Vaginal Infections and Their Symptoms

Vaginal discharge, itching and burning are among the most common reasons for consultation. The natural vaginal flora protects against infection; when this balance is disturbed, different types of infection can develop. This article describes the three most common vaginal infections and how they differ.

Normal discharge versus infection

A certain amount of clear or whitish, odourless discharge is normal, and its amount varies across the cycle. Infection is suspected when there is a marked change in colour, odour or consistency, accompanied by itching, burning, or pain during intercourse or urination.

The most common vaginal infections

Bacterial vaginosis

Develops when lactobacilli in the vaginal flora decrease and other bacteria multiply. The most characteristic finding is a thin, grey-white discharge with a fishy odour; itching is usually not prominent. It is not a sexually transmitted infection, but a new partner, douching and smoking increase the risk. Because it may be associated with preterm birth in pregnancy, assessment is important.

Vaginal yeast infection (candidiasis)

Caused by overgrowth of Candida species. A white, cottage-cheese-like, odourless discharge with marked itching, redness and burning is typical. Antibiotic use, pregnancy, uncontrolled diabetes and immunosuppression predispose to it. Four or more episodes per year require separate assessment.

Trichomoniasis

A sexually transmitted infection caused by the parasite Trichomonas vaginalis. Yellow-green, frothy, foul-smelling discharge, itching and burning on urination may occur. The partner also needs treatment.

How is it diagnosed?

History, examination and microscopic examination of the discharge are usually sufficient; culture or molecular tests are requested where necessary. Because the symptoms overlap, self-medication without examination can lead to the wrong treatment and prolonged symptoms.

Principles of treatment

Treatment is planned by the physician according to the type of infection: antibiotics for bacterial vaginosis and trichomoniasis, antifungal agents for yeast infection. Medication should be taken for the full recommended period, and the underlying cause should be investigated in recurrent infections.

Prevention

• Avoid douching and perfumed products; wash the external genital area with water or a mild cleanser only
• Prefer cotton, non-tight underwear; do not stay in wet clothing for long
• Avoid unnecessary antibiotic use
• Use condoms to protect against sexually transmitted infections
• Keep chronic conditions such as diabetes under control

When to see a physician

A marked change in the colour or odour of discharge, itching and burning lasting more than a few days, accompanying fever or pelvic pain, pregnancy and recurrent infection are all reasons to seek assessment.