Vaginal Discharge & Related Conditions

Question 1

What is vaginal discharge?

Answer 1

Healthy vaginal environment varies from person to person but there will be vaginal and cervical cells secretions; Glycogen, fed on by Lactobacillus spp (most populus bacteria)
-> this produces bacteriocins, lactic acid and hydrogen peroxide
->leads to acidic pH at ≤4.5 inhibiting overgrowth of pathogens

‘Healthy’ discharge; clear, white, slippery to slightly sticky depending on the phase of cycle. Circa a teaspoon per day.

Some of the other bacteria may overtake the Lactobacillus and the balance is unended.

Risk factors often involve pH balance;
* Affected by age, douching.
* Hormonal influences (cyclical changes)
* Underlying conditions
* Sexual intercourse (friction etc)
* Lubricants and semen
* Feminine hygiene products
* Medication

Question 2

What causes unhealthy discharge?

Answer 2

Infective causes of discharge
* Bacterial vaginosis;
* Candida vaginitis aka thrush
* Some STDs; Trichomoniasis (main one), Chlamydia, Gonorrhoea - though herbalists NOT ALLOWED to treat STIs

Other causes
* Hormonal vaginitis: atrophic vaginitis (post menopausal),
* Irritant vaginitis: allergies to latex in condoms, spermicides, deodorants, soaps. inflammation: sore swollen, red, pruritis, dysuria
* Non-infectious causes of vaginal discharge: foreign body such as forgotten tampons or diaphragms, or malignancy.

Question 3

What is Bacterial Vaginosis?

Answer 3

Bacterial Vaginosis - Caused by overgrowth of bacteria naturally found in vagina, and not an infection caused by a single microorganism but rather an imbalance;
* reduced acidity (favouring anaerobic organisms)
* reduced Lactobacillus
* Gardnerella vaginalis most often involved, others involved too

Risk factors - See above on pH plus
* Copper intrauterine device use may increase
colonization by bacterial vaginosis
* Smoking
* Decreased risk with hormonal contraceptive use

Conventional treatment: Metronidazole: re-occurrence common as cause lack of healthy vaginal microbiome.

Question 4

What are the signs and Symptoms of Bacterial Vaginosis?

Answer 4

Symptoms
* Discharge: thin, frothy, grey/milky especially after intercourse or during menstruation.
* A fishy odour
* Vaginal pH over 4.5
* ‘Clue cells’; cells that line the vagina and have clusters of bacteria adhered to their surface) is diagnostic.

Complications include
* increased risk of miscarriage,
* premature labour,
* increased incidence of perinatal death
* increased incidence of abnormal pap smear, PID, infertility, and endometriosis
* complications such as post-surgical gynaecological infections.

Question 5

What is Candida vaginitis aka Vaginal Thrush?

Answer 5

Overgrowth of fungus in the vagina and/or vaginal opening

Symptoms include
* Discharge: white, yellow-white cottage cheese–like in character (watery to thick), yeasty smell
* Happens within a normal vaginal pH ≤4.5;
* Pruritis, soreness, irritation, vulvar burning, dysparunia, and urinary discomfort
* Candida is part of the normal flora

Risk factors
* Immuno-compromised individuals
* High-oestrogen medication
* Medications (cytotoxic drugs, immunosuppressive drugs, radiotherapy or chemotherapy), or frequent antibiotic use
* Type and fit of clothing
* Pregnancy (in late pregnancy often)
* Impaired glucose tolerance
* Allergic factors

Question 6

What is conventional treatment for Candida vaginitis?

Answer 6

Conventional Treatment

OTC anti-fungal oral and/or topical and should clear within 7-14 days

Four or more confirmed candida
symptomatic infections within one year:
likely the patient has systemic causes.

Question 7

What is Trichomoniasis vaginalis?

Answer 7

Sexually transmitted infection, by parasite.

• Motile flagellate protozoan.
• Sexually transmitted.
• In man; leads to non-gonococcal urethritis and can have negative impact on fertility.
• In women; affect vagina and urethra, can also infect the Bartholin glands and bladder.

Question 8

What are the signs and symptoms of Trichomoniasis vaginalis?

Answer 8

Symptoms - can be asymptomic but can get:
* Discharge: frothy, bubbly, white/green/yellow-green discharge, or colourless
* Foul smelly, musty, fishy…..
* pH greater than 4.5
* Dyspareunia, bleeding on intercourse, dysuria
* Vulvovaginal pruritis, burning, irritation, vulvar redness and swelling
* Occasional; lower abdominal pain
* Can be present alongside other sexual transmitted disease
* “Strawberry cervix” (cervix with small hemorrhages - only in a small % of people see this

• Dx: microscopic; culture is more sensitive
  for diagnosis.

Complications:
* female infertility
* post-partum infection
* pelvic inflammatory disease (PID), and
increased risk of postoperative infection,
* cervical dysplasia
* pre-term delivery, and low–birth weight
infants