KENNETH B. GOODRICH, M.D.
COMMON VAGINAL DISCHARGES
YELLOW DISCHARGES WITH AN ODOR
TRICHOMONAS
GONORRHEA
FOREIGN BODIES
WHITE THICK DISCHARGE – NO ODOR
YEAST INFECTION
WHITISH –GREY DISCHARGE WITH AN ODOR
BACTERIAL VAGINOSIS
BROWNISH, MAROON, PINK, BLOODY DISCHARGE
VAGINAL TEAR OR IRRITATION
CERVICAL OR UTERINE INFECTION
CERVICAL OR UTERINE POLYP / FIBROID
VAGINAL, CERVICAL OR UTERINE CANCER
YELLOW DISCHARGES WITH AN ODOR
TRICHOMONAS
Trichomoniasis, sometimes referred to as "trich," is a common STD that affects 2 to 3 million Americans yearly. It is caused by a single-celled protozoan parasite called Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urogenital tract; the urethra is the most common site of infection in man, and the vagina is the most common site of infection in women.
Symptoms - in women a mild to heavy yellowish green to gray discharge, vaginal odor, discomfort during intercourse, and sometimes irritation with urination. Itching and irritation of the vaginal area is common. Rarely an infection inside the uterus will cause lower abdominal discomfort.
In men no symptoms are usually present, but occasionally a thin, whitish discharge is seen from the tip of the penis, and painful or irritating urination.
Treatment – Both partners need treatment even though neither partner may have symptoms. Metronidazole is the primary drug used to treat trichomoniasis. Do not drink alcohol because mixing the drug and alcohol will cause severe nausea and vomiting. Please eat before taking this medication.
Complications – research suggests that women infected have and increases risk of transmission of HIV infection and may be more prone to premature labor and delivery of premature infants.
Gonorrhea
Over 600,000 new cases of gonorrhea occur each year. Often called The Clap, gonorrhea is caused by the Neisseria gonorrhea bacteria. These bacteria can be found in moist areas of the body including the vagina, penis, eyes, throat, and rectum. Infection can occur with contact to any of these areas. An infected person may also spread gonorrhea from one part of their body to another by touch, such into the eye, skin sores, etc. Gonorrhea can be spread through all forms of sexual activity including oral, vaginal, and rectal sex. Mothers infected at the time of childbirth can pass gonorrhea on to their infants.
Who gets gonorrhea?
Although any sexually active person can get gonorrhea, it is most prevalent among those from 15 to 30. Women who have vaginal intercourse with an infected man have a 60 to 90 percent chance of becoming infected; while men who have vaginal sex with and infected women have a lower 30 to 50 percent chance of becoming infected by this sexually transmitted disease.
Risk of Gonorrhea
Gonorrhea and Chlamydia are the major causes of pelvic inflammatory disease ( PID ), infertility, ectopic pregnancy, and chronic pelvic pain and discomfort .
