By Dr Aishah Fadila Adamu
A vaginal discharge is one of the most common gynecological symptoms affecting women and a very common cause for seeking medical attention.
The woman’s perception as to the cause of the discharge will influence her choice of medical attention. In many cases, the woman may have attempted self-treatment of the discharge with over-the-counter (OTC) preparations prior to consulting a doctor. This action often leads to an unsuccessful outcome, with the majority using OTC antifungals (like clotrimazole and fluconazole) inappropriately to treat gynecological conditions that are similar, but potentially more severe. Consultation is often delayed due to embarrassment or fear, with most women believing that sexual transmission played a role in the transmission of symptoms. A common misconception is that a vaginal discharge is synonymous with a vaginal infection. Let us look at a few causes of vaginal discharge below.
What is a normal (physiological) discharge?
A normal vaginal discharge exists and consists of secretions from the different structures in the reproductive tract. It is usually clear or white. The type and amount of the above secretions are influenced by hormone levels. The phase of the menstrual cycle, therefore, influences the quantity and quality of normal discharge. During the follicular phase, there is a gradual increase in vaginal fluid discharge, peaking at ovulation. After ovulation (luteal phase), the discharge becomes more viscous and thicker. Diet, medication, and OTC dietary supplements affect the odour of normal vaginal discharge.
Pregnancy
Growth of the vaginal cells during pregnancy leads to an increased number of cells being shed into the vagina. Women thus notice an increase in vaginal discharge. However, pregnancy may also predispose women to infective conditions, such as Candidiasis.
Atrophic vaginitis
Atrophic vaginitis is a vaginal inflammatory condition that results when the cells lining the vaginal wall are deficient in oestrogen. It mostly occurs in postmenopausal women.
Symptoms include vaginal spotting, soreness, painful urination, itching, painful sex and an increased vaginal discharge.
Infectious causes of vaginal discharge.
- Bacterial vaginosis
Bacterial vaginosis (BV) is the most common vaginal infection among women in their reproductive years, accounting for half of all cases of vaginal inflammation. It reflects an overgrowth of microorganisms that live in the vagina causing a disequilibrium of the vaginal ecosystem. Changes in the vaginal flora occur most commonly around the time of menstruation and following sexual intercourse, and women who suffer recurrent BV often report that the discharge is worse at these times.
Clinical presentation: The predominant complaint is of an offensive, fishy-smelling, thin vaginal discharge present at the opening of the vagina. The odour is often more noticeable after unprotected sexual intercourse.
Complications: Among the gynecological complications are pelvic inflammatory disease, abnormal bleeding, and transmission of HIV infection. Obstetric complications are preterm delivery, mid-trimester miscarriages, and infections during pregnancy and after delivery.
- Candida vulvovaginitis (Candidiasis)
Candidiasis ranks as the second most common cause of vaginal infection. Approximately 3 in 4 women are estimated to have at least one episode of this infection during their reproductive life. Of the infected women, 1 in 2 will experience recurrence.
Predisposing factors: Antibiotics, pregnancy, diabetes, tight synthetic underwear and HIV infection.
Clinical presentation: The presentation typically consists of vulvar itching, vulvar pain, and a variable vaginal discharge, ranging from thick, cottage cheese-like to watery. An odour is significantly absent in Candida infections. However, diagnosis based on clinical findings alone is unreliable and as many as 2 in 3 women who believe they have Candidiasis have a different condition causing their symptoms.
Sexually Transmitted infection causing vaginal discharge.
1.Trichomonas vaginalis (Trichomoniasis)
The third most common cause of infectious vaginitis and responsible for about 1 in 3 cases. It is also one of the more common STIs. It has been isolated from toilet seats, baths, poorly chlorinated water, etc.
Predisposing factors: It is a sexually transmitted disease, with transmission being greater from men to women. Trichomoniasis is also an important co-factor in increasing HIV transmission.
Clinical presentation: A copious green or yellow vaginal discharge is the presenting complaint for 70% (more than 2 in 3) of infected women, and about 50% (1 in 2) complaint of an associated offensive odour.
Sexual contacts with women with confirmed infection must always be treated.
2. Chlamydia trachomatis and Neisseria gonorrhoeae
These two sexually transmitted organisms are grouped, for they are the main causes of vaginal discharge due to infectious cervicitis (inflammation of the cervix). The infection is asymptomatic in 80% (4 in 5) of women
Clinical presentation: A purulent vaginal discharge, intermenstrual bleeding or bleeding after sexual intercourse, pain on urination, lower abdominal pain and painful sex are encountered.
A word of caution on over-the-counter drugs
Certain drugs were released over-the-counter to enable women to self-medicate a perceived minor complaint and common infections such as Candida. The easy access to self-treatment is appealing to the patient, the pharmaceutical providers, medical aid funds, and many clinicians. The crucial aspect of self-medication is that the woman should be able to self-diagnose correctly. Recent studies have shed light on the inappropriate use of these medications. Nearly all women have used clotrimazole/fluconazole before and 2 in 3 of them did not have candidiasis, but another cause for the discharge. The main disadvantages of self-medication are unnecessary use and use for the wrong indication. The clinical implication of this is a delay in diagnosing and initiating treatment for a potentially more serious cause, such as STIs and cancers.
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