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Vaginal discharge
Medical expert of the article
Last reviewed: 04.07.2025
Vaginal discharge that does not contain pathological impurities may be psychogenic. Vaginal discharge most often has an unpleasant odor, causes vaginal itching and is the result of an infection.
Very heavy vaginal discharge may appear due to the presence of a foreign body (for example, a forgotten tampon, etc.).
What types of vaginal discharge are there?
Vaginal discharge rarely fits the classic description.
Psychogenic vaginal discharge
Their number increases with puberty, increased sexual activity, pregnancy, and also when taking combination pills (which causes concern).
Mycotic vulvovaginitis (vaginal thrush) (Candida albicans)
This is the most common cause of vaginal discharge, classically described as "cheesy". The vulva and vagina may be red, slit-like and painful, especially if an allergic component is involved. The partner may not have any symptoms.
Risk factors include pregnancy, taking contraceptives and other steroid drugs, immunodeficiency states, taking antibiotics, and diabetes - a glucosuria test is required.
Microscopic examination reveals mycelial threads or characteristic oval spores. Grown on Sabouraud medium.
Who to contact?
Diagnosis of vaginal discharge
Find out the specifics of the anamnesis. Does the patient recognize the risk of contracting a sexually transmitted disease? If the patient is diagnosed with such a disease, it is necessary to examine the persons who were in sexual contact with her, for which you should contact a gynecological and urological clinic.
Conduct a mirror examination (if there is no pronounced pain) and take smears. To detect chlamydia, a cervical smear (and sowing on a special medium) is required; to detect gonorrhea, a cervical smear.
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Treatment of vaginal discharge
A single injection of an imidazole pessary, such as clotrimazole 500 mg, plus vulvar cream (and for the partner) is sufficient. The patient should be explained that the discharge is not related to sexually transmitted diseases.
Thrush often recurs; prescribe vaginal nystatin balls at night for 14 days or fluconazole 150 mg orally (but not during pregnancy). Widespread candidiasis (e.g. in the oral cavity, in the gluteal groove) in both partners may be the cause of reinfection. Fresh yoghurt (inserted on a tampon into the vagina) or acetic acid jelly with a pH of 4.0, such as Aci-Jel, can help prevent or reduce the symptoms of mild exacerbations. It is also advisable to avoid using chemicals, especially in the vulva (bath salts), the anus should be wiped from front to back, preferably wearing cotton underwear; thoroughly rinsed from washing powder or soap; baths with the addition of vinegar can be effective.
Trichomonas vaginalis (TV)
As a result of infection, vaginitis develops, accompanied by foamy discharge with a fishy smell. The disease is sexually transmitted. It is necessary to exclude the often accompanying gonorrhea. Trichomonas - mobile flagellate microorganisms (magnification x 40) can be seen on fresh smears or the pathogen can be identified by sowing. Treatment with metronidazole at a dose of 400 mg every 8-12 hours for 5 days.
Gardnerella vaginalis
Gardnerella are gram-variable anaerobic microorganisms that cause gray discharge with a fishy odor. The vagina is not inflamed, itching and pain in the vagina are rare. When mixed on glass with a 10% solution of potassium hydroxide, an ammonia smell appears. When examining a wet smear, granular cells of the vaginal epithelium - "glued cells" - can be seen. The diagnosis is based on a microscopic examination of the isolated culture of the pathogen. Treatment: similar to that for trichomoniasis.