What is a vaginal discharge?
It is caused by vaginal secretions and its color can be:
Is a vaginal discharge abnormal?
- No, physiologic vaginal discharge may occur.
- These are then due to secretions by cells located on the vaginal wall and the cervix.
- The quantity and the nature of physiologic vaginal discharge can vary with:
- the menstrual cycle
- sexual activity
When is the discharge abnormal and what are the causes?
- Excess vaginal discharge, yellowish or greenish in color or with an unpleasant smell are considered not normal.
- They can be caused by infections:
- Fungi: vaginal thrush (Candida Albicans) for example
- Bacteria: Neisseria Gonorrhoea and Chlamydia Trachomatis for example
- Protozoa: Trichomonas Vaginalis for example
- Virus (Herpes Simples Virus) and genital warts (Human Papillomavirus) par exemple
- Sometimes, vaginal discharge can be due to non infectious causes:
- cervical polyps
- cancerous growths
- foreign bodies (tampons for example)
How do we find the cause of a vaginal discharge?
- History, physical examination and appropriate laboratory tests will enable your doctor to identify the cause.
A) What is vaginal thrush?
- It is caused by an infection by the yeast Candida Albicans
- The yeast is present on normal skin and in the vagina, but under some circumstances (diabetes, pregnancy, steroid treatment, oral contraceptives, antibiotics), it multiplies rapidly to lead to a vaginal discharge.
- Usually, vaginal thrush is not sexually transmitted. However sexual partners of infected individuals can develop the infection on the penis.
- How is vaginal thrush treated?
- Pessaries are inserted into the vagina and this is what is most frequently done (clotromazole, miconazole).
- Oral antifungals (ketoconazole, itraconazole, fluconazole…) can be prescribed in more severe and recurrent infections.
- The underlying causes (diabetes, antibiotics…) must be controlled or stopped.
B) What is gonorrhea?
- In ladies, gonorrhea can present with a greenish or yellowish discharge (see “gonorrhea”).
- Dysuria may also be present (pain and burning sensation when urinating).
C) What is chalamydial cervicitis?
- It is a sexually transmitted infection caused by the bacteria chlamydia trachomatis.
- What are the symptoms of chlamydial cervicitis?
- It can present as vaginal discharge occurring 1 to 3 weeks after sexual intercourse with an infected individual.
- It can be accompanied by dysuria (pain when urinating).
- However, most women with chlamydial infection no not have any signs nor symptoms.
- The infection must be differentiated from other causes of vaginal discharge, especially gonorrhoea and trichominiasis.
- Chronic chlamydial infections may extend to the surrounding organs in the pelvis (Fallopian tubes and ovaries) which leads to:
- ectopic pregnancy
- Infected can contaminate the newborn which can lead to blindness (ophthalmia neonatorum) and pneumonia.
- How is chlamydial cervicitis diagnosed?
- The bacteria is detected by culture of secretions from the cervix (or other sites if relevant).
- Direct antigenic testing and amplification of nucleic acids (PCR: polymerase chain reaction) are also available.
- Blood testing is not useful for diagnosis of this condition.
- How is chlamydia cervicitis treated?
- Oral antibiotics (tetracycline, erythromycin and azithromycin) is the treatment of choice.
- Injections and insertion of pessaries into the vagina are not useful.
D) What is trichomoniasis?
- It is due to an infection by a protozoa called Trichomonas Vaginalis.
- What are the symptoms of trichomoniasis?
- The most common clinical presentation is profuse vaginal discharge which is greenish and foul smelling.
- It can be accompanied with itching and irritation of the vulva and vagina.
- This is to be differentiated from gonorrhea and chlamydial infections.
- How is trichomoniasis diagnosed?
- The protozoa can be identified with microscopic examination of the secretions of the vagina or the cervix.
- Culturing the secretions enables diagnosis confirmation.
- How is trichomoniasis treated?
- It is treated by oral metronidazole (antibiotic) for a week.
- Sexual partners must also be treated to avoid reinfection.
E) What is bacterial vaginosis?
- It is a frequent bacterial infection in women. It is accompanied with:
- vaginal discharge
- burning sensation
- It is caused by an imbalance in the normal bacterial flora.
- Women with a new sexual partner or who have had multiple sex partners carry a greater risk of developing the infection. Women who haven’t had sex are rarely affected.
- How is bacterial vaginosis diagnosed?
- By looking for clinical signs (vaginal discharge, secretion odour)
- Laboratory tests done on a sample of vaginal fluid
- How is bacterial vaginosis treated?
- It is treated by taking oral antibiotics. Two drugs are recommended – metronidazole or clindamycin.
What to do if I think my vaginal discharge is abnormal?
- Consult a medical doctor (gynecologist) as soon as possible.
- Refrain from sexual intercourse.
- Do not self-medicate.
- Inform your doctor of any drug allergy.
- Complete the treatment prescribed by your doctor.
- Ask your sexual partner (partners) to also see a medical doctor.
Source of information: here