Female Sexual Health
Six Causes of Vaginal Discharge
Learn about the different types of discharge
Edited By:Raja Sivamani , MD, MS, AP
Vaginal discharge is the presence of fluid leaking from the vagina, which can be connected to several infectious and non-infectious conditions. Here are six causes of vaginal discharge. If you have any of these symptoms you should seek advice from your physician:
1) Bacterial Vaginosis (BV)
This is the most common cause of abnormal vaginal discharge in women. It is not sexually transmitted. In BV, the normal healthy bacteria of the vagina are replaced with different types of bacteria. Currently, the reason why this occurs is not clear.
Symptoms can include a thin, watery discharge that often has a noticeable fishy smell. It does not usually cause itching or soreness of the internal or external vagina.
Treatment involves taking metronidazole (an antibiotic) orally for one week, or using an applicator to insert antibiotic cream into the vagina for five to seven days. If you are given metronidazole to take by mouth, alcohol should be avoided for the duration of treatment and for 24 hours after taking the last tablet. As BV is caused by an imbalance of bacteria in the vagina, studies have looked at whether probiotics could help restore this balance. Both oral and vaginal probiotics appear to be helpful in the treatment of BV.
This is often referred to as thrush or a yeast infection. It is the second most common cause of vaginal discharge after Bacterial Vaginosis (BV). Approximately 75% of women will have a yeast infection and up to 45% will have two or more episodes.
Symptoms can include a thick white discharge that is odor-free. A yeast infection can also cause itching, soreness, and pain during sexual intercourse or urination. Risk factors for the development of a yeast infection include: diabetes, antibiotic use, and having a weakened immune system due to medications or infections such as HIV.
Treatment can either be with antifungal creams (or antifungal pessaries which are inserted into the vagina) or with oral antifungal medications such as fluconazole. Vaginal probiotics with the bacteria L. fermentum LF10 and Lactobacillus acidophilus LA02) appear to be helpful, although more studies are needed.
3) Normal Discharge
Physiological discharge is normal discharge that women may experience. This is usually clear or white in color and is odor-free. Physiological discharge varies with a woman’s menstrual cycle.
Chlamydia infections are the most common sexually transmitted bacterial infection in the United States and are caused by the Chlamydia trachomatis bacterium. It is more common in men and women under the age of 25. Complications of untreated infections in women include pelvic inflammatory disease, infertility, and ectopic pregnancy.
In men and women, chlamydia infections usually don’t cause symptoms. If there are symptoms, these can include vaginal discharge, bleeding between periods, and pain during sexual intercourse.
Antibiotic treatment involves a single dose of azithromycin or 7 days of doxycycline. The Center for Disease Control and Prevention (CDC) advises that men and women who have been diagnosed with chlamydia infections should be retested 3 months after the start of treatment. Sexual partners should also be tested and treated. In many cases, the treatment will also cover gonorrhea discussed next.
Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae. More than 85% of women do not have any symptoms of infection. In women, as there are often no symptoms, an infection might not be diagnosed until complications such as pelvic inflammatory disease occur. This can lead to scarring of the fallopian tubes, which can cause infertility and ectopic pregnancy. Gonorrhea may also produce symptoms such as vaginal discharge, burning with urination, itching, and vaginal bleeding.
Neisseria gonorrhoeae is able to develop resistance to the antibiotics used to treat it. This means that it is able to avoid being killed when exposed to certain antibiotics. Therefore, treatment involves two different antibiotics (ceftriaxone and azithromycin). Sexual partners should also be referred for testing and treatment.
Trichomoniasis is a sexually transmitted infection. It is caused by the protozoan Trichomonas vaginalis. This can not only cause infection of the vagina but can also cause infection of the urethra (this is the tube through which urine leaves the body).
Symptoms can include a frothy and foul-smelling discharge. There may also be soreness, itching, or pain during urination and abdominal pain. Ten to fifty percent of women can have no symptoms of infection.
Treatment involves oral antibiotics such as metronidazole or tinidazole. Alcohol consumption should be avoided when taking both of these antibiotics. As this infection is sexually transmitted, the CDC advises that those who have been infected with Trichomonas vaginalis infection abstain from intercourse until they and their partners have been treated. There are high rates of re-infection with T. vaginalis in women; therefore, women are encouraged to be retested three months after treatment. Studies have shown that pregnant women who have a T. vaginalis infection have a higher chance of having an early (or preterm) delivery.
What to Expect When You See Your Doctor?
If you have vaginal discharge your physician will ask you questions such as:
- Description of the discharge: color, thickness, odor, changes during the menstrual cycle, and what makes it worse
- They will ask about itching, bleeding, abdominal pain, pain during urination, pain during sexual intercourse and fever
- They will ask you questions about your medical history and sexual history
- They will ask you about what medications you take and what contraception you use
- They will ask you about your last pap smear and any previous sexually transmitted infections
Your physician will also examine you:
- They will feel your abdomen to see if you have any pain.
- They will also perform an examination of the vulva and vagina to see if there are any signs of infection. They can insert a speculum, which is a device that is inserted into the vagina to allow the physician to see the cervix (the opening of the uterus) and the walls of the vagina. Samples such as swabs can be taken to help diagnose the cause of vaginal discharge.
- Your physician will also offer testing for other sexually transmitted infections.
What Can You Do to Prevent Sexually Transmitted Diseases (STDs)?
- Condoms: Latex condoms are an effective method to reduce the spread of sexually transmitted infections. Condoms should be used every time with vaginal, anal or oral sex. Condoms do not prevent all sexually transmitted infections, as some infections such as Herpes and HPV (Human papillomavirus) are spread by skin-to-skin contact.
- Vaccination: There are vaccines available that can protect you against Hepatitis B and HPV; these should be completed before you become sexually active.
- Testing: Prior to sexual contact, you and your partner should get tested for STDs.
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