The World of Pregnancy

Vaginal Discharge: Causes, Evaluation & Treatment

A vaginal discharge is a common sign and can either have physiological or pathological causes. Vaginal discharge isn`t determined by sexually transmitted diseases and doesn`t require any treatment, but some STDs can have this symptom.

Vaginal Discharge

Vaginal discharges are most of the times part of the normal physiological processes. However, a series of factors and diseases present in the organism can lead to changes in their consistency and aspect, and in these cases is required the intervention of the doctor.

Normal discharges, also known as leucorrhea, are noticed by most women and represent normal manifestations of the body, but can also indicate infections with certain diseases. Typically, a woman experiences thick white discharges that come from the vaginal area or cervix, and consist from cervical glera, vaginal cells and bacteria from the vagina, these being normal during periods of genital activity. Still, a lot of women are complaining of excess of leucorrhea that is accompanied by unpleasant aspects.

Because of this is important to make the difference between normal vaginal discharges and the ones that trigger a signal regarding your health.

Normal Vaginal Discharges vs. Abnormal Vaginal Discharges

A normal discharge usually has a milky consistency and a cloudy white color, and its characteristics are slightly changing depending on various physiological factors. This discharge has the role of cleaning the vagina and to maintain its pH at normal rates.

Besides the menstrual period`s phases, when a normal discharge will change its aspect and flow depending on them (during ovulation vaginal discharges produced are more abundant than in other periods because the vagina is changing its level of acidity), there are other factors that can influence the changes of vaginal discharges, such as breastfeeding and pregnancy, hormonal treatments, sexual arousal, stress, diet, diabetes, hygiene products and various medications.

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An abnormal vaginal discharge is usually more liquefied than leucorrhea or has a more viscous consistency. The changes occur in the color of the discharge which can be grey-whitish or white-greenish. If the vaginal discharge meets these characteristics, there are high chances that an infection or a pathological cause can be behind this kind of discharge.

An abnormal discharge is accompanied by other symptoms specific the diseases that generate the changes of the discharge, such as pruritus (itching), sensations of burning when urinating, vaginal bleeding between periods.

Vaginal Discharge from Infectious Causes

Bacterial Vaginosis

It`s caused by an infection with anaerobic bacteria. It can be asymptomatic at 50% of all women. It can cause dyspareunia and can be associated with nulliparity, endometriosis, miscarriages and pelvic inflammatory disease.

Treatment

  • Asymptomatic Bacterial Vaginosis at women who aren`t pregnant don`t require treatment.
  • Normal treatment: Metronidazole oral route 400-500 for 5 to 7 days.
  • Alternative treatment: Metronidazole topical route 0.75% with nightly application 5 days or Clindamycin 300mg oral route for 7 days or cream topical application of 2% Clindamycin during the night, 7 days.
  • In case of recurrent infections: Metronidazole 300mg for 3 days when the menstrual cycle starts and ends. Also, talk to a specialist.
  • Women who breastfeed should avoid diets and alcohol during treatment with Metronidazole and up to 48 hours after finishing the treatment. Clindamycin can damage Latex condoms. Women who take birth control pills should talk to a doctor before beginning the treatment.

Vaginal Candidiasis

The statistics show that 3 out of 4 women develop this kind of disease sooner or later during a lifetime. Doctors recommend a strict hygiene and proper diet along with a correct treatment with medications.

Vaginal candidiasis is caused by a microscopic fungus known as Candida albicans. On the surface of the vaginal mucosa there`s a flora that`s permanently present, without causing a genital mycosis. This flora is formed from microorganisms with a protective role, but also from other ones which are potentially dangerous.

Microorganisms with a protective role, such as lactobacillus, actually control the evolution of the fungus from the Candida albicans group.

In certain conditions, the number of fungus increases significantly, and in this case these conditions occur: vaginal candidiasis.

Treatment

  • Asymptomatic vulvovaginal candidiasis doesn`t require treatment.
  • Vaginal preparations with Imidazole (e.g. clotrimazole, econazole, miconazole) sau fluconazole oral route 150 mg.
  • The role for alternative treatments (tea, yogurt that contains Lactobacillus) wasn`t determined.
  • Recurrent infections: the treatment presented above initially, then fluconazole: 100mg 1 tablet each week for 6 months or clotrimazole: 1 unique tablet of 500mg each week for 6 months or itraconazole oral route 400mg (divided in 2 per day), monthly for 6 month.
  • For pregnant women: local treatment topical route with imidazole. Diets should be avoided due to the potential teratogenic.

