Recurrent Vaginal Discharge Syndrome And How To Treat It

What is Vaginal Discharge Syndrome

Vaginal discharge syndrome is associated with only women. Most vaginal discharge syndromes are due to sexually transmitted infections (STIs).  

Other vaginal discharges are non-STI related but usually due to other infections such as UTIs, bacterial vaginosis and candidiasis.  Pregnancy, menstruation, stress and menopause are other normal physiological states that are associated with vaginal discharges which generally do not require medicines for treatment. 

However, some physiological discharges may have superimposed infections such as gonorrhea, trichomoniasis, bacterial vaginosis, syphilis, and UTIs which would warrant treatment.

Vaginal discharge syndrome is abnormal vaginal discharge or discomfort which is usually a result of at least two different causes. 

What are the signs and symptoms of Vaginal Discharge Syndrome

Symptoms of vaginal discharge syndrome are 

  • vaginal discharge, 
  • offensive odor, 
  • painful urination, 
  • painful sexual intercourse, 
  • lower abdominal pain, 
  • vaginal sores and 
  • vaginal itchiness. 

The discharge is increased and usually of varying colors, such as creamy, greenish, yellowish, or purulent with or without the symptoms listed above. 

What causes recurrent vaginal discharge syndrome?

Infective causes of vaginal discharge syndrome are 

  • Neisseria gonorrhoeae, 
  • Chlamydia trachomatis, 
  • Trichomonas vaginalis, 
  • Gardnerella vaginalis and 
  • Candida albicans. 

The above organisms cause sexually transmitted infections. 

The non-STI infective causes of vaginal discharge syndrome are Gardnerella vaginalis (causes bacterial vaginosis) and Candida albicans.  

Vaginal discharge due to non-pathogens are chemicals irritants like soap and shampoos, feminine hygiene preparations, solid matter (tampons,  forgotten condom pieces), stress, menstruation, menopause, use of hormonal contraceptives and pregnancy. 

Other causes are fistulae, malignancy and cervical polyps.

What are some of the risk factors associated with vaginal discharge syndrome?

Risk factors for vaginal discharge syndrome includes 

  • being single, 
  • younger age between 15-24 years, 
  • multiple sexual partners, 
  • homosexuality, 
  • douching,  
  • combined oral /hormonal contraceptive use, 
  • having sex with a symptomatic partner, 
  • history of trauma or surgery. 

Risk factors commonly associated with Candida albicans diabetes mellitus, steroid use, use of broad-spectrum antibiotics, tight-fitting synthetic underwear, and use of hormonal contraceptives.

How is vaginal discharge syndrome diagnosed?

Prompt diagnosis and treatment is required in all cases to halt the progression of the condition and development of complications.  

Diagnostic approaches usually employed are the syndromic diagnosis or definitive (aetiological) diagnosis.  In the syndromic approach, the clinician or pharmacist would take your history and complaints, examines you (usually with a chaperone) and consider the most possible causes of the signs and symptoms found and treat them as a whole. 

This approach can lead to overtreatment or misdiagnosis and promotion of antibiotic resistance. The syndromic diagnosis is however commonly employed especially in developing countries where resources are constrained because it is economical, large numbers of patients are treated at a time, does not require sophisticated machines or laboratory investigations. 

The etiological approach involves the clinician taking your presenting complaint and history, examining the patient and requesting for laboratory investigations.  During the laboratory investigation a sample (vaginal swab) is taken for microscopy, culture and sensitivity testing, gram staining,  PH testing or PCR. 

The aetiological method of diagnosing sexually transmitted diseases is the best method as treatment is targeted at the cause and frees the patient of the burden of many drugs, prevention of resistance, prevents waste and leads to identification of asymptomatic cases.

Some symptomatic vaginal discharges can be managed at home with common home remedies and over-the counter-medicines. Most of the remedies are particularly for yeast infections and bacteria vaginosis. 

Examples of these remedies are natural yogurt which is either eaten or applied to the vulva or inserted into vagina to restore normal vaginal flora and therefore treats the yeast infections. Natural yogurt contains beneficial bacteria (lactobacillus) that prevent the growth of pathogens like fungus which commonly cause yeast. Coconut oil, tea tree oil and garlic are also safe and effective in treating yeast.

Over-the -counter medicines available are the various antifungal medicines which come as creams, pessaries and oral tablets or suspensions. Examples are the clotrimazole, nystatin and miconazole pessaries and creams and fluconazole tablets. 

