Vaginal Discharge

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

What is a vaginal discharge?

It is caused by vaginal secretions and its colour can be:

• transparent
• whitish
• yellowish
• greenish

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:

1. age
2. the menstrual cycle
3. sexual activity

When is the discharge abnormal and what are the causes?

• Excess vaginal discharge, yellowish or greenish in colour or with an unpleasant smell are considered not normal.
• They can be caused by infections:

1. Fungi: vaginal thrush (Candida Albicans) for example
2. Bacteria: Neisseria Gonorrhoea and Chlamydia Trachomatis for example
3. Protozoa: Trichomonas Vaginalis for example
4. Virus (Herpes Simples Virus) and genital warts (Human Papillomavirus) par exemple

• Sometimes, vaginal discharge can be due to non infectious causes:

1. cervical polyps
2. cancerous growths
3. 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?

1. Pessaries are inserted into the vagina and this is what is most frequently done (clotromazole, miconazole).
2. Oral antifungals (ketoconazole, itraconazole, fluconazole…) can be prescribed in more severe and recurrent infections.
3. The underlying causes (diabetes, antibiotics…) must be controlled or stopped.

B) What is gonorrhoea?

• In ladies, gonorrhoea can present with a greenish or yellowish discharge (see “gonorrhoea”).
• Dusuria 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?

1. It can present as vaginal discharge occurring 1 to 3 weeks after sexual intercourse with an infected individual.
2. It can be accompanied by dysuria (pain when urinating).
3. 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:

1. pain
2. ectopic pregnancy
3. infertility

• Infected can contaminate the newborn which can lead to blindness (ophthalmia neonatorum) and pneumonia.
• How is chlamydial cervicitis diagnosed?

1. The bacteria is detected by culture of secretions from the cervix (or other sites if relevant).
2. Direct antigenic testing and amplification of nucleic acids (PCR: polymerase chain reaction) are also available.
3. Blood testing is not useful for diagnosis of this condition.

• How is chlamydia cervicitis treated?

1. Oral antibiotics (tetracycline, érythromycin and azithromycin) is the treatment of choice.
2. 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?  

1. The most common clinical presentation is profuse vaginal discharge which is greenish and foul smelling.
2. It can be accompanied with itching and irritation of the vulva and vagina.
3. This is to be differentiated from gonorrhoea and chlamydial infections.

• How is trichomoniasis diagnosed?

1. The protozoa can be identified with microscopic examination of the secretions of the vagina or the cervix.
2. Culturing the secretions enables diagnosis confirmation.

• How is trichomoniasis treated?  

1. It is treated by oral metronidazole (antibiotic) for a week.
2. 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:

1. vaginal discharge
2. smell
3. pain
4. itching
5. 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?

1. By looking for clinical signs (vaginal discharge, secretion odour)
2. Laboratory tests done on a sample of vaginal fluid

• How is bacterial vaginosis treated?

1. 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 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.

Contributors

Dr Husain Ali Mahdi Juma  (دكتورحسين علي جمعه) – dermatologist. Manama, Bahrain

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore

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