Author's details
Reviewer's details
Vaginal Discharge
The vagina has no gland of its own and sources of discharge noted from the vagina include Bartholin’s
gland, skene gland, transudate from vaginal walls, cervical glands and endometrial glands. The normal
vaginal PH is acidic and </= 4.5. The vaginal has normal commensals which range from lactobacilli,
anaerobes, diphtheroid, coagulase-negative staphylococcus and a-hemolytic streptococcus. Vaginal
discharge could be physiological or pathological. Alteration in the activity of some of these commensals
could lead to a change in vaginal discharge especially if overgrowth occurs for example Candida albicans.
Physiological causes
● Periovulatory period
● Premenstrual period
● Sexual excitement
● Hormonal contraceptives
● Pregnancy.
Pathological causes
● Infections e.g. Candidiasis, Trichomoniasis and Bacterial vaginosis, Gonorrhea, and Chlamydia
infection.
● Atrophic vaginitis
● Benign tumors like cervical polyp
● Malignancy eg endometrial cancer and cervical cancer
● Vaginal fistula
● Others e.g. foreign body, cervical ectropion.
The symptoms associated with abnormal vaginal discharge may include vaginal itching, burning sensation in vagina, dyspareunia, urinary symptoms and pelvic pain.
Patient may present with discharge which is colored and foul smelling. On examination, other findings may be lower abdominal tenderness (seen in PID). The vagina may be hyperemic, there may be associated tenderness. Genital ulcer may be present as seen with herpes. There may also be excoriation marks on perineum if there is associated itchiness. In some cases of trichomonas infection, strawberry cervix may be seen.
| T, vaginalis | C.albicans | BV | Herpes genitalis | |
| Consistency | Frothy | Thick cheesy | Thin homogenous | |
| Amount | Copious | Variable | Copious | Small volume |
| Colour | Yellow green | White curdy | Greyish white | Mucoid |
| Odour | Offensive | Odourless | Fishy | |
| pH | 5.0-7.0 | 3.5-4.5 | 5.0-6.0 | |
| Pruritus | ++ | +++ | - | - |
| Burning | + | ++ | - | +++ |
| Redness | +++ | +++ | - | +++ |
| Oedema | ++ | +++ | - | +++ |
| Ulcers | - | - | - | +++ |
| Microscopy | Flagellated organism | Presence of pseudo-hyphae | Clue cells | |
| Leucocytes | +++ | ++ | ++++ | + |
These include high vaginal swab m/c/s (can detect cases of candida infection), endocervical swab m/c/s (can detect cases of gonorrhea and chlamydia infection), urinalysis, urine m/c/s, Wet mount (may show flagellated organism seen with trichomonas infection and clue cells seen with bacterial vaginosis) and Serology
This depends on cause of the vaginal discharge. General advice should include good skin care by avoiding local irritants, usage of emollients for personal hygiene, avoid wearing incorrectly fitted clothing and panty liners
Specific treatment is as follows
For candidiasis, antifungal preparations commonly used include topical clotrimazole, clotrimazole pessary 500mg stat or 100mg daily for 6/7days 3-7 days. An alternative is to use oral fluconazole 150mg stat.
For trichomoniasis, use of oral metronidazole 400-500mgmg bd for 5-7days. Treat male partner as well. Avoid sexual intercourse during treatment and follow up. In cases of persistent infection, treat for up to 4 weeks.
For bacterial vaginosis, it can be treated with oral metronidazole 500mg bd for 5-7days. Alternative to metronidazole is Clindamycin 300mg b.d for 7days. In a case of recurrence treat for 10-14 days.
Chlamydia infection can be treated with oral doxycycline 100mg bd for 7days. Alternative drugs especially in breastfeeding women or pregnancy include Single dose 1g Azithromycin though resistance may be high, Erythromycin 500mg qds for 7days or b.d for 14days, Amoxicillin 500mg tds for 7days. Partner should receive treatment as well
Gonorrhea treated with intramuscular Ceftriaxone 1000mg stat dose. The partner should receive treatment as well.
