Hi Astrid..
oh thanks hun, i am sure all will be good soon..
just tackling the problems that was picked up on my smear..
explains alot as often i felt i may have thrush, and used canestan and not felt much improvement..
turns out i had something that mimics thrush and thrush together..
now my bladder feels sensitive too.. 😫
So ladies if your have thrush and treat it and it persists, it may be what i have now ..
my smear came back with a Bacterial vaginosis this particular one i have is CV... Cytolytic Vaginosis .. and thrush 😩, i had no unusual symtoms, just thought I was sore with dryness due to menopause .. no unusual discharge ..
Cytolytic vaginosis, which was previously known as lactobacillus overgrowth syndrome or Doderlein's cytolysis, is an important cause of vaginal discharge, particularly in women who are otherwise healthy.
To understand the pathogenesis of the condition, one needs to appreciate that Lactobacilli are a key component of the normal vaginal flora in healthy women of reproductive age. They help maintain an acidic vaginal pH (4.0-4.5), and also reduce overgrowth of E. coli, Candida spp., Gardnerella vaginalis and Mobilincus spp, via the production of hydrogen peroxide (H2O2).
However, overgrowth may occur in some of these women; the abundant lactobacilli then damage the vaginal intermediate epithelium, causing lysis of those cells.
The underlying etiology for the overgrowth is still unknown; however, patients with diabetes mellitus have an increased incidence, as Lactobacilli are more abundant in women with high serum glucose levels.
Interestingly, lactobacilli levels have been observed to increase during the luteal phase; this explains why many of these patients experience an increase in symptoms during this time.
While the true incidence is still unknown, cytolytic vaginosis is believed to account for around 1% to 5% of all vulvovaginal complaints.
Unfortunately, the condition is often missed, as the symptoms and signs are suggestive of vulvovaginal candidiasis (VVC); thus, patients self-diagnose themselves inaccurately and medicate themselves with over-the-counter (OTC) antimycotics.
As mentioned earlier, the symptoms of cytolytic vaginosis mimic those of VVC; thus, many of these patients present with a lengthy history, possibly due to previous misdiagnosis.
They typically complain of a thick, odorless, white vaginal discharge and intense pruritus; dysuria and dyspareunia along with a sensation of vulvar burning or discomfort may also be present.
Note that the symptoms of cytolytic vaginosis characteristically cyclical; they tend to increase in severity during the luteal phase with a peak shortly before the menstruation.
The physical examination may reveal an erythymatous and edematous vaginal tissue; the cervix, uterus, and adnexa typically appear normal.
The investigations required for diagnosis are relatively simple; these include microscopic examination, vaginal pH measurement, and any other investigations necessary to rule out the other differentials.
Microscopy of a saline wet mount typically reveals a large number of intermediate epithelial cells, copious amounts of lactobacilli of varying lengths, and cytoplasmic debris (including bare or naked nuclei). Leukocytes are sparse or generally absent.
Note that, some lactobacilli may adhere to the fragmented epithelial cells; this can be mistaken for the “clue cells” of bacterial vaginosis.
The vaginal pH is typically acidic with a range of 3.5-4.5.
In many patients, the diagnosis of cytolytic vaginosis can be challenging, due to the high degree of similarity to VVC. Thus, the following diagnostic criteria have been suggested:
- Strong clinical suspicion of cytolytic vaginosis.
- Absence of Trichomonas, Gardnerella or Candida on a wet smear.
- An increase in the number of Lactobacilli.
- A paucity of white blood cells.
- Evidence of cytolysis.
- The presence of a characteristic discharge.
- A vaginal pH between 3.5-4.5.
The key goal of management is to restore the vaginal equilibrium; this is achieved by increasing the vaginal pH in order to reduce the number of lactobacilli.
In many women using tampons, the vaginal pH can be sufficiently raised merely by discontinuing tampon use and thus restoring menstrual flow.
The other main modality of management involves douching with a sodium bicarbonate (baking soda) solution, by using a sodium bicarbonate suppository vaginally, or via sodium bicarbonate in a sitz bath. This is typically performed twice weekly for 2 to 3 weeks.
Note that if symptoms persist beyond 2 to 3 weeks of treatment, re-evaluation is warranted.
Patient education is also an important aspect of management; this includes informing them about the condition, and providing instructions on basic vulvovaginal care (i.e. using cotton undergarments, and avoiding the use of soap to cleanse the genital area).
let's hope it passes quickly and you get make to your normal bubbly self xx