Similar to Thrush Like Symptoms but its actually Cytolytic Vaginosis (CV)

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Thought I would share info.. 

i am one year full menopause... age 50 ...

received my pap smear results and although had some thrush type symptoms in the past and treated with canestan once... 

my results revealed I have Cytolyic Vaginosis, and thrush and require vaginal antibiotics for three nights then three nights of a different thrush treatment

( not Canestan) 

Useful Info..  Awareness....

Women's Health Update: Cytolytic Vaginosis; A Vaginitis You May Not Have Heard About

Cytolytic vaginosis(CV) is the current term for a condition of lactobacilli overgrowth.

It is a little recognized but common cause of cyclic vulvovaginal complaints in women of reproductive age.

CV is often misdiagnosed as candidiasis and most women have tried many antifungal medications both conventional and alternative, with little or no relief.

CV was first described as a clinical entity by Cibley and Cibley in 1982 and it was initially referred to as Doderlein's cytolysis (DC).

They observed that the symptoms of CV were similar to Candida vaginitis, but when viewed under a microscope, there were differences.( 1, 2)

The name of Doderlein's was abandoned because these same authors realized that DC only refers to the Doderlein's species of lactobacilli when in fact there are approximately 80 different species of lactobacilli that have been described.

CV was then proposed as the more accurate term that described the actual destruction of the epithelial cells caused by the overgrowth of lactobacilli.

The experience of Cibley and Cibley was that the majority of the patients referred to them that thought they had chronic vulvovaginal candidiasis actually had CV instead.( 1)

The normal ecosystem of the vagina involves many different organisms that are involved in a system of checks and balances.

No other concept in vaginal health is as important as the state of the ecosystem of the vagina.

The flora that colonizes the vagina takes place in the birth canal during delivery, and the flora that is established in the newborn girl must therefore consist of the same strains as in the mother.

The vaginal environment of a newborn changes during the first month, then again at prepuberty, puberty, during the reproductive years and post-menopausally.

Additionally, the cyclic hormonal changes of the menstrual cycle also influence the vaginal ecosystem.

It is a variable state throughout a woman's lifetime, but nothing is more key to this ecosystem than lactobacillus.

The range of bacterial types isolated is immense, including Staphylococcus species, Garnerella vaginalis, Streptococcus species, Bacteriodes species, Lactobacillus species, Mobiluncus, Candida species, (most commonly Candida albicans), and more. The predominant organism isolated from the normal vagina are members of the Lactobacillus genus. One species of bacteria inhibits another and an elegant combination of pH, vaginal immunity, hormonal activity and the community of organisms that occupy the vagina interact in a manner in which bacterial overgrowth is controlled, unless the well-established mechanism of balance is thrown off by one factor or another.

Factors controlling this defense system include the health of the vaginal squamous epithelium, the dominance of Lactobacilli and the subsequent low or acid pH balance and hydrogen peroxide production, hormonal activity both over our lifetime as well as our monthly cyclic changes, pregnancy, contraceptive devices, feminine hygiene products, and vaginal sexual activity including friction, lubricants, foreign objects, and semen.

It has been proposed that lactobacilli and possibly other bacteria cause the symptoms of CV.

Even though we lack full understanding about the exact mechanism of lactobacilli overgrowth, a clinical condition does exist with this overgrowth that manifests as chronic cyclic burning and itching. It appears that this is probably related to an overgrowth of lactobacilli that produces irritating acids.( 1)

Several mechanisms are possible for how Lactobacillus in normal amounts does its remarkable job of controlling the environment. A low vaginal pH is believed to be a primary mechanism controlling the composition of the vaginal micro flora. Lactic acid is produced by the metabolism of lactobacillus and although there may be other ways in which the vagina maintains its normal acidic environment, the role of lactobacilli seems evident. Lactobacilli thrive at an acidic pH of 3.5-4.5 and these values are indeed found in the normal vagina throughout the menstrual cycle.

