Vaginal Discharge

A Woman with Vaginal Infection Consults with a Doctor

• Vaginal discharge is fluid that exits from the vaginal opening.
• Some vaginal discharge is normal when an infection is present there may be an increase in quantity or change in the appearance of vaginal discharge.
• Bacterial vaginosis, a condition of unbalanced overgrowth of normal vaginal bacteria, is another common cause of the abnormal vaginal discharge.
• Causes of vaginal discharge include STDs such as trichomoniasis, gonorrhea, and chlamydia as well as yeast infections.
• Vaginal discharge can be associated with other symptoms such as burning or itching.
• Antibiotics are given for infections that cause vaginal discharge. The choice of antibiotic depends upon the specific infection.
• Many causes of vaginal discharge can recur after successful treatment.

Vaginal discharge is a fluid or semisolid substance that flows out of the vaginal opening. Most women have vaginal discharge to some extent, and a small amount of vaginal discharge is a reflection of the body's normal cleansing process. The amount and type of vaginal discharge also vary among women and with the woman's menstrual cycle.

A change in vaginal discharge (such as an abnormal odor or color or increase in amount), or the presence of vaginal discharge associated with irritation or other uncomfortable symptoms, can signal that an infection is present.

Vaginal discharge may range in color from clear to gray, yellow, greenish, or milky-white and may have an unpleasant smell. The symptoms and character of vaginal discharge depend upon the specific condition that is the cause of the discharge.

• Bacterial vaginosis: Not all women with bacterial vaginosis will have symptoms, but bacterial vaginosis typically produces a discharge that is thin and grayish-white in color. It is usually accompanied by a foul, fishy smell.
• Trichomonas: Trichomonas infection produces a frothy, yellow-green vaginal discharge with a strong odor. Associated symptoms can include discomfort during intercourse and urination, as well as irritation and itching of the female genital area.
• Gonorrhea: Gonorrhea may not produce symptoms in up to half of infected women, but it can also cause burning with urination or frequent urination, a yellowish vaginal discharge, redness and swelling of the genitals, and a burning or itching of the vaginal area.
• Chlamydia: Like gonorrhea, Chlamydia infection may not produce symptoms in many women. Others may experience increased vaginal discharge as well as the symptoms of a urinary tract infection if the urethra is involved.
• Vaginal yeast infection: A vaginal yeast infection is usually associated with a thick, white vaginal discharge that may have the texture of cottage cheese. The discharge is generally odorless. Other symptoms can include burning, soreness, and pain during urination or sexual intercourse.

The vaginal walls and uterine cervix contain glands that produce a small amount of fluid that helps to keep the vagina clean. This normal vaginal discharge is typically clear or milky white in color and does not have an unpleasant odor.

A number of different infections can cause a change in the amount, consistency, color, or odor of vaginal discharge. These include:

• Bacterial vaginosis is a condition is caused by an imbalance in the growth of the bacteria that are normally present in the vagina. It is not known exactly why this imbalance in bacterial growth occurs. This condition was formerly known as Gardnerella vaginitis after one type of bacteria that commonly causes the condition.
• Trichomoniasis (trich) is an infection by a single-celled parasite known as Trichomonas vaginalis. The infection is transmitted by sexual contact.
• Gonorrhea is a sexually transmitted disease (STD) resulting from infection by the bacteria known as Neisseria gonorrhoeae.
• Chlamydia is another sexually transmitted infection (STD) due to the bacteria Chlamydia trachomatis. Although infected women may not have symptoms, a vaginal discharge may occur.
• Yeast infection (candidiasis) occurs when there is an overgrowth of yeast in the vagina, often due to antibiotic use or other factors that affect the natural balance of bacteria in the vaginal area. Candida species are the type of yeast most commonly responsible.

While trichomoniasis, gonorrhea, and chlamydia are examples of sexually transmitted diseases (STDs), bacterial vaginosis and yeast infection are not considered to be STDs.

