A discharge to check

Known in the medical world as leucorrhoea, this normal discharge corresponds to the physiological elimination of cells and secretions from the vagina and while the volume, thickness, colour and odour may vary throughout the menstrual cycle, it causes no discomfort.
However, when the characteristics of the leucorrhoea change notably and/or are associated with local symptoms such as itching and pain or discomfort in the pelvis or tummy, the abnormal discharge is related to an infection of the vagina (vaginitis) or sometimes of the vulva or the cervix.
Between eight and 10 different species of bacteria are present in the vagina. This normal flora is the result of a delicate balance between the different populations of germs and can be affected by numerous factors including hormonal fluctuations (oestrogens), modifications of the acidity of the vagina, excessive hygiene, serious stress, oral antibiotic use and of course Sexually Transmitted Infections (STI).
When the protective flora is impaired, infection can occur. This may be the result of excessive growth of existing “normal” vaginal germs or from various pathogens originating from the skin or the intestine, from contaminated water or hands or from sexual contacts.
Contrary to popular belief, most sudden occurrences of leucorrhoea are not sexually related and are generally limited to minor infections.
Abnormal leucorrhoea episodes tend to be frequent from pre-puberty to post-menopause and the features of the discharge as well as the concomitant manifestations are often suggestive of the pathogen involved:
Gardnerella vaginalis is a bacterium present in a small fraction in the vaginal flora. In some circumstances, the germ becomes dominant and induces vaginitis with a small and whitish discharge but a very strong odour that’s similar to rotting fish.
Vaginal candidiasis is a yeast infection that comes from a common type of fungus named Candida albicans. The discharge is cheesy and moderately abundant and the area around the vulva or anus is usually subject to skin abnormalities caused by fungal infection. The main symptom is severe itching that often leaves skin excoriations due to scratching. Candidiasis commonly occurs after oral antibiotic treatment that triggers an imbalance of the vaginal flora.
Various species of bacteria near the genital area may contaminate the vagina, especially when the flora is weakened. These infections are named bacterial vaginosis and lead to a purulent and smelly discharge as well as a marked burning sensation around the vulva.
Some STI can also induce abnormal discharge. Common and highly contagious STI include Trichomonas, a parasite infection that produces abundant, greenish and foamy vaginal discharge with itchiness and pain during intercourse or when urinating. Gonococcal infection or gonorrhoea is often asymptomatic in women but can occasionally produce purulent yellowish discharge with abdominal pain or urinary disorders. The presence of purulent penile discharge associated with painful urination in a male sex partner is highly suggestive of gonorrhoea.
Any prolonged vaginal discharge, especially if associated with occasional bleeding and abdominal pain, may also be a sign of upper genital infections or even a tumour and any women with these symptoms should consult her gynaecologist.
Diagnosis is usually made through a simple examination or through lab analysis of the discharge. Other tests are rarely needed. Even tough but ordinary vaginal infections are mostly not sexually related and the patient should not get upset when the doctor requires about possible signs and symptoms among a sex partner(s). If sexual transmission is suspected, then screening for HIV, hepatitis B, syphilis and chlamydia as well as other STIs needs to be carried out for all sex partners.
The treatment of common vaginal discharges includes antibiotic and/or antifungal medicines in tablet form or gynaecologic preparations (vaginal ovules or cream). Sex partners may also be treated.
Proper feminine hygiene can help prevent most of the common vaginal discharges but douching, which destroys the natural flora, is never recommended.

DR GERARD LALANDE is managing director of CEO-Health, which |provides medical referrals for expatriates and customised executive |medical check-ups in Thailand. He can be contacted at [email protected].