Abnormal vaginal discharge is often the first sign of a genital infection in women. However, the absence of discharge does not always mean there is no infection. Normal vaginal discharge is usually small in quantity, white to colourless, and not associated with unpleasant smell or irritation. While some vaginal infections are sexually transmitted, not all are caused by sexual activity.
If you notice unusual discharge, itching, burning, pain during sex, or a change in smell or colour, you can get personalised advice from licensed doctors through Hope Plus. This service helps you receive timely care, understand your treatment options, and prevent complications.
Key Takeaways
- Abnormal vaginal discharge can signal infections that need treatment, but not all infections are sexually transmitted.
- Early medical evaluation is important to prevent complications and ensure proper treatment.
- Practising safe sex, good hygiene, and seeking care for persistent or unusual symptoms can protect your reproductive health.
- Partners may need evaluation and treatment to prevent reinfection.
Causes of Abnormal Vaginal Discharge
The causes of abnormal vaginal discharge can be diverse and often involve a mixture of organisms:
- Vaginitis: Inflammation of the vagina caused by Candida albicans (yeast infection), Trichomonas vaginalis, or bacterial vaginosis (Gardnerella vaginalis, Mycoplasma hominis).
- Cervicitis: Inflammation of the cervix, often due to Gonorrhoea or Chlamydia. This may be asymptomatic and sometimes causes mild discharge.
It is important to know that Candida and bacterial vaginosis are not sexually transmitted, even though sexual activity can be a contributing factor.
Recognising the Symptoms
Symptoms vary depending on the cause:
- Candida albicans: Thick, lumpy, white discharge with intense itching and red, inflamed vulva.
- Trichomonas vaginalis: Greenish-yellow frothy discharge with a strong, unpleasant smell and itching.
- Bacterial vaginosis: Thin discharge with a fishy smell.
- Gonorrhoea or Chlamydia: Thin, purulent or colourless discharge, often without smell or itching.
Other conditions can mimic vaginal infections, including cervical cancer (blood-stained, smelly discharge), allergic reactions, or irritation from detergents, chemicals, herbs, or chronic tampon use.
Diagnosis
Healthcare providers use a combination of history, physical examination, and laboratory tests:
- Speculum examination: To check the vagina and cervix.
- Microscopy and cultures: Swabs of vaginal discharge.
- pH and KOH tests: To detect yeast or bacterial infections.
- Blood tests: Screening for HIV and syphilis.
Treatment Options
Treatment depends on the cause of the discharge:
- Candida (yeast infection):
- Clotrimazole pessary 100 mg once daily for 6 days (or twice daily for 3 days), or
- Fluconazole 150–200 mg single oral dose
- ± Metronidazole 2 g stat if mixed infection suspected
- Bacterial vaginosis / Trichomonas:
- Metronidazole 2 g single oral dose
- Gonorrhoea / Chlamydia / High-risk infections:
- Cefixime 400 mg stat or Ceftriaxone 1 g
- Doxycycline 100 mg every 12 hours for 7 days
- Metronidazole 2 g stat
- Treat sexual partners at the same time
- Pregnant women:
- Replace Doxycycline with Erythromycin 500 mg every 6 hours for 7 days or Azithromycin 1 g stat
- Metronidazole only after the first trimester
If discharge persists despite treatment, or if sexual partners were treated and symptoms remain, referral to a specialist is recommended.
Follow-Up and Prevention
- Ensure sexual partners are treated to prevent reinfection.
- Return for follow-up if symptoms do not improve within 7 days.
- Practise good hygiene and safe sexual behaviours.
- Promptly report any new or persistent symptoms to a healthcare provider.
With early recognition, proper treatment, and preventive care, most causes of abnormal vaginal discharge can be effectively managed, helping women maintain reproductive health and comfort.