The pessaries are usually inserted deep inside the vagina. on the other hand; the creams are inserted with an applicator or applied inside and on the vulva. 

Others are the probiotics specifically formulated for female reproductive health such as lactobacillus pessaries.  Lactobacillus may also be co-formulated with other medicines such as clotrimazole and metronidazole as pessaries or creams.

Home remedies for bacterial vaginosis (Gardnerella vaginalis)

Yogurt: yogurt is a rich source of beneficial bacteria. Eating it helps restore and maintain a balance of the body’s beneficial bacteria and therefore prevents the growth of harmful bacteria that causes bacterial vaginosis.

Garlic: garlic has been shown to possess strong antibacterial properties. Inserting garlic into the vagina or taking garlic capsules daily helps treat bacterial vaginosis.

Tea tree oil: It has also got both antibacterial and antifungal properties.  

It has to be diluted with coconut or olive oil which serves as carrier oil before insertion into the vagina. It is corrosive to the skin.

Hydrogen peroxide: it is a cheap home remedy for bacterial vaginosis. it is used to irrigate the vagina once daily for up to a week. 

Metronidazole vaginal cream or pessaries or the oral tablets

Administered for one week is also an effective treatment for bacterial vaginosis. Metronidazole is a common over-the-counter antibiotic that is very effective at treating bacterial vaginosis and trichomonas vaginalis. Other nitro-imidazoles are tinidazole and secnidazole.

For the other causes of symptomatic vaginal discharge like N. gonorrhea (causes gonorrhea) ,  Chlamydia trachomatis (causes chlamydia),), herpes simplex type 2  (causes genital herpes), and trichomonas vaginalis (causes trichomoniasis) which requires the use of antibiotics or antivirals for treatment,  a medical doctor should be consulted for proper diagnosis and treatment. 

Inappropriate use of antibiotics can lead to the development of resistance of various pathogens to the antibiotics available.

Counselling To Patients With Symptomatic Vaginal Discharge

  • Partners should also be treated to prevent re-infection.
  • Barrier contraceptives such as condoms and diaphragms should be used during intercourse. 
  • Having unprotected sex increases the risk of contracting HIV and hepatitis B infection in addition to other STIs.
  • Take medicines as directed by the medical doctor or pharmacist.
  • Avoid douching or the use of fragrances, soaps, and other chemicals in the vagina.
  • Avoid wearing tight nylon made underwear but rather wear cotton underwears.
  • Wash underwears properly using detergents and dry them in the sun or iron after drying.
  • Avoid indiscriminate use of antibiotics unless they are recommended by a medical doctor or pharmacist.

What is Recurrent Vaginal Discharge Syndrome

Recurrent vaginal discharge is sometimes a challenging situation to both the clinician and the patient and requires investigations such as risk assessment, speculum examination, and vaginal samples for microscopy and culture and sensitivity testing to identify the cause and not merely continue with the empiric syndromic treatment approach.

Recurrent vaginal discharge is the symptomatic vaginal discharge of four or more episodes in a year following treatment with appropriate medications. 

Recurrent vaginal discharge occurs due to resistance of the infection to various medications used, poor compliance to therapy, re-infection, and immunocompromised state of the individual.  Continuous exposure to various allergens such as soaps and various chemicals, and being psychologically stressed accounts for some persistent vaginal discharges. 

Patients experiencing recurrent discharges have to seek medical attention for further investigation.

Treatment may require a longer duration of therapy. 

Avoid self-treatment when one has recurrent vaginal discharge to prevent the emergence of resistant organisms as a result of misdiagnoses or use of inappropriate medicines and to prevent the development of complications such as pelvic inflammatory disease, ectopic pregnancy, infertility, systemic infections, urethral stricture, prematurity, miscarriage, and low birth weight.

How can I prevent vaginal discharge syndrome?

  • Both partners should receive treatment.
  • Avoid multiple sex partners.
  • Use condoms or diaphragms during sexual intercourse.
  • Avoid douching or use of chemicals in the vagina.
  • Seek psychological treatment on depression or counseling on stress management strategies.
  • Complete all treatment courses prescribed by the physician.
  • Good nutrition as well as management of other conditions that causes suppression of the immune system.
  • Surgical repairs of fistulae and removal of cervical polyps.

In the video below, you will learn about various types of vaginal discharge especially the ones that you need to worry about. If you usually have watery discharge that feels like you have peed yourself then check this article out instead.

WRITTEN AND EDITED RESPECTIVELY BY:

Chief Editor at Wapomu.com

MPSGH, MRPharmS, MPhil.

Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.

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