Patient can be seen at the follow up clinic to ensure compliance with medication, resolution of symptoms and test of cure.
- Use of barrier methods during sexual intercourse to reduce risk of STI.
- Avoid injudicious use of antibiotics.
- Avoid wearing tight nylon pants.
- Sleep without pants
- Avoid douching.
- Do not use soap for washing the vulva
- Avoid multiple sexual partners.
Vaginal discharge is a common symptom among women in low-income settings, often linked to infections such as sexually transmitted infections (STIs), bacterial vaginosis, and candidiasis. Due to limited access to healthcare and inadequate education on reproductive health, many cases remain untreated, potentially leading to serious complications. Improving access to healthcare, promoting sexual health education, and ensuring proper diagnosis and treatment of vaginal infections are crucial to addressing this issue and improving women's reproductive health in the region.
A 32-year-old teacher from rural Eastern Uganda presented to a local health centre with a three-week history of abnormal vaginal discharge, itching, and discomfort during urination and intercourse. Her symptoms began shortly after her husband’s return from a trip, but she delayed seeking care due to stigma and concerns about her husband’s reaction. Upon examination, she was diagnosed with trichomoniasis, a common sexually transmitted infection.(Mariam-expunge this) She was treated with metronidazole and advised to abstain from sex until both she and her husband completed the treatment. At follow-up, her symptoms had resolved, and she expressed a commitment to better communication and safer sexual practices. This case highlights the challenges women in sub-Saharan Africa face in addressing sexual health issues due to social stigma and limited access to healthcare.
- Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291:1368.
- Nyirjesy P, Peyton C, Weitz MV, et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108:1185.
- Anderson M, Karasz A, Friedland S. Are vaginal symptoms ever normal? a review of the literature. MedGenMed 2004; 6:49.
- British Association for Sexual Health and HIV National guideline for the management of Vaginal discharge & The Faculty of Sexual & Reproductive Healthcare
Author's details
Reviewer's details
Vaginal Discharge
The vagina has no gland of its own and sources of discharge noted from the vagina include Bartholin’s
gland, skene gland, transudate from vaginal walls, cervical glands and endometrial glands. The normal
vaginal PH is acidic and </= 4.5. The vaginal has normal commensals which range from lactobacilli,
anaerobes, diphtheroid, coagulase-negative staphylococcus and a-hemolytic streptococcus. Vaginal
discharge could be physiological or pathological. Alteration in the activity of some of these commensals
could lead to a change in vaginal discharge especially if overgrowth occurs for example Candida albicans.
Physiological causes
● Periovulatory period
● Premenstrual period
● Sexual excitement
● Hormonal contraceptives
● Pregnancy.
Pathological causes
● Infections e.g. Candidiasis, Trichomoniasis and Bacterial vaginosis, Gonorrhea, and Chlamydia
infection.
● Atrophic vaginitis
● Benign tumors like cervical polyp
● Malignancy eg endometrial cancer and cervical cancer
● Vaginal fistula
● Others e.g. foreign body, cervical ectropion.
The symptoms associated with abnormal vaginal discharge may include vaginal itching, burning
sensation in the vagina, dyspareunia, urinary symptoms, and pelvic pain.
The patient may present with discharge which is colored and foul smelling. On examination, other findings may be lower abdominal tenderness (seen in PID). The vagina may be hyperemic, there may be associated tenderness. Genital ulcers may be present as seen with herpes. There may also be excoriation marks on the perineum if there is associated itchiness. In some cases of trichomonas infection, a strawberry cervix may be seen.