Candida albicans

Candida albicans is a fungus which belongs to the family of yeasts and it exists normally in small doses in the gastrointestinal tract where it co-exists with various other good or bad bacteria.

Issues appear when the balance between Candida and other good bacteria inclines in the favor of Candida (often due to treatments with antibiotics), creating the so-called over-growth Candida syndrome (Candidiasis). The most frequent manifestations are bloating, intestinal gas, diarrhea, fatigue, headache, depression, repeated vaginal infections.

Acute candidiasis affects the absorption of nutrients at the gastrointestinal level and can affect both the immune system and metabolism in a devastating manner. A lot of doctors offer various diagnoses and applies improper treatments when they should think about Candidiasis.

Candidiasis is a condition which regrettably a lot of people are neglecting it (sometimes even doctors), treating is as a minor issue. However, in reality the consequences can be devastating through the disruption of metabolism and destruction of the immune system. A lot, if not the main majority of conditions, can appear as a starting point from Candida.

Rarely there are people that don`t suffer from Candidiasis, more or less. Treating yourself of Candida is a step towards health recovery, a step towards preventing other diseases from which there may be no going back.

Vaginal Discharge from STD Causes

Vaginal discharges can be caused by chlamydia trachomatis, neisseria gonorrhoeae and trichomonas vaginalis, but these infections can be asymptomatic as well. They are also associated with an increased risk of HIV transmission.

  • Trichomonas Vaginalis – can lead to a thick yellow discharge accompanied by vulvar itching, abdominal pain, bad moods, dysuria and superficial dyspareunia. A lot of pregnant women are asymptomatic and may lead to premature birth.
  • Chlamydia Trachomatis – can cause a purulent thick discharge or it`s asymptomatic at 80% from all women; 10% to 40% from all untreated infections will lead to pelvic inflammatory disease.
  • Neisseria Gonorrhoeae – can appear as a purulent vaginal discharge or can be asymptomatic at 50% from all women; among symptoms: dysuria and bleeding between periods. Can lead to pelvic inflammatory disease.

Treatment

  • Chlamydia Trachomatis: doxycycline 100mg 2 times per day for 1 week; not indicated during pregnancy; azithromycin 1g single dose.
  • Gonorrhea: cefixime 400mg as a single dose / ceftriaxone 250mg intramusculary as a single dose.
  • Trichomonas Vaginalis: Metronidazole 2g as a single dose oral route or 400-500mg 2 times per day 5-7 days;
  • Patients must be investigated completely to detect other STDs.
  • Sexual partners should also be identified and treated.

Vaginal Discharges from Non-Infectious Causes

  • Retention of foreign bodies – may lead to a fetid vaginal discharge. The diagnosis is placed by examination.
  • Cervical polyps and ectopia – have a tendency of being asymptomatic, but may also lead to abundant vaginal discharge or bleeding between periods. The diagnosis is placed on examination with the speculum.
  • Genital tract tumors – they present themselves differently, but in some cases a persistent vaginal discharge that doesn`t respond to conventional treatment could be the first clue. The diagnosis is placed through biopsy.
  • Fistulas – The history of trauma or surgical interventions is suggestive. It may appear as a fetid discharge or fecal incontinence associated with recurrent urinary infections.
  • Allergic reactions – the diagnosis is placed based on the medical history – e.g. usage of irritant cosmetic substances, contact with latex, etc.

Treatment

  • Retention of foreign bodies – most of them can be removed manually, but sometimes they can be very little (fibrous materials, pieces of condom, etc) which aren`t visible and may need lavage (children might need sedation). When larger or sharper objects determine spasms in the vaginal walls, sedation or anesthesia may be needed. A short treatment with antibiotics should be made in case of older objects which may lead to a secondary infection.
  • Cervical polyps and ectopia – excision of the larger or suspect ones might be required.
  • Allergic reactions – the cause must be founded and removed.

Evaluation of Vaginal Discharge

A complete history should be effectuated (sexual history as well), data about the nature of the discharge (if there are changes in duration, color, odor, consistency), and also any associated symptoms (itching, superficial dyspareunia or dysuria, abdominal pain, deep dyspareunia, abnormal bleeding, fever).