Symptoms - The symptoms of genital gonorrhea differ in men and women. The vagina and cervix are primarily affected in women infected with this sexually transmitted disease; however gonorrhea can spread to the uterus and fallopian tubes if left untreated. Often women do not experience recognizable symptoms; however when symptoms do occur they can include:
· Abnormal vaginal bleeding
· A burning sensation during urination
· Yellowish vaginal discharge with odor
· General irritation of the outer area of the vagina
The primary point of infection in men is most often the urethra. About one in five infected men may not experience symptoms of gonorrhea; however the majority of men who do have symptoms may experience:
· A yellow pus-like discharge from the tip of the penis
· Stinging and burning during urination
· Frequent urination
· Blood in the urine
· Swelling of the glands in the groin
· The head of the penis may turn red
Other symptoms such as are pain, swelling, discharge can occur when gonorrhea affects the throat or rectum of both women and men
Treatments for gonorrhea:
· Cefixime 400 mg orally in a single dose,
· Ceftriaxone 125 mg IM in a single dose,
· Ciprofloxacin 500 mg orally in a single dose,
· Ofloxacin 400 mg orally in a single dose, PLUS Azithromycin 1 g orally
· in a single dose,
·
FOREIGN BODIES Some objects are designed for use in a woman’s vagina. These include tampons, vaginal suppositories, and medications delivered through the vagina. Others are not intended to be inserted and may be placed there accidentally or intentionally. Doctors refer to these objects found in the vagina as “ foreign bodies ”. These foreign bodies may produce symptoms or be asymptomatic for long periods of time. Vaginal foreign bodies are very commonly seen in children. Adolescent girls may present with foreign bodies, which primarily consist of forgotten tampons or broken portions of condoms. Adults may also present to the emergency department with vaginal foreign objects, which may have been placed there intentionally or as part of a sexual encounter or placed as part of an episode of abuse. Glass, cigarettes, vegetables and all sorts of objects have been found in the vagina. Symptoms Whle a variety of symptoms may result from a foreign body in the vagina, the most common symptoms are bleeding or foul-smelling vaginal discharge. Less common symptoms may include pain or urinary discomfort. The most common foreign body of the vagina in small children is small amounts of fibrous material from clothing, carpets, and tissue. Other foreign objects found in the vagina in children may be placed there at the time of self-exploration, such as crayons and marker caps. Adolescent women may use tampons once their menses begin, and sometimes these tampons are forgotten and may not be removed for days. Condom breaks may also leave bits of latex or non-latex material in the vagina. Adults may place foreign objects into the vagina as part of a sexual experience. Less commonly, cases of domestic abuse may result in very unusual objects being placed into the vagina. Adult women may also experience forgotten tampons or bits of condom.
Common symptoms of a vaginal foreign body include the following:
· Vaginal discharge, generally foul-smelling and yellow, pink, or brown
· Vaginal bleeding, especially light bleeding
· Vaginal itching or foul odor
· Urinary symptoms such as discomfort with urination
· Vulvar discomfort due to vaginal discharge producing skin irritation of the outside of the vagina
· Abdominal or pelvic pain from placement of large objects or perforation of a foreign body into the peritoneal cavity
Signs accompanying the presence of a foreign body include the following:
· Skin redness ( erythema )
· Swelling of the vagina and entrance to the vagina
· Rash in the vagina area
Vaginal Foreign Body Treatment
The best management of a foreign body is removal. This is generally the only treatment necessary. Treatment of the vaginal discharge with cultures and appropriate antibiotics.
YEAST INFECTION
Vaginal yeast infections are caused by the fungus, Candida. Vaginal yeast infection (yeast vaginitis) and vulvitis cause symptoms that are nonspecific, which means that aside from the yeast infection, other conditions can cause the identical symptoms. The most common symptom of a vaginal yeast infection is itching in the vaginal and/or vulvar area. Other symptoms of vaginal yeast infection and vulvitis include:
- Burning,
- Soreness
- Pain during intercourse and during urination
- Vaginal discharge, thick white cottage cheese like
- No odor
Vulvitis can also cause local pain in addition to the above symptoms. Pain in the vulvar area is referred to as vulvodynia.
In up to 5% of women, yeast vulvovaginitis may cause a recurrent problem. A recurrent yeast infection occurs when a woman has four or more infections in one year that are not related to antibiotic use. Recurrent yeast infections may be related to an underlying medical condition and may require more aggressive treatment.
Treatment
Clotrimazole (Lotrimin, Mycelex), miconazole (Monistat; Micatin), terconazole (Terazol), and nystatin (Mycostatin) are other antifungal medications that are also available as vaginal tablets.
Oral medications for yeast vaginitis and vulvitis include fluconazole (Diflucan).
Bacterial Vaginosis (BV) is a common condition of the vagina caused by an overgrowth of BV is not caused by a single bacterium (germ). In BV, an 'overgrowth' of various bacteria occurs in the vagina. It is not clear why this happens. Normally, there are a number of different types of harmless bacteria in the vagina. These bacteria help in the defense against harmful germs (such as candida ). In BV, there is a change in the balance of the normal bacteria in the vagina, and certain bacteria multiply and thrive much more than usual. Some bacteria become much more prominent than they normally are.
BACTERIAL VAGINOSIS
various bacteria (germs). It is not just a simple infection caused by one type of bacterium.