Lactobacilli have also been shown to interfere with how pathogenic bacteria adhere and colonize the cells of the vagina.( 3) Hydrogen peroxide production is another well-recognized method of antagonism to problematic bacterial populations and there are strains of lactobacilli that produce hydrogen peroxide (H( 2)O( 2)). A lack of H( 2)O( 2) producing lactobacilli predisposes a woman to bacterial vaginosis by allowing the overgrowth of Gardnerella and other anaerobic bacteria. Lactobacilli also act directly as antibacterials( 4) and may function as an immune stimulant locally in controlling microbial levels in the vagina.

But what happens when there is too much Lactobacilli? Several species of lactobacilli ferment both glycogen and glucose to lactic acid, carbon dioxide, alcohol, formic acid, acetic acid, and hydrogen peroxide. It is these acids that cause the problem. When lactobacilli overgrow, toe many acids are produced, causing vulvar irritation and itching.

Symptoms

Symptoms of CV usually mimic those of vulvovaginal candidiasis. The most common symptom is itching, but vulvar burning, dysuria, and entry dyspareunia are often present as well. Cyclical and recurrent symptoms typically occur during the luteal phase and worsen premenstrually, increasing in intensity and severity until the onset of menses. Once the onset of menstrual flow occurs, the blood raises the vaginal pH and there is often dramatic relief of symptoms.( 1)

The physical exam is not particularly different from candida vulvovaginitis. The vulva may appear red and slightly swollen.

There may be a small amount of white and slightly clumpy discharge.

The vulvar tissues may be a little tender with discomfort during the speculum exam. The cervix, vagina, uterus and adnexae are normal unless there is also some other kind of co-infection. Even the pH of the vagina is normal in CV.

Diagnosis

Diagnosis of CV is improved if the clinician has a high degree of suspicion of the condition. The history and physical exam basically mimics candida vulvovaginitis. The key is in the microscopic exam: 1) false clue cells with agglutination of lactobacilli to epithelial cells; 2) few white blood cells; 3) cytolysis of epithelial cells with pale or bare nuclei/cytoplasm and poorly defined cell borders; 4) absence of yeast, trichomonas, bacterial vaginosis, or other organisms.( 1)

Repeat microscopic exams that reveal the same findings is confirmation of CV. As you know, each episode of vaginitis symptoms may be due to a different cause.

Treatment

The goal of therapy is aimed at reducing the overgrowth of lactobacilli and providing relief of symptoms. Use of antifungal agents, both conventional and alternative, should be discontinued because these agents may contribute to the recurring nature of the condition. Use of lactobacilli in the form of yogurt, supplements and suppositories should be stopped. It may also be wise to discontinue use of tampons because unimpeded menstrual flow acts much like an alkalinizing agent, raising the vaginal pH and inhibiting the overgrowth of lactobacilli.

Baking soda sitz baths offer relief by removing irritating acid secretions from contact with the vulvar tissues and also just a local soothing effect to excoriated tissue from itching. Mix 2 to 4 tablespoons of baking soda in 1 to 2 inches of warm bath water. Sit in the sitz bath twice a day for 15 to 20 minutes. Wash the tub after each use. Baking soda douches should be reserved for women whose symptoms do not respond to the sitz baths. This is because douching removes vaginal secretions and can disrupt the desired organisms in the vagina and create further problems in maintaining an ecological balance. Consider douching with baking soda once or twice a week during symptomatic phases when the sitz baths do not provide relief. Mix 1 to 2 teaspoons of baking soda in a pint of warm water and gently douche either in the bathtub or over the toilet.

Cytolytic vaginosis may coexist with candidiasis and may need to be managed by combining therapy for both. Using the local antifungal agent in the morning and the baking soda gentle douche in the evening for seven days would be an appropriate regime that may need to be repeated monthly in the premenstrual phase of the cycle.

Other recommendations may prove prudent:

Reduce dietary sugar.

