Vaginal Discharges And Diseases

Bacteria are omnipresent. The same holds true for vaginal secretions as well. The normal bacteria present in vaginal secretions are lactobacilli. They are a part of the normal vaginal flora and it is believed that they play a role in protecting the vaginal epithelium against infection. These bacteria flourish in a pH between 3.8 and 4.4, which is the normal vaginal pH. However, the pH of the vagina may get altered during the different phases of the menstrual cycle or because of factors like consuming birth control pills, using certain deodorants, wearing the wrong kind of undergarments, douching and unhealthy sexual practices. Certain diseases like diabetes and health conditions like pregnancy and menopause wherein the estrogen level falls may also cause the pH to change. Any alteration in the vaginal pH is harmful for the normal vaginal flora and encourages the growth of harmful bacteria. This may lead to vaginal infections associated with abnormal discharges.

The normal vaginal discharge is either clear or white in color. It becomes slippery in consistency at the time of ovulation, which is around two weeks after your menstrual period. Normally the vaginal discharge is odorless. However, in the presence of any infection, the vaginal discharge no longer remains clear and is often accompanied by a foul smell.

Common conditions that may lead to abnormal vaginal discharges

Some of the most common conditions which can alter the vaginal pH and consequently lead to vaginal infections and abnormal discharges include:

• Exercising in tight fitting clothes
• Wearing non- cotton synthetic undergarments which do not allow proper air circulation. Hence, the sweat doesn’t dry up.
• Use of antibiotics
• Use of birth control pills
• Use of scented products like soaps, pads, tampons and douches
• Pregnancy
• Menopause
• Stress
• Diabetes
• Sexually transmitted diseases

Commonly encountered vaginal infections

Abnormal vaginal discharges are commonly associated with the following infections:

Bacterial vaginosis

Bacterial vaginosis is a condition wherein the normal vaginal flora is replaced by an overgrowth of certain anaerobic bacteria like Gardnerella vaginalis, Mycoplasma, Ureaplasma, Prevotella sp., Mobiluncus sp., etc.

Trichomoniasis

Trichomoniasis is a condition where the vagina is infected by T. vaginalis. This is a single cellular parasite which spreads during sexual contact.

Candidiasis

Yeast is normally present in the vaginal flora. An overgrowth of yeast (Candida) especially associated with the use of antibiotics can lead to candidiasis.

Gonorrhea

This is a sexually transmitted disease caused by Neisseria gonorrhoeae.

Chlamydia

This is again a sexually transmitted disease caused by Chlamydia trachomatis. The disease is characterized by no other symptom except a foul smelling vaginal discharge.

Symptoms Associated With Vaginal Diseases

The most important symptom associated with vaginal diseases is the offensive vaginal discharge. The color and odor of the discharge varies from disease to disease.

Candidiasis: Yeast infection is characterized by a curd-like, white discharge which resembles cottage cheese in appearance. The discharge is generally odorless.

Trichomoniasis: It is characterized by a vaginal discharge which is often frothy, greenish yellow or gray in color with a strong odor.

Bacterial vaginosis: The hallmark of vaginal discharge in case of bacterial vaginosis is its strong fishy odor.

Gonorrhea: The patient observes a yellowish vaginal discharge associated with redness of the genitals.

Apart from color and smell of the vaginal discharge, vaginal infection is often associated with itching. Although some amount of itching is seen in all forms of vaginal infections, it is most marked in case of candidiasis. Vaginal infection may also be associated with fever, discomfort in the lower abdomen, pain during passing urine and during sexual intercourse. Atrophic vaginitis, caused around menopause due to reduced levels of estrogen, is associated with a dry and irritable vaginal membrane which is painful especially during intercourse.

Diagnosis of vaginal infection

It has been seen that obtaining a medical history alone is insufficient to diagnose the exact cause of vaginal infection. What is required is a carefully written medical history, examination of the pelvic region, and laboratory testing of the vaginal discharge. It is also important to elicit information about the sexual behaviors and practices of the patient, number of sexual partners and their genders, hygiene practices employed for cleaning the vaginal area, menstrual history and history of any medication in the recent past.

Treatment of vaginal diseases and vaginal discharge

The vaginal discharge is treated by treating the underlying cause of the infection. Once the nature of pathogen responsible for the vaginal infection is diagnosed, medication specifically directed to the pathogen is administered. Antibiotics and antifungal medicines form the mainstay of the treatment. They can be given either orally, as an injection or for topical application.

• Trichomoniasis is usually treated with either metronidazole or tinidazole. Both the sex partners are treated simultaneously to prevent the infection from recurring.
• Bacterial vaginosis is usually treated with metronidazole, tinidazole or clindamycin.
• Gonorrhea was usually treated with penicillin. But now, strains resistant to penicillin have also emerged. They are treated with injections of ceftriaxone or by oral administration of cefixime.
• Chlamydia infection is best treated with either azithromycin or doxycycline.
• Candidiasis is usually dealt with topical application of creams containing butaconazole, clotrimazole or terconazole. Oral fluconazole is also effective in treating the condition. Vaginal suppositories containing nystatin are also preferred by certain patients.
• Atrophic vaginitis is treated with the help of hormonal replacement therapy.

Prevention of vaginal diseases

Although conditions like pregnancy and stress and antibiotics for other disease conditions cannot be avoided, one can avoid vaginal infections by taking care of the undergarments one wears. Loose fitting cotton undergarments allow air to circulate and go a long way in improving vaginal hygiene. Birth control pills should not be stopped but their content and strength can be altered after talking to the physician. Healthy sexual practices like use of condoms, and avoiding sexual promiscuity can also help in preventing vaginal infections. The American College of Obstetricians and Gynecologists do not favor the use of douching, unless specifically recommended by the physician. Most important of all, if the infection is not responding to the over the counter medications within a reasonable time frame, one shouldn’t hesitate to take an opinion from a doctor.