One very common health concern that most women face during their lifetime is a vaginal infection. Not all vaginal discharge is an infection so let’s begin with what is considered normal. Some amount of milky white, clear or cream-colored discharge is normal as fluid, cells and microbes bath the healthy vagina in response to the female hormone estrogen.
This discharge helps provide lubrication during intercourse and can protect the vagina from irritation and infection by creating a balanced ph. The amount of normal discharge varies in color and consistency during each phase of the menstrual cycle. For example, during ovulation the cervical mucous becomes clear, stringy and sticky to assist sperm in swimming up through the cervix to potentially meet with an egg and achieve a pregnancy.
It is also normal for vaginal discharge to have a slight odor though it should not be strong or offensive. The amount of vaginal discharge usually lessens as a woman reaches the menopause due to the decreasing amount of estrogen produced by the ovaries.
The most common vaginal infections are either yeast or bacterial vaginosis. The classic symptoms of a yeast infection are itching, burning and a thick white discharge. Yeast infections can occur in any woman but are more common in diabetic patients whose glucose levels are not well controlled. Other times that women suffer with yeast infections are during or after a course of antibiotics.
This is because the antibiotic which wipes out the infection can also wipe out microbes called lactobacilli which are a type of good bacteria in the vagina. When this happens the other organisms in the vagina overgrow causing an infection. There are now over-the-counter medications that will treat simple yeast infections however they do not always offer complete relief.
Unfortunately, unless your discharge is tested, you could be treating a yeast infection when what you really have is something else. If you try over-the-counter medications and do not have relief within a few days, it is best to see your provider.
Bacterial vaginosis (BV) most commonly presents as a watery discharge with a “fishy” odor. This vaginal infection can be treated with pills prescribed by your provider, or a medication placed in the vagina at night. BV is usually quite easy to treat however there are some women who have recurrent vaginitis, and it takes working with your provider to control the symptoms.
It is also possible that the same symptoms are being caused by a sexually transmitted infection (STI). So, if there is any chance that you have had unprotected sex (sex without a condom) you should see your provider to have the discharged tested either in the office or sent to a lab by your provider. Once tested your provider will know how to treat the infection appropriately.
There are other vaginal infections that are transmitted sexually (STIs) and if go untreated can cause more serious problems that could lead to hospitalizations for treatment or infertility (inability to get pregnant). The most common STI associated with a vaginal infection is Chlamydia which can occur with or without symptoms.
This STI can also lead to pelvic inflammatory disease. If found early, it is easily treated with oral medications. If you have been diagnosed with Chlamydia and received treatment, your partner will also have to be treated and you should have a repeat culture 3 weeks after treatment to make sure the infection has resolved.
During that time, you should refrain from intercourse, or you could develop a repeat infection. The more infections with STIs that you have the greater your chance of uterine scarring and infertility in the future.
There are two other vaginal infections that are considered STIs, gonorrhea (GC) and trichomoniasis. GC is caused by a bacterium and usually presents with a thick vaginal discharge. There are more than 3 million cases of GC every year in the United States. It is easiest to treat with an injectable antibiotic if found early before the woman has symptoms of pelvic pain and tenderness.
Many women who are found to have GC also have Chlamydia, so the infections are often treated together. Like with Chlamydia it is important to refrain from sexual contact until your follow up visit 3 weeks after treatment and to make sure that anyone you have had sex with is also treated and their results are negative before you have sex with them again.
Trichomoniasis (Trich) is the final vaginal infection that is transmitted with close sexual contact addressed in this article. It is caused by a parasite and up to 70% of women do not have symptoms.
When this infection is diagnosed by your provider you will be prescribed an oral medication. Again, as with other STIs, your partner will also have to be treated and you will need to refrain from sex until you both have negative results.