Avoid soap in the genital area. Instead, wash with plain water, use pure unscented mineral oil on cotton balls as a cleanser

Wear white, all cotton underwear and launder with mild soap and hot water, rinsing thoroughly.

Avoid sexual intercourse during symptoms and initial therapy. Oral sex should also be avoided during symptomatic periods because bacteria in the partner's mouth may be irritating to the vulva.

Summary

As women and clinicians become aware of CV, women with cyclic vulvovaginitis will receive better health care and be managed more appropriately. With improved diagnosis of this condition and accurate treatment, fewer women will experience cyclic recurrences of their vaginitis. Success is especially seen when the wrong treatments are discontinued and something as simple as using menstrual pads are used instead of tampons. Treatment approaches to treat CV must be modified as necessary and practitioners must recognize the individual needs of each patient and be willing to be creative and somewhat experimental, utilizing the basic concepts and understanding of CV that we have discussed here.

 

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  • Posted

    Further info on Cytolytic Vaginosis

    How does someone contract cytolytic vaginosis?

    Vaginal discharge is normal for any woman beyond adolescence and puberty,

    but there are at times some symptoms of the vaginal discharge that are abnormal and suspicious.

    The lactobacilli are bacteria in the vaginal tract that are responsible for producing lactic acid to maintain the best pH. Some species of this bacterium too produce hydrogen peroxide, which has antiseptic properties.

    The optimum vaginal pH lies between 3.8 and 4.5. 

    However, when there is an overgrowth of the lactobacillus bacteria, disaster strikes; too much lactic acid strains the vaginal lining and too much hydrogen peroxide kills even the necessary microorganisms.

    The pH also goes to as low as 3 or, worse still, 2. This happens when the lactobacilli start converting all the glucose into lactic acid, formic acid, acetic acid, and alcohol and CO2 gas.

    The vaginal lining gets on the defensive and starts producing too much discharge to counteract the effect of too much lactobacillus.

    This discharge flows together with the acid and killed microorganisms, which makes it even more toxic. As a result, the patient feels itchy, red and swollen as they continuously pass the thick white or thin colorless discharge.

    This results to a condition known as cytolytic vaginosis.

    Most of the times, cytolytic vaginosis is mistaken, even by medical practitioners, to be a fungal and yeast infection (Candida) or a bacterial infection.

    The patient therefore ends up taking all the wrong medication while the real condition hides and continues to develop.

    Cytolytic vaginosis is different from all the other vaginal conditions in that it is not an infection, but merely a condition whose main cause is not really known but is suspected to be imbalance of hormones and of the general ecosystem of the vaginal environment.

    Main causes of this imbalance include pregnancy, abortions, contraceptives and IUDs, sexual intercourse, sanitary products and hygienic standards and products. 

  • Posted

    The different types of Bacterial Vaginitis .... Useful info ...

    The following is a list of the most common, and a few less common types of vaginitis.

    Bacterial Vaginosis

    This is the most common type of vaginitis in the US with nearly 30 percent of all women experiencing it at some time in their life.

    It used to be known as non-specific vaginosis, gardnerella vaginitis, hemophilus vaginitis and corynebacterium vaginitis.

    It used to be thought that bacterial vaginosis was caused by one type of bacteria, but now it is thought to be the result of different ones which produce similar symptoms.

    According to the National Vaginitis Association, bacterial vaginosis is associated with potentially more serious infections including genital tract infection and sexually transmitted diseases such as HIV. This is because bacterial vaginosis lowers the body’s immune system. However it is not considered an STD. It may also contribute towards pregnancy complications (miscarriage, low birth weight and premature ruptures) and for this reason the Centers for Disease Control and Prevention (CDC) recommends all pregnant women be tested for the condition. It has also been linked to pelvic inflammatory disease (PID).

