Vaginal Discharge

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Vaginal Discharge

It is important to address because untreated discharge can lead to discomfort or vaginal irritation, it can affect one’s self image, personal relationships, and when severe, cause missed days of school and work. 

The vagina is self-cleaning and does not require internal soap, feminine washes, cleanses, steaming or a special diet. Like the rest of the body, the vagina has a normal microbiome made up of many different bacteria living in balance. A byproduct of this normal microbiome is a physiologic discharge that helps keep the vagina lubricated, clean and healthy. This discharge is typically clear or white and slightly creamy. Because of a temporary change in the microbiome following menses, this discharge can change just after a period but should resort back to baseline within a few days. Conditions such as yeast infections, bacterial vaginosis, trichomonas, gonorrhea, and chlamydia can cause abnormal vaginal discharge. 

Yeast infections, or vulvovaginal candidiasis, can cause thick, white discharge that appears similar to cottage cheese. It is often accompanied by vaginal itching or burning, redness or swelling on the vulva and pain with urination. Candidiasis is more common in women who have immunosuppression, diabetes, obesity, who are pregnant or who were recently on antibiotics. Girls who have not yet reached puberty and women who have reached menopause are less likely to have candidiasis. There are many over the counter medications that are likely to successfully treat uncomplicated candida however self-diagnosis is not recommended. Evaluation by a health care provider is recommended to ensure correct diagnosis and treatment, especially if an over the counter medication has failed to cure symptoms. 

Bacterial vaginosis, BV, is the most common cause of abnormal vaginal discharge in reproductive age women. It is not an infection but an overgrowth of certain types of bacteria causing an imbalance in the vaginal microbiome. This results in a thin, watery, white or gray discharge often accompanied by a fishy odor. The discharge is often increased after menses or intercourse but causes no vaginal irritation. Risk factors for BV include multiple or new sexual partners, oral sex, douching, cigarette use, and intercourse during menses. While BV is not a sexually transmitted infection, it is rare in women who are not sexually active. 80-90% of patients are cured within 1 week of being treated with antibiotics however up to 30% of women will have a recurrence within 3 months. 

Trichomoniasis is a very common nonbacterial sexually transmitted infection in the United States.  Up to half of infected patients are asymptomatic and infections can last years without signs. Those with symptoms typically have a frothy green or yellow, foul smelling discharge. Patient may also notice pain or spotting with intercourse, and/or pain with urination. Trichomonas can be treated with metronidazole or tinidazole and alcohol should be avoided until 24 and 72 hours after the last dose respectively. 

Chlamydia is the most common sexually transmitted infection in the United States. The biggest risk factor for infection is being under 25 years of age. Unfortunately, many patients are asymptomatic and the infection goes undiagnosed. If symptoms are present, they frequently include a mucopurulent or pus-like discharge or pain with urination. Chlamydia is frequently treated successfully with Azithromycin. 

Gonorrhea is a sexually transmitted infection (STI) with symptoms ranging from no symptoms at all to profuse yellow/white discharge. This discharge typically has no odor, is not irritating but can cause spotting between periods or after intercourse. Like other STIs, risk factors include age younger than 25, history of other STIs, new or multiple partners, and unprotected intercourse. Gonorrhea can be treated with Ceftriaxone and Azithromycin but like other STIs, all partners need to be treated and asymptomatic before resuming intercourse.   However resistance to gonorrhea is rising and some strains now require IV antibiotics.

 

Normal vaginal discharge is usually small in volume, white or clear in color and not associated with itching, burning or an odor. If you are having a change in discharge accompanied by an odor, vaginal itching or burning, pain with intercourse, pain with urination or bleeding between periods or after intercourse please see your healthcare provider.



Author
Dr. Gottschalk Dr. Kathryn Gottschalk OBGYN

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