usually mucous or watery (sometimes bubbly) and transparent. I´ve been to many doctors and I´ve been given the following antibiotics without any improvement:

- Metronidazole
- Tinidazole
- Clindamicin
- Azithromycin
- Tetracycline

This discharge just disappears when I acidify the vaginal PH through vinegar douching or by applying Bio-Fem (sold in the United Kingdom). However, after this procedure, I start having another type of discharge: white and cheesy... and this one just goes away if I alkalinize the PH with sodium bicarbonate... but then the watery/mucous discharge comes back. So it seems to be an endless cycle and I´m really tired of it.

I´ve taken PCR for chlamydia and gonorrhea that came back negative and vaginal cultures that sometimes show normal flora, sometimes a slight alteration with the presence of diphteroid gram-positive bacteria. I was positive for herpes II, but I´ve never had any blisters or severe ulcers. I don´t have any systemic disease, just a low progesterone level which I´m about to treat.

I´d like to know what genital pathogens could be causing this condition and what antibiotics would be most appropriate to treat it. I´d also appreciate it if you could recommend me any good health clinics or specialists in the US with experience in treating chronic vaginitis.

Thank you in advance!
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603463_tn?1220630455
Hi!
This problem is (unfortunately) relatively common.  And I'm not sure I'll be able to give you any better answers than you have already gotten.  I have a couple of thoughts.  Have you tried antivirals like Acyclovir or Valtrex when the watery discharge appears?  I wonder if it could be an atypical presentation of HSV II.  Also, I much prefer diflucan orally for treatment of yeast.  Many of the topical prepartations lead to chronic dermatitis which then need to be treated with  steroids.  
That brings up one more thought, which is have you had biopsy done of the vulvar skin?  There are other chronic conditions like lichen sclerosis or eczema or Bechet's that can be diagnosed with biopsy and treated with topical anti-inflammatory agents like Clobetasole.
We used to have something in the States called Acijel which worked well, but we no longer do.
If you are on oral contraceptives, I would recommend stopping those.  As far as antibiotics go, I don't have any that you have not used with the exception of the vaginal forms of metrogel and cleocin ovules--but I wouldn't expect miracles from those.

As far as who to see in the States, I would recommend a large comprehensive center like the Mayo Clinic or  Brigham and Women's hospital.  I don't know anyone person in particular.

Good luck!
Dr B
4 Comments
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Avatar_n_tn
Hi there.  I just read your post to the dr. and I thought I'd comment.  I have the exact same situation as you...its uncanny.  I have scoured the internet and have seen many doctors.  I thought I'd mention what I've come up with.  I believe the doctor is "unfortunately" right on the money.  Its an atypical presentation of herpes 2.  As you are probably aware, a watery discharge is quite common with herpes; most doctors will tell you that its only with the sores, but that is untrue.  I also have genital herpes, no sores whatsoever, only the discharge.  I also sometimes have urinary pressure which is also atypical of herpes.  I am going back to my gyno on Friday to speak with him about anti-virals in the hope of assisting with this never ending discharge problem.  When were you diagnosed with herpes in comparison with when the discharge started?  Its so difficult because its not typical, all health care professionals mis-diagnose it as not being related to the herpes...but it is.  Let me know what you find out, and I will let you know what my doctor says.
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Avatar_f_tn
Hi CWorried,

I had chronic recurring bacterial vaginosis (BV) for 15 years with symptoms as you describe. Before I found treatments that worked, I also went back and forth between BV and yeast infections. The clear watery discharge that you discribe is typical of BV, whereas the pasty white discharge is typical of yeast. But it's good that you've been tested for other possible causes.

The Acijel that Dr. Brown mentioned worked very well for me. It used to be availabe in both the US and the UK, but the patent expired and the company stopped making it. However, there is a generic version called Acidic Vaginal Jelly. The NDC code is 0603-7701-92.  Any pharmacy in the U.S. should be able to find the product in their database using that code. But be prepared to wait a couple of days for them to order it because few pharmacies keep it in stock. I used it so often that my pharmicist began stocking just for me. Acidic Vaginal Jelly requires a prescription, so you'll have to see a doctor first. Don't be surprised if your doctor has never heard of it.

As it's name implies, the jelly increases the acidity in the vagina, which helps to destroy or slow the problematic bacterial growth and encourage growth of the "good" bacteria. Ask your doctor for several refills and you can use it on a regular basis as a preventative measure.

Something else you might try is taking probiotics. The best ones cost around $20 and contain 10 to 15 different strands. Probiotics are the "good" bacteria that are found in the vagina and intestinal tract. They help to keep the "bad" bacteria and yeast in check.  When you take antibiotics, not only does it kill the "bad" bacteria, but it kills the "good" bacteria, too. Not surprisingly, a yeast infection or BV often occurs a couple of weeks after a woman finishes a course of antibiotics. Taking probiotics and using Acid Jelly is the most effective method that I have found yet. Some women even insert probiotics into the vagina by mixing it with yoghurt. I don't think I'll go there with yoghurt, but I have mixed a probiotic powder with the acid jelly before inserting.

You might also consider cutting sugars and yeasts out of your diet. Yeast feeds like crazy on sugar--you'd be amazed! And it's a vicious cycle. When your body is full of yeast toxins, your sugar cravings increase. You eat sugar. The yeast multiplies. You crave more sugar, and so on. I highly recommend the book called The Yeast Connection Handbook by William G. Crook, M.D.  I read it looking for a way to fight chronic yeast infections, but found a mountain of information that changed my life.

I am not a doctor, and I can't guarantee that doing these things will be an absolute cure for you, but thousands of women report good results after conventional antibiotics have failed them for years. After years of embarrassment and depression, I finally got my life back!

Hope this helps!

Helynne
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Avatar_f_tn
P.S. Another product you might try is Replens. It's an over-the-counter product for daily use. It provides more moisture than acid jelly and restores vaginal elasticity lost due to atrophy. Unlike the acid jelly, Replens doesn't smell like vinegar and it works well as a lubricant for intimate moments. However, the acid jelly is more potent for treatment of an immediate infection.
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