The World of Pregnancy

Vaginal Discharge: Causes, Evaluation & Treatment

A vaginal discharge is a common symptom and can be physiological or pathological. 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.

Leucorrhea – A Result of a Good Estrogen Discharge

A thick white discharge is generally considered a normal discharge. Most of the times is harmless and varies depending on the menstrual period.

Before ovulation, it`s possible to notice an increase in vaginal discharges caused by a good secretion of estrogen, which is at high levels during period. These discharges don`t have an unpleasant odor, they aren`t accompanied by blood, itching or redness of the vulva, and the amount in which they appear vary from one woman to another. It`s quite possible for you to be a part of the category of women with strong vaginal discharges, and so to feel embarrassed because of the permanent sensations of moisture or stains that may appear on your clothes. Although it offers you a sensation of discomfort, as long as it won`t change its color or odor, you have nothing to worry about. Also, if you are pregnant, it`s possible for you to experience abundant vaginal discharges, and a more special case will represent the cervical ectropion which consists of an eversion of the cervical mucosa.

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.

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.

Causes for Vaginal Discharges

Noninfectious Causes

  • Physiological;
  • Cervical polyps & ectopia;
  • Foreign remaining (e.g. tampons);
  • Vulvar dermatitis;
  • Erosive lichen planus;
  • Genital malignancies (e.g. cervical cancer, uterine cancer or ovarian cancer).

Infectious Causes non- STD

  • Bacterial vaginosis: it`s an infection that isn`t sexually transmitted; it`s the most common cause for sexually active women;
  • Candidiasis: caused by candida albicans.

Sexually Transmitted Diseases (STDs)

  • Chlamydia trachomatis;
  • Neisseria gonorrhoeae (gonococcus);
  • Trichomonas vaginalis: especially at young women, often found in association with Neisseria gonorrhoeae.

Physiological Vaginal Discharge

  • Newborns can show insignificant vaginal discharge, sometimes mixed with streaks of blood due to a high concentration of maternal estrogen hormones. This will disappear until 2 weeks.
  • During the reproductive period, the fluctuations of the levels of estrogen and progesterone during the menstrual cycle affect the quality and quantity of cervical mucus, which is noticed by the woman as a change in the appearance of the discharge. Initially, when the level of estrogen is low, the mucus is thick and sticky. After ovulation, these changes in the mucus`s appearance become more pregnant.
  • At menopause, the normal amount of discharge decreases with the levels of estrogen.

The 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
  • 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.

Vaginal Discharge from Infectious Causes (non-STD)

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.

Candidiasis

It`s a sticky white and harmless vaginal discharge. It`s associated with itching and indisposition, especially at women with one or more risk factors (pregnancy, diabetes, recent treatment with antibiotics or immunosuppressant).

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.

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.

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.

Treatment

  • In some cases, not even repeated tests cannot reveal the causes of these discharges. In this case physiological causes or personal hygiene habits (avoiding vaginal showers, scented items or synthetic linen) could be taken into account.
  • Postmenopausal atrophic changes could predispose women to recurrent episodes of vaginitis which respond well at cream hormonal treatments.

When Do You Need to Contact your Doctor?

If we are talking about an abundant, transparent discharge, it will be almost impossible to make the difference between mucus and amniotic liquid. Therefore, it`s best to talk to a doctor when you fail to realize what it is about.

Also, get in touch to your doctor immediately if you didn`t yet reached 37 weeks of pregnancy and notice an increase in the amount of vaginal discharges or even a change in its consistency (if it becomes watery, similar to mucus or accompanied by blood – even if it`s only a bit bloody), because all these symptoms can signal the beginning of premature labor.

If you also suspect you have an infection, you still need to contact your doctor. Therefore, if you experience a whitish discharge without odor accompanied by burning or itching, or if your vulva looks a bit inflamed, it`s possible to have an infection.

On the other hand, yellowish-greenish-grey discharges with bad odor may appear due to a general or vaginal infection caused by a STD. If this happens, you may also experience itching, burning or irritation.

In any way, don`t try to treat yourself with drugs without prescription that you took from the pharmacy on your own. It`s important first to visit your gynecologist to establish a diagnosis and only then to start a treatment.

Is There Anything I Can Do with these Discharges?

No, there isn`t anything you can do to prevent these discharges from happening. But if you want to maintain the health of your genital area, it`s important to take care of yourself, keep that area clean and wear cotton underwear. Try to avoid tight or synthetic clothing, perfumed toilet paper, and soaps or sprays for personal hygiene.

Also, don`t do any vaginal washes because this way you may upset the normal vaginal flora and increase the risk of vaginal infections. Also, lots of doctors may forbidden pregnant women to do any vaginal washes because during pregnancy this way, although in rare cases, it may be air introduced in the circulatory system through the vagina, which may lead to serious complications.

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