Discharge from the vagina

This content is from
pages 323 to 328 of A Book for Midwives

It is normal for women to have some discharge (wetness) from the vagina. This discharge is the way the vagina cleans itself. The discharge changes during the days of the monthly cycle and also during pregnancy.

But a major change in the amount, color, or smell of the vaginal discharge can mean there is an infection of the genitals. This infection could be an STI, or could be another type of infection.

STIs that might cause discharge from the vagina are chlamydia, gonorrhea, trichomonas, or a vaginal infection that is not sexually transmitted, such as PID, yeast or BV.

If possible, every pregnant woman should be tested for chlamydia and gonorrhea. If the test shows she has one or both of these infections, she and her partner should be treated. But if it is not possible for her to be tested, and she or her partner have signs of the infection, they should be treated anyway. It is better to treat someone who might be infected — even if you do not know for sure.

To treat chlamydia
give 1 gram azithromycin			by mouth, 1 time only
or
give 500 mg erythromycin			by mouth, 3 times a day for 7 days
or
give 500 mg amoxicillin			by mouth, 3 times a day for 7 days
To treat gonorrhea
inject 250 mg ceftriaxone			in the muscle,1 time only
OR
give 400 mg cefixime			by mouth,1 time only

It is very common to have chlamydia and gonorrhea at the same time. If you are not sure whether the woman has chlamydia or gonorrhea, or both, treat her and her partner for both infections.

Note: In the past, penicillin was used to cure gonorrhea. Now, in many places, penicillin will not kill gonorrhea anymore because of drug resistance. Find out which drugs work best in your area.

Problems in babies from chlamydia and gonorrhea

Women who have chlamydia or gonorrhea when they give birth can pass these infections on to their newborn babies. This can cause eye infection leading to blindness, or serious lung problems. A chlamydia or gonorrhea infection in the eyes usually causes a thick yellow discharge from the eyes within the first month. To prevent eye infection in babies, put antibiotic ointment into each baby’s eyes after birth.

To treat chlamydia or gonorrhea or both:
If the baby is less than 7 days old
inject 125 mg ceftriaxone			in the thigh muscle, 1 time only
If the baby is 7 to 28 days old
inject 125 mg ceftriaxone			in the thigh muscle, 1 time only
and
give 50 mg azithromycin			by mouth, 1 time a day, for 3 days
OR
inject 125 mg ceftriaxone			in the thigh muscle, 1 time only
and
give 30 mg erythromycin			by mouth, 4 times a day, for 14 days

Pelvic infection (pelvic inflammatory disease, or PID)

womb

abscess

pelvic infection

Pelvic inflammatory disease is a serious infection of a woman's womb, tubes, or ovaries.

Pelvic inflammatory disease is a serious infection of a woman’s womb, tubes, or ovaries.

A pelvic infection can happen when a woman has an STI, usually chlamydia or gonorrhea, that is not treated. It can also happen to a woman after an abortion or after a birth, when germs get into the woman’s womb, tubes, or ovaries and cause infection.

If a pelvic infection is not treated, it can cause long-term pain for the woman. Women who have had pelvic infections have a greater chance of having a tubal pregnancy or of becoming infertile. Pelvic infection can even lead to death.

Signs of pelvic infection

pain in the lower belly
high fever (more than 38°C or 100.4°F)
feeling very ill or weak
bad-smelling green or yellow discharge from the vagina
pain or bleeding during sex

To treat pelvic infections
A woman with a pelvic infection should take 3 medicines at once. One medicine to treat chlamydia, one to treat gonorrhea, and another antibiotic — metronidazole:
For chlamydia
give 1 gram azithromycin			by mouth, 1 time only
or
give 500 mg erythromycin			by mouth, 2 times a day for 14 days
or
give 500 mg amoxicillin			by mouth, 3 times a day for 7 days
AND for gonorrhea
inject 250 mg ceftriaxone			in the muscle, 1 time only
or
give 400 mg cefixime			by mouth, 1 time only
AND to kill any other germs that cause pelvic infection
give 400 to 500 mg metronidazole			by mouth, 2 times a day for 14 days
Do not drink alcohol during the time you are taking metronidazole.
If the woman is not better after 2 days and 2 nights (48 hours), or if she has high fever or vomiting, she should go to a medical center right away. She needs strong IV medicines (in the vein).