     

    Symptoms

    1. Grayish, white/yellow discharge or it may be thin and watery.

    2. Discharge has a strong fish odor and is more noticeable after intercourse or washing with soap.

    3. Any usual discharge should be checked to rule out gonorrhea or chlamydia infections.

    4. There may or may not be vaginal itching or irritation.

    5. Cramps and stomach pain.

    See also vaginitis causes and a guide to vaginitis prevention tips.

    Yeast Infections

    A yeast infection is the second most common type of vaginitis and are caused by yeast-like fungi called Candida albicans or Monilia.

    Both Candida and Monilial fungi occur naturally in the vagina.

    When something upsets the delicate balance of the vaginal ecosystem, they can multiple and cause a yeast infection.

    Anything from overuse of antibiotics to hormone changes and lowered immune system can trigger this situation. See also causes of yeast infections.

    The Classic Symptoms

    1. Vaginal discharge which is usually white, sticky and clumpy. It can smell sweet or bread-like.

    2. Itchiness & burning, both internal and external of the vulva (called vulvitis). This can occur without the presence of a discharge. 

    3. Red and sore looking skin around the vulva. Cracks may appear in the skin if the infection is not treated and the vulva can be covered in the discharge.

    Other Symptoms

    • Abdominal pain, diarrhea and bloating

    • Depression

    • Feeling tired or drained

    • Severe premenstrual syndrome (PMS) symptoms

    • Irritability

    • Heartburn

    • Skin rashes

    • Bad breath

    • Puffy eyes

    • Constant bladder infections

    • Rectal itching

    • Sleeping difficulties

    Trichomoniasis

    Trichomoniasis (or trichomonas) is the third most common type of vaginitis and is caused by a one-celled parasite called trichomonas vaginalis. This is transmitted sexually which makes it an STD. There are an estimated 7.4 million cases a year and statically women are far more likely to infect men. Usually trichomonas can be harmless, but symptoms can be uncomfortable. It only causes a problem when a woman is pregnant as it raises the risks of pregnancy complications. Symptoms usually occur between 5 and 28 days after infection. However according to the CDC, 85 percent of women are asymptomatic (experience no symptoms).

    Symptoms

    Women

    1. Gray/greenish discharge which may be frothy.

    2. Discharge can have a fishy smell.

    3. There may be itching and irritation.

    4. Soreness or burning when passing urine (dysuria).

    5. Sexual intercourse may be painful.

    6. Lower abdominal pain, but this is unusual.

    Note: It is possible to have no symptoms and still pass on the infection.

    Men

    Most men do not experience any symptoms, although some may experience: 

    1. Temporary irritation inside the penis.

    2. Slight burning after ejaculation or urination.

    Prevalence Statistics

    According to the CDC, trichomonas affects: 

    • About 3 percent of the female population in America.

    • Typically it significantly affects more black women than white or Mexican.

    Vaginitis Diagnosis: Important step to attaining correct treatment.

    Cytolytic Vaginosis

    The organism that causes this type of vaginitis has not been identified.

    Although it is suspected that cytolytic vaginosis may result from the overgrowth of lactobacilli.

    Doctors are not sure what causes this event to happen.

    Sometimes a woman has been treated for a chronic vaginal discharge with various medications including anti-fungal and antibiotics.

    These treatments can lead to an imbalance in the normal vaginal bacteria and lead to an overgrowth of lactobacillus.

    Symptoms

    1. Vaginal and/or vulva itching and redness.

    2. Vaginal discharge which can be either thick and clotty, or thin and watery.

    3. Mild discomfort with urination or intercourse.

    4. Symptoms become more prominent in the latter half of the menstrual cycle.

    Atrophic Vaginitis.... ( Dryness ) Ovestin Estriol the kinder estrogen is a good treatment ... 

    Atrophic vaginitis is an inflammation of the vagina caused by a thinning of the vaginal wall and decreased lubrication.

    It is closely linked to decline of estrogen in postmenopause women. For this reason it is also known as senile vaginitis.

