Vaginal Discharge: Types, Complications and Treatment

Vaginal discharge is made up of mucus and bacteria and this mucus helps to clean the vagina. The bacteria present in vaginal discharge keep the vagina clean. The good bacteria also keep the bad bacteria and yeast in check. Normally vaginal discharge is clear, thin, and has no bad odor. But if there is a change in the color, thickness, and odor of the vaginal discharge then there are chances of vaginal infection. There are different bacteria that can affect the cervix, vagina and, the male genital organs. 

Neisseria Gonorrhea (Gonococcal Discharge)

• It can cause gonococcal urethritis or cervicitis.
• The patient will present with constitutional symptoms like fever and urinary symptoms like pain during micturition.
• There will be thick copious purulent discharge coming from the cervix. In males, there will be complaints of thick copious purulent discharge from the penile urethra.
• The cervix is friable.

Investigations

• On gram staining the discharge, gram-negative diplococci will be seen.
• These may be present intracellularly or extracellularly. These are seen inside the polymorphonuclear leukocytes.
• Thayer-Martin medium is used to culture.
• A nucleic acid amplification test is performed to confirm the diagnosis.

Complications

• In females, it can cause salpingitis, pelvic inflammatory disease and, Bartholin gland Abscess.
• In males, it can cause prostatitis, urethritis, epididymitis, and Perianal Abscess.
• It is very important to note a disease called ophthalmia neonatorum in infants who are born to a mother having gonorrhea.
• Severe cases of gonococcal infection can lead to arthritis and tenosynovitis and it is also called disseminated gonococcal infection.

Treatment 

The treatment of choice is injection ceftriaxone and azithromycin.

Also Read: Trichomoniasis: Symptoms, Causes, Risk Factors, Complications, Diagnosis, Treatment and Prevention

Chlamydia Trachomatis (DK)

• It can cause non-gonococcal urethritis and cervicitis.
• The specialty of this disease is there will be no constitutional symptoms and the urinary symptoms will be absent.
• The discharge from the cervix will be thin, watery, scanty, and clear-looking.

Investigations

• On gram staining, only polymorphonuclear lymphocytes will be present and the absence of diplococci will rule out gonorrhea.
• Nucleic acid amplification test is done to confirm the diagnosis.

Complications

• Arthritis
• Perihepatitis

Treatment

Azithromycin is given alone.

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Gardenella Vaginalis

• It can cause bacterial vaginosis which is the most common pathological cause of vaginal discharge.
• Due to altered flora the anaerobic bacteria can overtake the lactobacilli and the concentration of lactobacilli is reduced. There is an increase in gram-negative bacteria and anaerobes which leads to infection.
• The pH of the vagina will also get altered that is it will become basic ( >4.5).
• This kind of vaginal infection can be seen in nuns as well.
• It is very important to note that the partner is treated in all sexually transmitted infections except in bacterial vaginosis.
• The discharge is thin, white and it coats the vaginal walls.
• The patient may or may not be symptomatic.

Investigations

• On gram stain, clue cells will be found which are the diagnostic criteria for bacterial vaginosis.
• There will be stippled appearance of vaginal squamous cells.

Treatment

Metronidazole is given for seven days.

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Trichomonas Vaginalis

• It is a protozoan that can cause a disease called trichomoniasis.
• Green frothy vaginal discharge will be seen.
• These symptoms like vaginal pruritus will be present.
• In pregnant females it can lead to adverse outcomes like low birth weight etc.
• The vaginal pH will be more basic.

Investigations

On wet mount, motile, pear-shaped bodies will be seen.

Treatment

Secnidazole or tinidazole can be used.

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Vulvovaginal Candidiasis

• It is caused by candida albicans.
• It mainly affects the females who are diabetic or immunocompromised.
• Other symptoms like vaginal pruritus will also be present.
• The pH will be more acidic.
• The vaginal discharge is more white, cheesy, or curdy.

Investigations

KOH smear is used and it will detect the Pseudo hyphae and budding yeast cells.

Treatment

Topical or systemic azoles can be used.

Also Read: Cervical Mucus: Role in Fertilization, Types, Uses

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