1. Introduction
- Definition: Vaginal discharge refers to fluid secreted by the glands in the vagina and cervix, which serves to cleanse and protect the vaginal area. It is normal and varies in quantity, texture, and colour during the menstrual cycle. However, changes in discharge may indicate infections, hormonal imbalances, or other health issues.
- Epidemiology: A common concern among women of all ages, with abnormal discharge being a frequent reason for gynaecological consultations.
- Significance: While physiological discharge is harmless, abnormal discharge may signal infections (e.g., sexually transmitted infections [STIs]) or other gynaecological conditions requiring treatment.
2. Causes and Risk Factors
- Physiological Causes:
- Ovulation or luteal phase of the menstrual cycle.
- Pregnancy (increased vaginal secretions due to hormonal changes).
- Sexual arousal.
- Pathological Causes:
- Infectious:
- Bacterial vaginosis (BV): Thin, greyish-white, fishy-smelling discharge.
- Candidiasis (yeast infection): Thick, white, cottage-cheese-like discharge with itching.
- Trichomoniasis: Yellow-green, frothy discharge with odour.
- Sexually transmitted infections (e.g., chlamydia, gonorrhoea).
- Non-infectious:
- Allergic reactions (e.g., to soaps or sanitary products).
- Vaginal atrophy (postmenopausal women).
- Cervical polyps or cancers.
- Infectious:
- Risk Factors:
- Poor hygiene or excessive use of douches.
- Unprotected sexual activity or multiple partners.
- Hormonal fluctuations (e.g., pregnancy, contraceptive use).
- Diabetes or immunosuppression.
3. Pathophysiology
- Normal vaginal flora, primarily dominated by Lactobacillus species, maintains an acidic environment (pH ~3.5–4.5) to prevent overgrowth of pathogens. Disruptions in the vaginal microbiota or changes in the vaginal environment can lead to infections or inflammation, causing abnormal discharge.
4. Symptoms and Features
- Normal Discharge:
- Clear or milky white, odourless, and varies with hormonal changes.
- Abnormal Discharge:
- Changes in colour, texture, or smell.
- Associated symptoms: Itching, burning, swelling, pain during urination (dysuria), or pain during intercourse (dyspareunia).
- Specific Patterns:
- Greyish-white, fishy-smelling (BV).
- Thick, white, cottage-cheese-like (candidiasis).
- Yellow-green, frothy, malodorous (trichomoniasis).
5. Complications
- Untreated infections may lead to:
- Pelvic inflammatory disease (PID), infertility, or ectopic pregnancy.
- Chronic pain or recurrent infections.
- Adverse pregnancy outcomes (e.g., preterm labour, low birth weight).
6. Diagnosis
- Clinical Evaluation:
- Detailed history (onset, duration, associated symptoms, sexual history).
- Physical examination, including speculum and pelvic exams.
- Laboratory Tests:
- Vaginal pH testing (normal: 3.5–4.5; elevated in BV or trichomoniasis).
- Microscopy (wet mount, KOH test): Identifies yeast, bacteria, or protozoa.
- Nucleic acid amplification tests (NAAT): Detect STIs like chlamydia or gonorrhoea.
- Cultures for recurrent or unclear infections.
7. Management Overview
- Goals: Identify and treat the underlying cause, alleviate symptoms, and prevent recurrence or complications.
- Approach: Treatment tailored to the cause (infectious or non-infectious) and patient’s history.
8. Treatment Options with Cost (USD)
- Medications:
- Antifungals (e.g., fluconazole for candidiasis): ~$15–$30 per course.
- Antibiotics (e.g., metronidazole for BV or trichomoniasis): ~$10–$20 per course.
- Antimicrobials for STIs (e.g., azithromycin or ceftriaxone): ~$20–$50 per course.
- Adjunctive Care:
- Probiotics (to restore vaginal flora): ~$10–$30 per bottle.
9. Advanced Treatment Options with Cost (USD)
- Refractory or Recurrent Cases:
- Long-term antifungal therapy: ~$50–$100 per month.
- Laser or topical oestrogen therapy for vaginal atrophy: ~$500–$2,000.
- Surgical Intervention:
- Removal of cervical polyps: ~$1,000–$2,000.
10. Pharmacological Treatment
- Bacterial Vaginosis: Oral or vaginal metronidazole, or clindamycin.
- Candidiasis: Oral fluconazole or vaginal antifungal creams.