    However younger women may experience this condition too if they take medications designed to lower estrogen levels (for conditions such as uterine fibroids, infertility, endometriosis and breast cancer).

    Estrogen levels can also be affected by stress, depression, and severe exercise. It may also occur in women who have had their ovaries removed. The vagina can also be irritated and dried by soaps, douching, fabrics softeners and perfumes sprayed in the area.

    Symptoms

    1. Burning on urination.

    2. Vaginal soreness, itching and burning.

    3. Slight vaginal discharge.

    4. Light bleeding after intercourse.

    5. Painful intercourse that can put you off the experience.

    Other Types

    On the rare occasion vaginitis can result from a Shigella bacteria infection, although typically symptoms are more likely to be diarrhea, fever and stomach cramps. Those who travel to poorer countries may acquire an amoebic vaginal infection. Symptoms include a bloody mucus discharge and inflammation of the vagina. Occasionally vaginitis can occur from the overgrowth of the bacteria streptococcus which occurs naturally in the vagina. It may also occur from an overgrowth of E.coli which occurs more commonly in the digestive tract.

      

  • Posted

    Hope you found some relief since your post months ago.

    A few days ago I learned of the term cytolytic vaginosis after months of OBSESSIVE GOOGLING to find SOMETHING that makes sense.... and it was the first thing that made sense as I probably could have written the post you wrote myself.

    I have never been one to have yeast issues, maybe a handful of times in my life. A little Monastat use and gone..until this...

    My symptoms started when I had a very bad bout of diarrhea in January and I haven't been the same since. The baking soda douche I learned of a couple of days back provided relief, but I just had a skin biopsy in that area to see if it is dermatis related, so I am a little leery of using it again...until those STITCHES are out. Not sure if using the baking soda would set me off with those stitches down there. I douched with that the night before a dermatologist  appointment for the first time.... so I figured if THAT baking soda flared me up, I already had the appointment with the dermatologist (4th doctor I've seen for this crap) and it would be taken care of.

    Anyway, I took all those drugs, anti yeast things, anti fungal things, cortisone creams, gels, etc..etc.. both RX and OTC. I even bathed in vinegar and tried jock itch cream to no avail before finding out about the baking soda douche.

    Monastat 1 was the first thing I used when this started up and I might as well have used BATTERY ACID as I never had such a reaction to any Monastat product before. Of course, when this did not work...off to the series of doctors....SINCE JANUARY.  My primary care one (2 times), a gyno he referred me to (2 times). He looked at the possibility of LC (don't care to spell the word) and it was not that, thank Almighty God.

    The urgent care doc treated me for scabies after looking at me for about 60 seconds and learned I was a health care worker.

    I simply could not stand the itch so I went there. Of course, I was berated by my doctor for going there. I think I was more upset with that than the incorrect diagnoses of scabies...to tell you the truth.

    I've had so much medicine, creams, ointments...ridiculous

    Buttock and upper leg itch has been an issue, too. Never had that before this....ever.

    No doc will listen to me concerning the diarrhea bout that I AM TOTALLY CONVINCED that kicked this off. I am pretty convinced it is lactobacillus out of control introduced by that horrid acidic diarrhea in January that probably got all over my private areas. Sorry if TMI, but maybe this can be of help to somebody else.

    However getting some of these left brained "by the book" doctors has been frustrating. Frustrating isn't the word. Maddening is more like it. If someone offers me an antidepressant as a band-aid for this, I will walk right out. I have heard women being presented with that, too and that's just over the top and negligent and shows nothing but a doctor who doesn't want to deal with your problem in line with the Hippocratic Oath.

    Hoping the dermatologist will find some skin irritation, treat it, and I can dump this nightmare out of my memory banks forever.

     

    • Posted

      hi 

      so sorry your suffering like this .. sounds awful..

      i am fine now, i had the treatment the Gyno gave me, it was the. repeated 4 weeks later and all is fine ..

      i am age 51 and also post menopause .. so that didnt help ..

      but all okay..

      hope you get some relief .. big hugs 

      jay x

    • Posted

      I swear MINE started with a bout of diarrhea, too! I told the doctor that I think some poop must have gotten in the wrong hole and caused my problem. Please let us know what you found out!