What causes Bacterial Vaginosis?
Doctors describe these changes as " a change in the bacterial flora of the vagina from mainly lactobacillus species to high concentrations of anaerobic bacteria."
BV is not caused by poor hygiene. In fact, excessive washing of the vagina may alter the normal balance of bacteria in the vagina, which may make BV more likely to develop.
Who gets Bacterial Vaginosis and how common is it?
At least 1 in 10 women have BV at some time in their life. It may be much more common than this as many cases are mild and cause no symptoms. (BV is at least twice as common as vaginal thrush.) Any woman can be affected by BV. BV is more common in women who have an intra-uterine contraceptive device (IUD). One study found that about half of women using an intrauterine contraceptive device had at least one episode of BV over a two year period.
Is Bacterial Vaginosis a sexually transmitted disease?
Most likely it is sexually transmitted, however, BV can affect any woman, including those who do not have sex. No bacterium is passed on that causes this condition. Sexual partners of women with BV are treated in this practice, and this process seems to decrease the recurrent discharge rates in our patients. It may develop after a change in sexual partner. However, a change in sexual partner may affect the balance of normal bacteria in the vagina.
How is Bacterial Vaginosis diagnosed?
- The typical discharge, and its characteristic fishy smell, makes BV likely.
- The discharge of BV has a typical acid level (pH) compared to other causes of discharge. (The overgrowth of the bacteria of BV causes the pH to change.) In addition, if an alkali is added to a sample of the discharge, it often causes a characteristic fishy smell.
- To help clarify the diagnosis, a sample (swab) of the discharge may be sent for testing. Large numbers of various bacteria that occur with BV are seen under the microscope.
- Vaginal cultures are usually performed if your insurance covers it.
What are the possible complications with Bacterial Vaginosis?
- Pregnancy. If you have untreated BV during pregnancy, you have an increased risk of developing some complications of pregnancy. For example, early labor, miscarriage, and infection of the uterus (womb) after childbirth.
- Surgery. If you have untreated BV, the chance of developing an infection of the uterus is higher following certain operations. For example, following a termination of pregnancy or a vaginal hysterectomy. However, antibiotics are given before various operations of the uterus if you have BV which usually prevents these infections.
- HIV. If you have untreated BV, you have an increased risk of developing HIV infection if you have sex with someone who is infected with HIV.
What is the treatment for Bacterial Vaginosis?
Metronidazole
A course of metronidazole tablets is the common treatment. It clears BV in about 7-8 in 10 cases. Read the leaflet that comes with the tablets for a full list of possible side-effects and cautions. However, main points to note about metronidazole include:
- The usual dose is twice a day for seven days. A single dose of 2 grams is an alternative, although this may be less effective and may cause more side-effects.
- Some people feel sick, and may vomit when they take metronidazole. This is less likely to occur if you take the tablets straight after food. A metallic taste is also a common side-effect.
- Do not drink any alcohol while taking metronidazole, and for at least 48 hours after stopping treatment. The interaction with alcohol can cause vomiting and other problems.
- Breastfeeding: metronidazole can get into breast milk, but is not thought to affect breastfed babies. However, to play safe, the standard 7-day course with the lower dose is preferred so as a baby does not get a large dose. If it is essential to use the large 2-gram single dose then it should be taken after the last breastfeed of the evening, at the start of the overnight breastfeeding break, to limit exposure to the baby.
Alternative antibiotic treatments
Metronidazole vaginal gel or clindamycin vaginal cream placed inside the vagina can be used if you prefer a topical treatment, or have unpleasant side-effects with metronidazole tablets. Note: clindamycin vaginal cream can cause weakening of condoms.
CERVICAL POLYPS
Cervical polyps can cause mild vaginal spotting to heavy vaginal bleeding depending on the size of the polyp. Removal of the polyps often stops the abnormal bleeding. Polyps inside the uterus may cause mild pink discharge to heavy vaginal bleeding.
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KENNETH GOODRICH, M.D. - OBSTETRICIAN- GYNECOLOGIST
Certified by the American Board of Obstetrics and Gynecology
Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women, Chronic Vaginal
Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
Aesthetic Services
