The female genitourinary tract is colonized with yeasts, in particular Candida albicans. These fungi are normally balanced by bacterial flora. The use of antibiotics or changes in the local environment due to hormones or other physiological conditions can result in proliferation of yeasts. As a society, we encourage individuals to self-diagnose and self-treat by making available over-the-counter antifungal agents that are applied topically to the surface of mucosal membranes. Although individuals with such infections are advised to seek medical care and follow instructions carefully, compliance is a major problem.
In 2001, nearly 2% of yeast samples cultured from the vaginal tracts of women using over-the-counter products were drug resistant.194 Although this overall resistance prevalence seems low, the total number of women colonized with drug-resistant yeasts is high. Yeast infections are generally not life threatening, but during serious illness, these colonizing strains may become infecting strains that can cause life-threatening invasive fungal disease. If the strains are already resistant, antifungal therapy will do little good. Moreover, self-diagnosis fails to identify the initial cause of vaginitis; consequently, cases caused by bacteria will be treated with an ineffective agent.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.