Non infective causes of vaginal discharge:
Foreign bodies
* Most can be manually moved but these may be very small (fibrous material or small beads in child’s vagina, a small piece of torn condom) not visible and require a lavage.
* Large or irregular shaped objects cause muscular contraction of vaginal walls. Anesthesia may also be needed.
* A short course of antibiotics may be needed to treat secondary infection.
* Allergic reactions can be treated by identifying and removing the cause.
Treatment of persistent discharge
* In some cases, repeated examination and screening no positive results and the patients still complain of vaginal discharge.
* It is appropriate to explore the nature of discharge relative to its normal discharge to review personal hygiene habits. Advise to avoid perfumed products, tight synthetic clothing.
* Explore the complaints like depression, anxiety or psychosexual dysfunctions.
* Premenopausal changes may predispose women to vaginal infection which may respond well to hormonal creams.
Epidemiology
* The most common cause of vaginal discharge in childbearing women is bacterial vaginosis.
* 50% cases of bacterial vaginosis are same that its true occurrence is mostly unknown.
Infective cause
The most common infective cause is vulvovaginal infection which affects 75%of women during their reproductive life.
Vaginal Discharge in pregnancy
The quality and quantity of vaginal discharge change during pregnancy. More discharge is produced during pregnancy.
Vaginal discharge during pregnancy is due to miscarriage, preterm labor, and premature rupture of membranes or low birth weight.
Diagnosis of Abnormal Vaginal Discharge
1. A full clinical and sexual history should be sought with the nature of the discharge (what is its color, odor, duration, consistency) and symptoms that includes itching, dyspareunia, abdominal pain, abnormal bleeding.
2. Consider the medications (e.g. antibiotics, steroids) previous treatments used and medical conditions like diabetes.
3. Patients who have the symptoms of bacterial infection can be treated without sampling. Otherwise “Triple Swab” test should be taken.
Triple Swab test consists of following steps
* High vaginal swab to identify bacterial infection.
* Endocervical swab in transport medium to diagnose the disease.
* Endocervical swab for DNA test to diagnose the abnormal discharge.
4. Vaginal pH testing (using narrow range pH paper) is a quick, cheap, simple test for the abnormal vaginal discharge.
It can be of three types:
1. Bacterial vaginosis.
2. Candidiasis. (Yeast infection)
3. Trichomoniasis.
1. Bacterial vaginosis
Bacterial vaginosis is caused by Gardnerella vaginalis bacteria. This infection is not caught from a partner.
2. Candidiasis (Yeast infection)
Small amounts of yeast fungus are found in a healthy vagina. If it grows too much it can cause a yeast infection. This infection is usually not caught by a sex partner. You can get a yeast infection if you are using antibiotics, if you are pregnant or you have diabetes or stay sweaty for long period.
3. Trichomoniasis
Trichomoniasis is caused by an organ called Trichomonas vaginalis. You can be infected but have no signs for a long time.
Non-sexually transmitted infection
* Bacterial Infection:
It is mostly seen in sexually active women.
* Brown discharge
It may happen after periods. It is just cleaning out vagina. Old blood looks like brown.
* Blood spotting
It occurs at the mid of ovulating cycle. Sometimes in early pregnancy spotting or brownish discharge is seen at the time of periods.