- Trichomoniasis: Oral metronidazole or tinidazole.
- STIs: Azithromycin (chlamydia) or ceftriaxone (gonorrhoea).
11. Medication Tables
Table 1: Doses and Side Effects
Drug | Indication | Dose | Common Side Effects |
---|---|---|---|
Metronidazole | BV, trichomoniasis | 500 mg twice daily for 7 days | Metallic taste, nausea |
Fluconazole | Vaginal candidiasis | 150 mg single dose | Headache, abdominal pain |
Clindamycin cream | Bacterial vaginosis | 5 g intravaginally for 7 days | Vaginal irritation, diarrhoea |
Azithromycin | Chlamydia | 1 g single dose orally | GI upset, rash |
Ceftriaxone | Gonorrhoea | 500 mg intramuscularly (single dose) | Injection site pain, rash |
Table 2: Brand Names and Approximate Costs (USD)
Drug | Brand Names | Approx. Cost |
---|---|---|
Metronidazole | Flagyl | $10–$20 per course |
Fluconazole | Diflucan | $15–$30 per course |
Clindamycin cream | Cleocin | $20–$40 per tube |
Azithromycin | Zithromax | $20–$50 per course |
Ceftriaxone | Rocephin | $25–$50 per dose |
12. Lifestyle Interventions
- Maintain good genital hygiene; avoid scented soaps or douches.
- Wear breathable, cotton underwear and avoid tight clothing.
- Use condoms to prevent STIs.
- Limit sugar intake to reduce the risk of yeast infections.
13. Monitoring Parameters
- Symptom improvement (reduced discharge, itching, or odour).
- Resolution of infection on follow-up testing (if indicated).
- Monitor for recurrence, particularly in patients with a history of recurrent infections.
14. Patient Counseling Points
- Explain the difference between normal and abnormal vaginal discharge.
- Educate on proper genital hygiene and safe sexual practices.
- Stress the importance of completing prescribed treatments, even if symptoms improve.
- Advise avoiding irritants like douches, scented products, or harsh soaps.
15. Special Populations
- In Pregnancy: Treat infections promptly to prevent complications; use pregnancy-safe medications (e.g., topical antifungals for candidiasis).
- In Postmenopausal Women: Vaginal atrophy may require oestrogen therapy.
- In Adolescents: Emphasise safe sexual practices and education about STIs.
16. Prevention
- Practise safe sex and use condoms to reduce the risk of STIs.
- Avoid douching or overuse of feminine hygiene products.
- Consume probiotics to maintain healthy vaginal flora.
- Manage underlying conditions like diabetes to reduce infection risks.
17. FAQs
How long does treatment take to work?
Answer: Most infections resolve within 7–14 days with appropriate treatment.
What is vaginal discharge?
Answer: A natural fluid that helps cleanse and protect the vagina.
What causes abnormal vaginal discharge?
Answer: Infections, hormonal changes, allergies, or irritants.
How is vaginal discharge treated?
Answer: Treatment depends on the cause; antifungals for yeast infections, antibiotics for bacterial causes, and lifestyle changes for non-infectious causes.
Is vaginal discharge normal?
Answer: Yes, as long as it is clear, odourless, and varies during the menstrual cycle.
Can vaginal discharge be prevented?
Answer: Practising good hygiene, safe sex, and avoiding irritants can help.
What does yellow-green discharge indicate?
Answer: It may indicate trichomoniasis or another infection; seek medical evaluation.
How is bacterial vaginosis treated?
Answer: With antibiotics like metronidazole or clindamycin.
Can vaginal discharge be a sign of an STI?
Answer: Yes, especially if associated with other symptoms like pain or odour.
Is thick, white discharge always a yeast infection?
Answer: Not always; a medical evaluation is needed for an accurate diagnosis.
Can hormonal changes cause vaginal discharge?
Answer: Yes, during ovulation, pregnancy, or menopause.
Can vaginal discharge be dangerous during pregnancy?
Answer: Certain types, like those caused by infections, may increase the risk of complications.
Should I see a doctor for vaginal discharge?
Answer: Yes, if it is abnormal, foul-smelling, or associated with other symptoms.
How can I prevent recurrent infections?
Answer: Practise good hygiene, take probiotics, and avoid unnecessary antibiotics.
Can I use over-the-counter treatments for discharge?
Answer: Only for yeast infections, but consult a doctor if unsure.