       I have similar symptoms and am googling like crazy. I've had it for 3 months now and been to my GYN twice, a urologist plus my PCP twice and had a vaginal ultrasound. Nothing shows up but I've got burning, stinging and pressure down there.  Any help would be appreciated! 

  • Posted

    Thanks, Jayneejay

    Yeah, this has been pure hell, plus all the wasted time. You know no amount of money matters when trying to get rid of something.

    So what was the treatment and you say in 4 weeks time it was gone?

    Thank the Good Lord for that.

    FWIW, I'm post-menopausal, too. Got through it without even a hot flash.

    No one can tell me this is a menopausal problem as almost all of the posts I have read on other forums are from people as young as their 20s.

    • Posted

      hi

      i had a full well woman check at private Gyno i have them annually 

      i live in southern spain..

      the smear revealed CV and mild thrush 

      Gyno gave me 3 Clindamycin vaginal ovules for 3 nights followed by 3 Laurimic vaginal Ovules for 3 nights ..

      repeated 4 weeks later ..

      he also said i had vaginal dryness post meno he also did a Colposcopy and looked at cells vaginally and on cervix and he said very dry.

      this can cause urethra dryness and awful discomfort which it did.

      i don't and havent  taken HRT as too high risk, and also dont want it, wanted a natural peri and it over with, HRT only boosts the naturally declining hormones and then you have all the peri again when you stop taking it .. ( no way do i want this again) i am there done ..

      however ... for the dryness he suggested vaginal Ovestinon Estriol Ovules and Ovestinon Cream for outer bits .. its the weaker kinder estrogen and only treats the dryness, doesnt enter blood stream or go via liver ..

      been using for 11 months with great results ..

      speak soon, off to bed now its gone midnight here 

      jay x

       

  • Posted

    Whatever you did got cut off in your post.

    Was it the baking soda douche??

  • Posted

    Sounds like you had the thrush combined in there after reading.

    Well I don't have that and that's been confirmed. So if you had the combo and you're fine, there certainly is hope for me....but I had to comb the internet to find it.

    So glad you are better and thanks for the hugs. Hugs to you, too and continued good health.

    • Posted

      my CV on my results which we also get a copy off said 

      Doderlein's cytolysis.  (CV) 

      It is characterized by abundant growth of Lactobacilliresulting in lysis of vaginal epithelial cells; and therefore, it is called as cytolytic vaginosis.

      jay x

  • Posted

    Getting my issue resolved. Not quite the same as yours more in the dermatology department, but thanks for the conversation. All will be well. Already feeling better. 
    • Posted

      Hello,

      I was wondering what you were diagnosed with, and how they're treating it? I've been having similar symptoms for 6 months...extremely despetate at this point. Thank you!!

    • Posted

      Wondering how you are doing with your vaginal problem that you posted about 10 months ago? I have similar symptoms and am googling like crazy. I've had it for 3 months now and been to my GYN twice, a urologist plus my PCP twice and had a vaginal ultrasound. Nothing shows up but I've got burning, stinging and pressure down there. I think mine started after a bout of diarrhea on Labor Day, too, like 147742's did. I wish she'd respond so we can know if she ever got a diagnosis. Any help would be appreciated! 

    • Posted

      Wondering how you are doing with your vaginal problem that you posted about 10 months ago? I have similar symptoms and am googling like crazy. I've had it for 3 months now and been to my GYN twice, a urologist plus my PCP twice and had a vaginal ultrasound. Nothing shows up but I've got burning, stinging and pressure down there. I think mine started after a bout of diarrhea on Labor Day, too, like 147742's did. I wish she'd respond so we can know if she ever got a diagnosis. Any help would be appreciated! 

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