Any concomitant medication (antibiotics, corticosteroids), prior treatments as well as other diseases (diabetes, immunocompromised status).

Symptoms

The signs that suggest an abnormal discharge are:

  • The ones that are in larger amounts than usual.
  • The ones that are sticker than usual.
  • Purulent vaginal discharge.
  • Greenish discharge, yellowish discharge or with bloody streaks.
  • Vaginal discharge with odor.
  • Vaginal discharge accompanied by bleeding. – Visit this web page!
  • Itching, burning, redness or worsen general condition.

Investigations

Women who show suggestive symptoms of bacterial vaginosis or vulvovaginal candidiasis can be treated without prior testing.

In all the other cases must be made a triple swap:

  • A high vaginal swab to detect bacterial vaginosis, yeast infection and Trichomonas vaginalis;
  • A endocervical swab to diagnose gonorrhea;
  • A endocervical swab for the test of DNA amplification, for the diagnosis of chlamydia trachomatis;
  • A vaginal pH test is fast and cheap and could differentiate bacterial vaginosis (pH of 4.5 or higher) from vulvovaginal candidiasis (pH less than 4.5).

Complications

A simple vaginal infection that is not treated could lead to its spread in the upper reproductive tract and could determine a more serious pathology, and even to infertility in the long term. The same thing can be said about the retention of foreign bodies that have the potential of developing the toxic shock. Cervical polyps are in general harmless, but could lead to infertility if they are too big. During pregnancy there may be complications associated with what was mentioned above.

Prediction

Bacterial vaginosis heals in 70% to 80% from all cases after treatment with medications, but often is periodical. Candidiasis has a healing rate of 80% to 95%, while trichomonas has a rate of 95%.

Preventing

  • Proper personal hygiene (washing without using vaginal cosmetic agents), avoiding synthetic underwear;
  • Sexual partners must be treated.

You Aren`t Sure You Have Candida?

You should only answer with YES or NO to these questions:

  1. Have you ever had vaginal infections characterized by: whitish cheesy vaginal discharge, with itching and burning in the genital area, or frequent urination?
  2. Have you ever taken antibiotics?
  3. Have you ever taken birth control pills?
  4. Have you ever used anti-asthmatic inhalants?
  5. Are you yearning after sweets?
  6. Are you yearning after bread? Do you eat bread every day?
  7. Do you feel the need to drink alcohol? Do you drink alcohol on a regular basis?
  8. Do you experience intestinal gas, bloating? Are you retching?
  9. Do you often feel tired or are you getting tired easily?
  10. Do you have whitish deposits on your tongue when you get up in the morning?
  11. Do you have depression characterized by not feeling like working?
  12. Do you often experience headaches?
  13. Do you experience allergies (itchy skin, itchy throat, allergic cough)?
  14. Do you experience vaginal itching?
  15. Do you often have vaginal infections?
  16. Do you experience itching in the anal area?

If your answer is YES for at least 3 of these questions, there are high chances for you to suffer from candidiasis. In this case, it`s recommended a treatment to control the increase of the disease.

Vaginal Discharges during Pregnancy

  • Vaginal discharge shows changes in quality and quantity in most women during pregnancy, most discharges being more abundant.
  • Bacterial Vaginosis it`s associated with late abortion, premature birth, premature rupture of membranes, postpartum endometritis and small weight at birth. Routine screening isn`t yet recommended for common usage in guidebooks but rather only for women who have a history of premature birth (less than 28 weeks from gestation) or miscarriage in the 2nd trimester of pregnancy.
  • Candidiasis is common during pregnancy (30% to 40%), often asymptomatic. It wasn`t proven that it affects the fetus.
  • Trichomonas Vaginalis can increase the risk of premature birth or low weight at birth.

Vaginal Discharge Related to Abortions, Miscarriages or Birth

These women should be completely investigated and treated empirically before even lab results offer a confirmation.

Bacterial vaginosis is associated with endometriosis and pelvic inflammatory disease after abortion, and the retention of the product of conception should be taken into consideration at all women, especially in the presence of a significant culture of coliforms.