Vaginal bleeding is different from vaginal discharge. The infections listed above are causes of abnormal vaginal discharge without the presence of significant vaginal bleeding.

It is appropriate to seek medical care any time you have a change in the character (color, odor, consistency) or amount of vaginal discharge or if you have other symptoms such as pain, burning, or itching of the vaginal area.

After reviewing your symptoms and medical history, the healthcare professional will likely perform a pelvic examination, which includes an examination of the external genital area and the insertion of a speculum to examine the vaginal walls and cervix.

Depending upon the examination, the healthcare professional may take swabs of the vaginal discharge for culture or for examination under a microscope to help define the cause of the vaginal discharge.

Yeast infections may be treated using over-the-counter medications, but other causes of vaginal discharge require prescription medications. It is critical to take the entire course of medication as prescribed or recommended by your doctor, even if the symptoms improve. If you are uncertain as to the cause of your vaginal discharge, it is important to visit a healthcare professional to determine the cause rather than starting OTC medications if you are unsure.

Some alternative medical approaches recommend douching for the treatment of some causes of vaginal discharge. However, douching is not recommended by most physicians. The body has a natural way of cleansing the vaginal canal by itself, and douching can disturb the normal environment of the vagina, potentially leading to inflammation and even worsening of the symptoms. The American College of Obstetricians and Gynecologists and most doctors recommend that women avoid douching unless specifically prescribed by a doctor.

The choice of medication depends upon the type of infection. Antibiotics and antifungal medications are the mainstay of treatment, administered either in topical, injection, or oral form, depending upon the particular infection.

Oral, injectable, and topical (applied as tablets or cream into the vaginal area) medications are used to treat the various causes of vaginal discharge.

• Bacterial vaginosis may be effectively treated by a number of medications, including metronidazole (Flagyl), tinidazole (Tindamax), and clindamycin cream (Cleocin). These medications are also effective in the treatment of trichomonas infections.
• Trichomonas is treated either with metronidazole (Flagyl) or tinidazole (Tindamax), given by mouth in a single dose. It is important for sex partners to be treated at the same time to avoid re-infection.
• Gonorrhea used to be treated with penicillin in the past. However, new strains of gonorrhea have become resistant to various antibiotics, including penicillins, and are therefore more difficult to treat. Gonorrhea may be treated by an injection of ceftriaxone (Rocephin) intramuscularly or by oral cefixime (Suprax). Other antibiotics may also be used.
• Chlamydia is typically treated by oral azithromycin (Zithromax, Zmax) or doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others).
• Vaginal yeast infections can be treated by topical creams such as butoconazole (Gynazole 1), clotrimazole (Lotrimin), miconazole (Monistat 3, Monistat 5, Monistat 7, M-Zole Dual Pack, Micon 7), and terconazole (Terazol 3, Terazol 7). Nystatin (Mycostatin, bio-Statin, Nilstat) is also available in vaginal tablet form. Oral medications such as fluconazole (Diflucan) can also be used if necessary.

It is important to take the full course of antibiotic or antifungal medication as prescribed, even if the symptoms have gone away. Should symptoms recur or persist despite treatment, contact your health care practitioner.

Antibiotic and antifungal medications are effective in eradicating the major infectious causes of vaginal discharge. Both gonorrhea and Chlamydia, when untreated, may progress to more severe infections involving the internal genital organs such as pelvic inflammatory disease (PID). PID can cause damage to the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences.

With sexually transmitted infections such as gonorrhea, chlamydia, and trichomoniasis, it is important for the sex partners of the infected woman to be examined and treated to prevent the further spread of the infection.

A woman in a monogamous relationship may become re-infected if her partner is also not treated.

Safe sex practices such as condom use can help prevent the spread of sexually transmitted infections.

It is not possible to completely prevent vaginal yeast infections and bacterial vaginosis because the conditions arise due to an imbalance in the bacteria and organisms normally present in the vagina and their cause is not completely understood.

Vaginal discharge can be treated by primary care physicians such as family practitioners or pediatricians as well as internal medicine doctors and gynecologists.