Vaginal discharge / infections

What is abnormal or excessive discharge?

It’s normal and healthy for women to have some discharge from their vagina.  The amount and colour of this discharge can change during your menstrual cycle, when you take the contraceptive pill and when you’re pregnant.

Discharge due to vaginal infection is of unusual colour and smelly, you may have an irritated and sore vulva, associated itching, pain when you have sex, bleeding between your periods or after you have sex, pain in your lower abdomen or pelvis, burning sensation when you pass urine.

What are the commonest causes of altered vaginal discharge?

You can get a vaginal infection if bacteria, fungi or viruses grow in and around your vagina. While it’s normal for some types of bacteria to live inside your vagina, other types of bacteria, viruses and fungi shouldn’t be there.

There are three common causes of altered vaginal discharge:

Infective (non-sexually transmitted): Bacterial vaginosis and Candida

Infective (sexually transmitted): Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Herpes simplex virus

Non-infective: Foreign bodies (e.g. retained tampons, condoms), cervical polyps and ectopy, genital tract malignancy, fistulae and allergic reactions.

What are the tests?

A detailed history, including sexual history, is essential to identify the necessary investigations and treatment options. In case of persistent vaginal discharge, you will be examined to exclude serious pathology.

You may be asked to provide a sample of urine. We may need to take a swab of a sample of discharge or cells from your vagina. These samples may be tested or examined under a microscope in the clinic, and sent to a laboratory for testing.

What are the treatment options for vaginal discharge?

Vulvovaginal Candidiasis: Vaginal and oral antifungals (tablets or gels) are equally effective in the treatment of vulvovaginal candidiasis (VVC). Women with vulval symptoms of VVC can use topical antifungals (in addition to oral or vaginal treatment) until symptoms resolve. There is no need for routine screening or treatment of sexual partners in the management of candidiasis.

Bacterial Vaginosis(BV): This infection usually clears up if you take antibiotics. These usually come as tablets although they can sometimes be in the form of a gel or cream. If you have male partner, they don’t need to be treated for BV. BV seems to be more common among lesbian women. But if you have a female partner, they will usually only need to get treated if they have symptoms.

Chlamydia: Chlamydia is the most common sexually transmitted infection (STI) in the UK. It’s caused by a bacterium called Chlamydia trachomatis. Lots of women have chlamydia without knowing it. Seven in 10 women and half of men with chlamydia don’t have any symptoms. Chlamydia is treated with antibiotics. You will be given a course of antibiotic tablets or a one-off dose. Any recent sexual partners will also need to be tested and treated if necessary.

Vaginal Trichomoniasis (TV): Oral antibiotic tablets are effective in treating trichomoniasis. Any recent sexual partners will also need to be tested and treated if necessary.

Other Non- infective causes of vaginal discharge: Treatment of the underlying causes may help with the symptoms.

Foreign bodies (e.g. retained tampons or condoms) Removal of the retained foreign body will help resolve the symptoms.

Cervical ectopy or polyps Cervical ectopy may be the cause of increased physiological discharge. Ectopy is a normal finding in women of reproductive age but treatments such as acidic gel, silver nitrate cauterisation, laser or cold coagulation are occasionally used in a gynaecology or colposcopy setting for symptomatic relief of vaginal discharge or postcoital bleeding.

Personal hygiene measures: may help women who are prone to vaginal discharge and/or pruritus (e.g. regular changing of sanitary protection, avoidance of douching and of potentially irritant chemicals in toiletries, antiseptics, wipes, so-called ‘feminine hygiene’ products, washing powders, fabric dyes).

Would changing contraceptive method help with the discharge?

As there is some association between the type of contraception you use and the recurrent vaginal discharge, it may help to consider changing the contraception to an alternative method. Women using CHC who experience recurrent VVC may wish to consider switching to an alternative method of contraception. Women with a Cu-IUD who experience recurrent BV may wish to consider switching to an alternative method of contraception.