Treatment for Recurrent Vaginal Discharge

This type of discharge has the same general indications as in the case of acute infections, with a few particular aspects:

  • It`s necessary for a detailed assessment of symptoms and a more rigorous examination to be performed to ensure that any pathology wasn`t missed (e.g. a STD in case of a patient treated for bacterial vaginosis).
  • Personal hygiene habits may contribute to the disruption of normal vaginal barrier (e.g. vaginal showers).
  • If the patient uses an intrauterine contraceptive device, a different contraceptive method should be taken into consideration.
  • Other risk factors should be taken into account: diabetes, immunosuppressive or antibiotics treatment – additional use of products based on acetic acid may be useful.
  • Phychological problems and depression should be taken into consideration, which may be associated with recurrent episodes of vaginal discharge.

When to Contact a Doctor?

When you consider you have an abnormal vaginal discharge, especially when there are also other symptoms that accompany your discharge, contact your family doctor or your gynecologist. If you are unsure, it`s best if you`ll control this symptom then letting your medical condition untreated. Sometimes, an abnormal discharge can also be the only sign of an infectious disease or a tumor.

In general, contact a doctor immediately if:

  • You have abnormal vaginal discharges and pain in the lower abdomen;
  • You have abnormal discharges and you had a sexual intercourse with a partner who has a STD;
  • You have abnormal discharges (which may reappear after treatment), you have a strong thirst, you urinate often, you are tired and you have lost a lot of weight – these may be signs of diabetes;
  • You have vesicles or little painful erosions or other injuries in the genital area;
  • A little girl who hasn`t reach puberty yet has abnormal vaginal discharges.

As mentioned above, you can either contact your family doctor or a gynecologist. Generally, vaginosis and candidiasis can be diagnosed and treated on clinical basis (through a discussion about your symptoms and a consultation.) Other affections require further investigation, which can be achieved only by a gynecologist.

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The doctor will ask you a lot of questions related to the appearance and evolution of your symptoms, local hygiene, sexual life and previous gynecologic consultations. You should mention if you take any medication or you have any allergies, as well as any methods you may have tried home to relieve your symptoms.

The clinical consult involves a pelvic examination which is realized on the gynecologic table. You may sense a small pain or have an unpleasant sensation, especially if you have an infection, when the speculum or valves are inserted. These are tools which are used to make a larger space between the vaginal walls and have a better view inside the vagina and cervix.

Diet & Lifestyle

To prevent and ameliorate abnormal vaginal discharges, keep in mind the following recommendations:

  • Maintain the genital area clean and dry;
  • Avoid soaps with a strong perfume, genital sprays or bubble baths because they can become irritating;
  • Avoid tight clothing and synthetic materials (use cotton underwear or underwear that has cotton in the genital area);
  • Don`t use intravaginal irrigators. This can modify the normal vaginal flora, which can lead to bacterial vaginosis or chlamydia. More than this, it can push the bacteria already present higher in the vagina causing more serious infections;
  • Consume yogurt with probiotic action (contains live bacterial cultures) or take probiotic medication when you are already taking birth control pills, especially if you have already experienced vaginal candidola in the past;
  • Maintain your blood sugar at normal values, if you have diabetes;
  • If you have a STD, inform your partner that he`ll need treatment and avoid sexual contact until your healing is confirmed. This way, you can avoid having your partner reactivating your infection, even though he may not show any signs;
  • Make the Pap test every 3 years or the Pap test plus the HPV test once every 5 years, if you are over 30 years old, so you can detect cervical cancer early.

Conclusion

  • Vaginal discharges are normal at every woman, especially in the fertile age. During pregnancy, the flow of these discharges is increased.
  • The characteristics of normal vaginal discharges change within a month and in some physiological situations. However, they remain of a transparent, white, yellowish color, with a thin texture, watery or thick, sticky, with a discrete odor and in small or medium amount.
  • There are big changes regarding normal discharges from one woman to another, reason for which you need to be aware what is normal for you.
  • Any significant deviation from the normal situation (in flow, color or odor) can be a symptom for a genital disorder. Generally speaking, they are accompanied by other local signs as well.
  • Vaginitis, candidiasis and other infections are the most common causes for abnormal discharges, but it rarely happens for a tumor to be involved.
  • Abnormal vaginal discharges require investigation and treatment offered by a gynecologist.
  • Candidiasis and vaginosis are diseases which may reappear at many women, so it can be useful to adapt your hygienic and eating habits to prevent new episodes.
Image courtesy of wikihow.com
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