WHAT ARE VAGINAL DISCHARGES?
Vaginal discharges are secretions present in the vagina (birth canal). It may be clear, white, yellow or greenish in colour.

ARE ALL VAGINAL DISCHARGES ABNORMAL?

• No, there are normal physiological discharges
  
• These are secretions of the normal vaginal lining and cervix
  
• The amount and nature of normal physiological discharges can vary with age, the menstrual cycle and sexual activities

WHEN IS VAGINAL DISCHARGE ABNORMAL AND WHAT ARE THE CAUSES?

• Vaginal discharge which is excessive in amount, yellow or green in colour or foul- smelling is considered abnormal
  
• It may be due to sexually transmitted infections:
  • Fungus eg. thrush
    
  • Bacteria eg. gonorrhoea, chlamydia
    
  • Protozoa eg. trichomonas
    
  • Viral eg. genital herpes, warts
    
• Sometimes vaginal discharge may be due to non-infectious causes, eg.cervical polyps, cancerous growth, foreign bodies (eg. tampons)

HOW IS THE CAUSE OF VAGINAL DISCHARGE IDENTIFIED?
A detailed medical history, pelvic examination and relevant laboratory tests would enable your doctor to identify the cause

A) What is Thrush?

• This is caused by the yeast Candida albicans
  
• individuals normally have the yeast spores on the skin and in the vagina, but under certain conditions (diabetes mellitus, pregnancy, steroid therapy, oral contraceptives, antibiotics) these grow and multiply rapidly to cause vaginal discharge
  
• Generally, thrush is not a sexually transmitted infection; however some sexual partners of infected persons may develop skin rashes on the penis

How Is Thrush Treated?

• Antifungal pessaries inserted into vagina are most commonly prescribed e.g. clotrimazole, miconazole
  
• Oral antifungal drugs e.g. ketoconazole, itraconazole, fluconazole, may be prescribed in more severe or recurrent infections
  
• The underlying predisposing factors should be controlled or removed, eg. diabetes, antibiotics

B) What is Gonorrhoea?

• Gonorrhoea in females may present with a greenish-yellow vaginal discharge (please refer to the section on GONORRHOEA for more details)
  
• There may also be dysuria (a burning and painful sensation during urination)

C) What is Chlamydial Cervicitis?

• This is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis

What Are The Symptoms of Chlamydia Cervicitis?

• This may present as vaginal discharge 1 to 3 weeks after exposure (sex) with an infected partner
  
• There may be accompanying dysuria (pain during urination)
  
• However most women with chlamydia infection do not have any signs or symptoms
  
• It has to be differentiated from other infective causes of vaginal discharge especially gonorrhoea and trichomoniasis
  
• Chronic chlamydia infections may result in the spread of the disease to the surrounding organs in the pelvis (eg. fallopian tubes and ovaries) resulting in pain, ectopic pregnancy and infertility
  
• Infected mothers may pass the infection to the newborn and cause blindness (chlamydial ophthalmia neonatorum) and pneumonia

How Is Chlamydial cervicitis diagnosed?

• Chlamydia is detected by chlamydia culture of secretions from the cervix (or other relevant sites)
  
• Direct antigen tests and nucleic acid amplificationtests are also available
  
• Blood tests are not useful

How is chlamydial cervicitis treated?

• Oral antibiotics (tetracyclines,erythromycin and azithromycin) are treatments of choice
  
• Injections and pessaries are not useful

D) What Is Trichomoniasis?

• This is caused by a protozoa called Trichomonas vaginalis

What Are The Symptoms Of Trichomonas Infection?

• The commonest presentation is vaginal discharge which is often profuse, greenish in colour and foul-smelling
  
• This may be accompanied by itch and soreness of the vulva and the vagina
  
• This has also to be differentiated from gonorrhoea and chlamydia infections

How Is Trichomonas Infection Diagnosed?

• The protozoa may be identified in secretions from the vagina and cervix when examined under the microscope
  
• Culture test of the secretions confirm the diagnosis

How Does One Treat Trichomonas Infection?

• It is treated with a 1-week course of the oral anti-trichomonas drug metronidazole
  
• The sexual partner(s) must be treated to prevent reinfection

E) What is Bacterial Vaginosis (BV)?

• Bacterial vaginosis (BV) is a common vaginal infection in women, it is accompanied by discharge, odor, pain, itching, or burning. BV is associated with an imbalance in the bacteria that are normally found in a woman's vagina.
  
• Women who have a new sex partner or who have had multiple sex partners are more likely to develop BV. Women who have never had sexual intercourse are rarely affected.

How is bacterial vaginosis diagnosed?

• The patient is examined for signs of BV (e.g., discharge, odour) and laboratory tests on a sample of vaginal fluid are performed

How is bacterial vaginosis treated?

• BV is treated with antimicrobial medicines. Two medications are recommended - metronidazole or clindamycin.

WHAT SHOULD I DO IF I HAVE ABNORMAL VAGINAL DISCHARGES?

• Seek medical treatment immediately
  
• Avoid sex
  
• Avoid self medication
  
• Inform your doctor of any drug allergies
  
• Complete the course of treatment prescribed by your doctor
  
• Refer your sex partner(s) for examinatio