Vaginal discharge is a physiological occurrence. Physiological discharge consists of cervical mucus, tissue cells, bacteria, water, and electrolytes. The quality and quantity of discharge change with the reproductive status and timing of the menstrual cycle. In premenopausal women, estrogen maintains vaginal pH at 4.5. Normal discharge is odorless, ranging from white to clear, and can collect in the vaginal area. At times, it may be somewhat thick. Discharges that deviate from this norm may indicate vulvovaginal infection.
Vulvovaginal Candidiasis
Candida is a ubiquitous fungus. Candida species are a part of the normal vaginal environment in many women and do not cause symptoms in most cases. Less commonly, candida glabrata or other fungal species can lead to VVC (Vulvovaginal Candidiasis). Risk factors for VVC include pregnancy, diabetes, obesity, corticosteroid use, or immunosuppression due to HIV. Most patients with recurrent VVC do not have known risk factors.
Patient Evaluation
Patients with VVC typically complain of thick white vaginal discharge accompanied by itching. Patients with more extensive involvement may experience burning, painful urination, and pain during sexual intercourse. Visual examination may reveal redness and swelling.
Trichomoniasis
Trichomonas vaginitis is an infection caused by the single-celled organism Trichomonas vaginalis. T. vaginalis is present in both males and females and is sexually transmitted, responsible for 25% of infectious vaginitis cases.
Symptoms of Trichomoniasis
Patients may complain of heavy vaginal discharge that can be white, gray, yellow, or green. They may also experience itching and an unpleasant vaginal odor, although many patients may not exhibit symptoms.
Bacterial Vaginosis (BV)
BV is defined by a reduction in the normal vaginal bacteria (e.g., lactobacilli) and an increase in anaerobic organisms.
What are the risk factors for Bacterial Vaginosis (BV)?
Risk factors for BV include having multiple sexual partners and vaginal douching. However, BV can also occur in sexually inactive women.
Complications of Bacterial Vaginosis (BV)
BV patients are at risk for both overt and atypical pelvic inflammatory disease and post-hysterectomy vaginal cuff cellulitis and urinary tract infections. It is associated with an increased susceptibility to HIV and HSV infections. Pregnant patients with BV are at risk for preterm premature rupture of membranes, preterm birth, intraamniotic fluid infection, and postpartum endometritis.
Diagnosis of Bacterial Vaginosis (BV)
Patients often describe thin, foul-smelling discharge. The odor is typically worse after sexual intercourse.
Should sexual partners of patients with BV be treated?
It is not necessary to treat sexual partners of patients with BV. Treating partners does not reduce the rates of cure or recurrence.
Please note that the content provided is for informational purposes only, and you should consult your doctor for diagnosis and treatment.
Content Update Date: December 26, 2022