Abnormal vaginal discharges

Dr Brigid Monda

A healthy vagina is never dry. It has natural secretions that keep it clean, moist and lubricated. The cervix, the lower end of the uterus that opens into the vaginal cavity has mucus-secreting glands which secrete a clear mucus secretion that drains downward into the vagina and mixes with bacteria, discarded vaginal cells and Bartholin’s gland secretions, and this is what constitutes the normal vaginal discharge.

Estrogen and Progesterone, the sex steroid hormones that control the menstrual cycle, also determine the amount and nature of mucus produced by the cervical glands. Which means, its volume and consistency is also pegged on the time of cycle. During ovulation for instance, you may notice increased wetness and a clear discharge because Estrogen makes the cervical mucus thin and runny to allow the sperm to pass through on their way to fertilising the ovulated egg. Pregnancy, emotional stress, nutritional status, medications, the pill, HRT and sexual arousal also increase the amount.

Many women do not know the difference between a normal and an abnormal discharge and assume it is yeast or thrush, but this is not always the case. Other infections like gonorrhoea, chlamydia, trichomonas, bacterial vaginosis, a ‘forgotten’ tampon, cervical polyps, some estrogen-containing drugs, cancer of the cervix, thread worms, diabetes, drug allergies, psoriasis and eczema can also cause abnormal discharges.

A normal vaginal discharge is clear, cloudy or egg-white in colour, sticky and elastic or thick and gooey in texture, has no smell, causes no itching or burning and may leave a yellow stain on the underwear. Any changes in colour, odour, texture and amount especially when accompanied with a smell, itching, burning, redness or bleeding could indicate a problem.

Bacterial Agenesis

It is the most common cause of an abnormal vaginal discharge in women during their child-bearing years and is more common than thrush. It is caused by an overgrowth of the bacteria that live as permanent non-paying guests in the vagina. You get an abnormal amount of a thin greyish watery discharge with a foul fishy smell that is more pungent immediately after sex, during menstruation or when exposed to air. Recurrence of bacterial vaginosis is common and can coexist with other vaginal infections like candidiasis.

Trichomoniasis

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Also called ‘trick,’ it is caused by a parasite called Trichomonas Vaginalis — a sexually transmitted infection common in people with multiple sexual partners. It is transmitted from penis to vagina or from vulva to vulva. Men harbour the infection in the urethra and prostate. It can also be transmitted through is genital contact with damp or moist towels, wet clothing, or toilet seats because the parasite can live outside the body for up to 45 minutes. You get a foul smelling profuse greenish-yellow frothy discharge that causes intense itching and irritation of the genitals with discomfort or pain while urinating and pain during intercourse. These symptoms are usually worse after menstruation, sexual intercourse and during pregnancy, and appear five to 28 days after exposure. Infection with Trichomoniasis increases your chances of getting HIV because of the inflammation the parasite causes in the genital area.

Chlamydia

It is also known as the silent STI, because it does not have symptoms, which makes seeking treatment a tricky affair. It is also sexually transmitted and is common in women aged 15-24. The few women who seek treatment do so because they get an abnormal vaginal discharge, burning when urinating, and spotting between periods or after intercourse any time from one to three weeks after being infected. It is transmitted through vaginal, anal, or oral sex and from mother to baby during vaginal birth. It is easily cured with antibiotics but if untreated, and this happens in majority of cases because the infection is silent, it spreads into the uterus and fallopian tubes wreaking havoc. It causes Pelvic Inflammatory Disease (PID) and permanent damage to the fallopian tubes and uterus. The woman then gets chronic pelvic pain, infertility, and the potential of ectopic pregnancy (pregnancy that occurs outside the uterus) because of the damaged fallopian tubes. It can also be passed from an infected mother to her baby during childbirth.

Gonorrhoea

Another common STI, it can also cause an abnormal vaginal discharge, yellowish, blood stained or purulent and is often mistaken for a bladder infection because there may also be pain or burning during urination and lower abdominal pain. It causes heavier periods and spotting in between periods. But just like Chlamydia, it is most often a silent infection and many doctors only see gonorrhoea as a pelvic abscess (a collection of pus) and PID.

And just like Chlamydia, it is also responsible for chronic pelvic pain, infertility, and ectopic pregnancy because of the permanent damage it causes to the uterus and fallopian tubes. Gonorrhoea can damage joints and heart tissue as well and increases your risk of acquiring HIV. It can also be passed from an infected mother to her baby during childbirth.

An infected partner will develop symptoms like a yellow purulent penile discharge and pain on passing urine within a few days of sexual contact. He may seek treatment, but because the woman is not complaining of any symptoms, and because the infection is an STD, most men will keep quiet about it to avoid conflict. She then develops the long-term complications because the infection quietly festers away in her pelvis damaging her tubes. Chlamydia and Gonorrhoea usually occur together.