Trichomonas (trich)

Trichomonas infection can be very uncomfortable, but is not dangerous itself. If untreated, it can make it easier to get other STIs including HIV, can make getting pregnant more difficult, or can make certain types of cancer more likely. In pregnant women, it can cause babies to be born early and smaller.

Some women who have trichomonas infections do not have any signs. Men usually have no signs but they can carry it in the penis and pass it to a woman during sex.

Signs of trichomonas

bubbly gray or yellow discharge
bad-smelling discharge
red and itchy genitals and vagina
pain during sex or burning while urinating

To help the woman feel better, she can take a sitz bath. She should sit in a pan of clean, warm water for 15 minutes as often as possible. This is soothing to the genitals and will speed healing. She should not have sex until she and her partner are finished with treatment and all the signs are gone.

To treat trichomonas
give 500 mg metronidazole			by mouth, 2 times a day for 7 days
Also treat the woman's partner with 2 g metronidazole by mouth, 1 time only.

Yeast (candida, white discharge, fungus)

Yeast is not usually sexually transmitted, but it is a very common vaginal infection. It is especially common in pregnant women or women who are taking antibiotics or birth control pills. Men can also get yeast infections.

Signs of yeast

itchy genitals
white, lumpy, sticky discharge
bright red skin outside and inside the vagina that sometimes bleeds
a burning feeling when urinating
a smell like mold or bread dough from the vagina

Treatment

Yeast is not dangerous, but it is best to treat yeast in a pregnant woman before the birth, or the baby can get thrush. Yeast may be cured using natural remedies.

Natural remedies for yeast infection

Mix vinegar or yogurt in a pan of clean warm water. The woman should sit in this liquid 2 times a day until she feels better. or she can also try making this mix: Mix 3 tablespoons of vinegar with 1 liter (quart) of boiled cool water.
	Soak a piece of clean cotton wool in this mixture and insert the cotton into the vagina every night for 3 nights. Remove the cotton each morning.

If natural remedies do not work, try one of these medicines:

To treat yeast infection
put one 100,000 Units nystatin insert or cream			high in the vagina, each night for 14 nights
or
put one 100 mg clotrimazole insert or cream			high in the vagina, each night for 5 nights
or
put one 500 mg clotrimazole insert			high in the vagina, each night for 1 night only

Prevention

Wearing loose clothing and underclothes made of cotton, rather than polyester or nylon, lets air around the genitals. This helps prevent yeast. Wash or change the underclothes often. Do not put soap in the vagina when bathing. Do not douche.

Bacterial vaginosis (BV, gardnerella)

Bacterial vaginosis is not sexually transmitted. It is not usually dangerous, but it can make it easier for women to get an STI, like HIV. It can cause pregnant women to have their babies too early. Many women who have bacterial vaginosis do not show signs.

Signs of bacterial vaginosis

more discharge than usual
a bad, fishy smell from the vagina, especially after sex
mild itching

To treat bacterial vaginosis
give 500 mg metronidazole			by mouth, 2 times a day for 7 days
or
give 250 mg metronidazole			by mouth, 3 times a day for 7 days
or
give 300 mg clindamycin			by mouth, 2 times a day for 7 days
Also treat the woman's partner with 2 grams of metronidazole by mouth, one time only.

Itching of the genitals

Itching of the genitals can have many causes. Itching around the opening of the vagina could be yeast or trichomonas.

Itching in the hair of the genitals or close to the genitals could be caused by scabies or lice. Scabies or lice can be treated with local remedies, or with medicines found in most pharmacies. For more information, see Where There Is No Doctor or another general medical book.

Some itching is caused by soaps or deodorants that have perfume in them. It can also be caused by plants and herbs that are used for douching or washing out the vagina. Wash with plain water and see if the itching goes away.

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This page was updated:01 Mar 2024

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