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Discharge from the vagina

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HealthWiki > A Book for Midwives > Chapter 18: Sexually transmitted infections > Discharge from the vagina


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.

In this chapter, we organize the different infections a woman can have by the symptoms the infection causes. Discharge from the vagina can be a symptom of chlamydia, gonorrhea, trichomonas, or a vaginal infection that is not sexually transmitted.

Contents

Chlamydia and gonorrhea (clap, the drip, gono, VD)

Chlamydia and gonorrhea are both serious illnesses. But they are easy to cure if they are treated early. If they are not treated, they can lead to severe infection or infertility in women and men.

Signs in a woman

Signs can start weeks or months after having sex with an infected person.

  • yellow or green discharge from the vagina or anus
  • pain or burning when urinating
  • fever
  • pain in the lower belly
  • pain or bleeding during sex
  • or no signs at all

Both men and women can have chlamydia or gonorrhea with no signs. And even a person with no signs can pass chlamydia or gonorrhea to another person.

Signs in a man

Signs usually start 2 to 5 days after a man has sex with an infected person.

  • discharge from the penis
  • pain or burning while urinating
  • pain or swelling in the testicles (balls)
  • or no signs at all
Treatment

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 500 mg erythromycin
by mouth, 4 times a day for 7 days
or
  • give 500 mg amoxicillin
by mouth, 3 times a day for 7 days
To treat gonorrhea
  • inject 125 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 if she might have 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.

If a baby has a chlamydia infection
  • give 30 mg erythromycin syrup
by mouth, 4 times a day for 14 days
If a baby has a gonorrhea infection
  • inject 125 mg ceftriaxone
in the thigh muscle, 1 time only
If you cannot test to find out which disease is causing the infection, give medicines for both.


Pelvic infection (pelvic inflammatory disease, or PID)

the womb, tubes, and ovaries, showing an infection, or abscess, in the tube.
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. Germs get into the woman’s womb, tubes, or ovaries and cause infection there.

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 500 mg erythromycin
by mouth, 4 times a day for 14 days
or
  • give 500 mg amoxicillin
by mouth, 3 times a day for 14 days
AND for gonorrhea
  • inject 125 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, 3 times a day for 14 days

Do not take metronidazole in the first 3 months of pregnancy.
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 is very uncomfortable and itchy. Men usually do not have any signs but they can carry it in the penis and pass it to a woman during sex.

Trichomonas is not dangerous, but it can irritate the vagina, which can make it easier for a woman to get other STIs including HIV.

Signs of trichomonas
  • bubbly gray or yellow discharge
  • bad-smelling discharge
  • red and itchy genitals and vagina
  • pain 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
If the woman is pregnant:
She should wait until after the end of the third month for treatment. This drug is not safe in the first 3 months of pregnancy. After the third month:
  • give 400 to 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 can often 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
soak a clean piece of cotton in gentian violet 1%:
  • insert the cotton
into the vagina, every night for 3 nights.
Remove the cotton each morning.
or
  • put one 200 mg miconazole insert
high in the vagina, each night for 3 nights
or
  • put one 100,000 Units nystatin insert
high in the vagina, each night for 14 nights
or
  • insert 1 full applicator of clotrimazole 1% cream
into the vagina, each night for 7 nights
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 cause pregnant women to have their babies too soon or get an infection after the birth.

Signs of bacterial vaginosis
  • more discharge than usual
  • a bad, fishy smell from the vagina, especially after sex
  • mild itching


To treat bacterial vaginosis
If the woman is pregnant:
She should wait until after the end of the third month. This drug is not safe in the first 3 months of pregnancy. After the third month:
  • give 400 to 500 mg metronidazole
by mouth, 2 times a day for 7 days
or
  • put one 500 mg metronidazole insert
high in the vagina, every night for 7 nights



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