| T, vaginalis | C.albicans | BV | Herpes genitalis | |
| Consistency | Frothy | Thick cheesy | Thin homogenous | |
| Amount | Copious | Variable | Copious | Small volume |
| Colour | Yellow green | White curdy | Greyish white | Mucoid |
| Odour | Offensive | Odourless | Fishy | |
| pH | 5.0-7.0 | 3.5-4.5 | 5.0-6.0 | |
| Pruritus | ++ | +++ | – | – |
| Burning | + | ++ | – | +++ |
| Redness | +++ | +++ | – | +++ |
| Oedema | ++ | +++ | – | +++ |
| Ulcers | – | – | – | +++ |
| Microscopy | Flagellated organism | Presence of pseudo-hyphae | Clue cells | |
| Leucocytes | +++ | ++ | ++++ | + |
These include high vaginal swab m/c/s (can detect cases of candida infection), endocervical swab m/c/s (can detect cases of gonorrhea and chlamydia infection), urinalysis, urine m/c/s, Wet mount (may show flagellated organism seen with trichomonas infection and clue cells seen with bacterial vaginosis) and Serology.
This depends on the cause of the vaginal discharge. General advice should include good skin care by avoiding local irritants, using emollients for personal hygiene, and avoiding wearing incorrectly fitted clothing and panty liners.
Specific treatment is as follows.
For candidiasis, antifungal preparations commonly used include topical clotrimazole, clotrimazole pessary 500mg stat or 100mg daily for 6/7 days 3-7 days. An alternative is to use oral fluconazole 150mg stat.
For trichomoniasis, use of oral metronidazole 400-500mgmg bd for 5-7days. Treat male partners as well. Avoid sexual intercourse during treatment and follow-up. In cases of persistent infection, treat for up to 4 weeks.
For bacterial vaginosis, it can be treated with oral metronidazole 500mg bd for 5-7 days. Alternative to metronidazole is Clindamycin 300mg b.d for 7days. In a case of recurrence treat for 10-14 days.
Chlamydia infection can be treated with oral doxycycline 100mg bd for 7 days. Alternative drugs especially in breastfeeding women or pregnancy include a Single dose of 1g of Azithromycin. However, resistance may be high, Erythromycin 500mg qds for 7 days or b.d for 14 days, Amoxicillin 500mg tds for 7 days. The partner should receive treatment as well.
Gonorrhea treated with intramuscular Ceftriaxone 1000mg stat dose. The partner should receive treatment as well.
Patients can be seen at the follow-up clinic to ensure compliance with medication, resolution of symptoms and test of cure.
- Use of barrier methods during sexual intercourse to reduce the risk of STI.
- Avoid injudicious use of antibiotics.
- Avoid wearing tight nylon pants.
- Sleep without pants
- Avoid douching.
- Do not use soap for washing the vulva
- Avoid multiple sexual partners.
- Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291:1368.
- Nyirjesy P, Peyton C, Weitz MV, et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108:1185.
- Anderson M, Karasz A, Friedland S. Are vaginal symptoms ever normal? a review of the literature. MedGenMed 2004; 6:49.
- British Association for Sexual Health and HIV National guideline for the management of Vaginal discharge & The Faculty of Sexual & Reproductive Healthcare
Content
Author's details
Reviewer's details
Vaginal Discharge
Background
The vagina has no gland of its own and sources of discharge noted from the vagina include Bartholin’s
gland, skene gland, transudate from vaginal walls, cervical glands and endometrial glands. The normal
vaginal PH is acidic and </= 4.5. The vaginal has normal commensals which range from lactobacilli,
anaerobes, diphtheroid, coagulase-negative staphylococcus and a-hemolytic streptococcus. Vaginal
discharge could be physiological or pathological. Alteration in the activity of some of these commensals
could lead to a change in vaginal discharge especially if overgrowth occurs for example Candida albicans.
Physiological causes
● Periovulatory period
● Premenstrual period
● Sexual excitement
● Hormonal contraceptives
● Pregnancy.
Pathological causes
● Infections e.g. Candidiasis, Trichomoniasis and Bacterial vaginosis, Gonorrhea, and Chlamydia
infection.
● Atrophic vaginitis
● Benign tumors like cervical polyp
● Malignancy eg endometrial cancer and cervical cancer
● Vaginal fistula
● Others e.g. foreign body, cervical ectropion.
