Vaginal Discharge

Vaginal Discharge Overview

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 varies among women and with the woman's menstrual cycle. A change in vaginal discharge (such as an abnormal odor or color), or the presence of vaginal discharge associated with irritation or other uncomfortable symptoms, can signal that an infection is present.

Vaginal Discharge Causes

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 cause the infection.
  
• Trichomonas (trich, trichomoniasis) is infection by a single-celled parasite known as Trichomonas vaginalis. The infection is transmitted by sexual contact.
  
• Gonorrhea is the 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 Trichomonas, 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.

Vaginal Discharge Symptoms

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.

• 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 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 may be not produce symptoms in up to 50% 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.
  
• 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.
  
• 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.

When to Seek Medical Care

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.

Exams and Tests

After reviewing your symptoms and medical history, the health care practitioner will likely perform a pelvic examination, which includes examination of the external genital area and the insertion of a speculum to examine the vaginal walls and cervix.
Depending upon the examination, the health care practitioner may take swabs of the vaginal discharge for culture or for examination under a microscope to help define the cause of the vaginal discharge.

Vaginal Discharge Treatment

Treatment for vaginal discharge is dependent upon the exact cause. Treatment goals include both symptom relief and eradication of the infection.

Medical Treatment

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

Medications

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

• A number of medications may be effective in the treatment of bacterial vaginosis, 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.
  
  
• In the past, penicillin was the drug of choice for treatment of uncomplicated gonorrhea. 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.