Symptoms
The symptoms associated with abnormal vaginal discharge may include vaginal itching, burning
sensation in the vagina, dyspareunia, urinary symptoms, and pelvic pain.
Clinical findings
The patient may present with discharge which is colored and foul smelling. On examination, other findings may be lower abdominal tenderness (seen in PID). The vagina may be hyperemic, there may be associated tenderness. Genital ulcers may be present as seen with herpes. There may also be excoriation marks on the perineum if there is associated itchiness. In some cases of trichomonas infection, a strawberry cervix may be seen.
| T, vaginalis | C.albicans | BV | Herpes genitalis | |
| Consistency | Frothy | Thick cheesy | Thin homogenous | |
| Amount | Copious | Variable | Copious | Small volume |
| Colour | Yellow green | White curdy | Greyish white | Mucoid |
| Odour | Offensive | Odourless | Fishy | |
| pH | 5.0-7.0 | 3.5-4.5 | 5.0-6.0 | |
| Pruritus | ++ | +++ | – | – |
| Burning | + | ++ | – | +++ |
| Redness | +++ | +++ | – | +++ |
| Oedema | ++ | +++ | – | +++ |
| Ulcers | – | – | – | +++ |
| Microscopy | Flagellated organism | Presence of pseudo-hyphae | Clue cells | |
| Leucocytes | +++ | ++ | ++++ | + |
Investigations
These include high vaginal swab m/c/s (can detect cases of candida infection), endocervical swab m/c/s (can detect cases of gonorrhea and chlamydia infection), urinalysis, urine m/c/s, Wet mount (may show flagellated organism seen with trichomonas infection and clue cells seen with bacterial vaginosis) and Serology.
Treatment
This depends on the cause of the vaginal discharge. General advice should include good skin care by avoiding local irritants, using emollients for personal hygiene, and avoiding wearing incorrectly fitted clothing and panty liners.
Specific treatment is as follows.
For candidiasis, antifungal preparations commonly used include topical clotrimazole, clotrimazole pessary 500mg stat or 100mg daily for 6/7 days 3-7 days. An alternative is to use oral fluconazole 150mg stat.
For trichomoniasis, use of oral metronidazole 400-500mgmg bd for 5-7days. Treat male partners as well. Avoid sexual intercourse during treatment and follow-up. In cases of persistent infection, treat for up to 4 weeks.
For bacterial vaginosis, it can be treated with oral metronidazole 500mg bd for 5-7 days. Alternative to metronidazole is Clindamycin 300mg b.d for 7days. In a case of recurrence treat for 10-14 days.
Chlamydia infection can be treated with oral doxycycline 100mg bd for 7 days. Alternative drugs especially in breastfeeding women or pregnancy include a Single dose of 1g of Azithromycin. However, resistance may be high, Erythromycin 500mg qds for 7 days or b.d for 14 days, Amoxicillin 500mg tds for 7 days. The partner should receive treatment as well.
Gonorrhea treated with intramuscular Ceftriaxone 1000mg stat dose. The partner should receive treatment as well.
Follow up
Patients can be seen at the follow-up clinic to ensure compliance with medication, resolution of symptoms and test of cure.
Prevention and control
- Use of barrier methods during sexual intercourse to reduce the risk of STI.
- Avoid injudicious use of antibiotics.
- Avoid wearing tight nylon pants.
- Sleep without pants
- Avoid douching.
- Do not use soap for washing the vulva
- Avoid multiple sexual partners.
Further readings
- Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291:1368.
- Nyirjesy P, Peyton C, Weitz MV, et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108:1185.
- Anderson M, Karasz A, Friedland S. Are vaginal symptoms ever normal? a review of the literature. MedGenMed 2004; 6:49.
- British Association for Sexual Health and HIV National guideline for the management of Vaginal discharge & The Faculty of Sexual & Reproductive Healthcare
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