Vaginal Infections

What are vaginal infections?

All women have a natural vaginal discharge. Vaginal secretions change depending on the time of the month in women of reproductive age. The normal secretion is usually a milky liquid which dries as a white or cream mark; this changes to a clear, stretchy mucus around the time of ovulation. Vaginal secretions should not smell unpleasant or cause pain or itching. An infection can cause the secretions to change. There may be more discharge than normal, a change in colour, a strong or unpleasant smell or itching and discomfort.

What causes vaginal infections?

Irritation and discharge may be caused by leaving a tampon in too long, a reaction to perfumed soaps, bubble baths or washing powder or wearing nylon underwear or tights.

A cervical erosion (a small ulcer on the neck of the womb) can cause an increase in secretions which should be checked by a doctor. The contraceptive pill may also cause changes to cervical fluids.

The most common vaginal infections are thrush (candidiasis), bacterial vaginosis and trichomoniasis (TV). Sexually transmitted diseases such as gonorrhoea and chlamydia can also cause symptoms and should be treated at a genito-urinary clinic.

What are the symptoms?

Thrush (candidiasis) is an infection caused by a fungus (yeast) called Candida albicans. This organism is present naturally in the intestines and vagina but in certain circumstances overgrowth may occur, causing an infection. The balance of micro-organisms in the vagina may be upset by antibiotics, pregnancy, the use of scented soaps or bubble baths or by wearing nylon underwear or tights. Thrush causes a thick white discharge often described as resembling cottage cheese. The discharge should not smell or change colour - if it does it may indicate that a different type of infection is present. If it is the first episode of thrush, swabs may be taken to confirm the diagnosis. If the thrush recurs, the symptoms are usually recognised and no further testing should be necessary.

Bacterial vaginosis is also known as gardnerella and causes a grey, watery discharge with a strong 'fishy' smell. It is caused by an increase in the bacteria which normally live in the vagina. A swab usually needs to be taken from the vagina to confirm the diagnosis.

Trichomoniasis (TV) is caused by a tiny parasite and is sexually transmitted. The symptoms start between four days and three weeks after contact with an infected person. It causes a thin, yellow or green discharge which may be frothy and have an unpleasant 'fishy' smell. Again, a vaginal swab is usually required to confirm the diagnosis. Sometimes there are no symptoms.

Gonorrhoea is caused by bacteria and is sexually transmitted. It may not always cause symptoms. If it does, the symptoms may be a sore throat, pain or discomfort when passing urine and a thin, watery, yellow or green discharge. It is not usually detected during cervical smear tests or routine health checks if there are no symptoms. If a sexual partner has gonorrhoea, it is important for the other partner to be tested even if they do not have any symptoms. If symptoms clear up without treatment it is still vital for the infection to be treated. Gonorrhoea can be cured with antibiotics but there is an increasing risk of antibiotic resistance. If symptoms do not improve with treatment the patient should return to their doctor for re-evaluation. Gonorrhoea can spread inside the body and can cause pelvic inflammatory disease (PID) in women. PID can cause infertility. Investigation at a genito-urinary clinic is strongly recommended.

Chlamydia is a sexually transmitted infection caused by bacteria called Chlamydia trachomatis. Infected persons often have mild symptoms or none at all. Most people do not get tested until complications arise. In those that do get symptoms, these usually occur around a month after infection and include pain or stinging when passing urine, a milky or mucus-like discharge, pain during sexual intercourse, bleeding between periods and stomach pain. If left untreated chlamydia can cause PID and may affect fertility. A vaginal swab is required to confirm the diagnosis.

How are vaginal infections treated?

Thrush is treated with antifungal creams that are applied locally to the area surrounding the vagina or with antifungal pessaries or cream inserted into the vagina. Often a combination of the two is used. Examples of topical antifungal agents used to treat thrush include clotrimazole (eg, Canesten®), econazole (eg, Gyno-Pevaryl®), fenticonazole (Gynoxin®) and miconazole (eg, Gyno-Daktarin®). Some treatments for thrush are available to buy from pharmacies without a prescription. Sometimes antifungals are given orally as tablets or capsules. Oral antifungals used to treat thrush include fluconazole (eg, Diflucan®) and itraconazole (eg, Sporanox®). Single-dose fluconazole capsules (eg, Diflucan® One) are available to buy over the counter from pharmacies.

Bacterial vaginosis can be treated with antiprotozoal-antibacterial tablets containing either tinidazole (Fasigyn®) or metronidazole (eg, Flagyl®). Metronidazole is also available as a vaginal gel called Zidoval®. Other vaginal treatments include a cream containing clindamycin (Dalacin® Cream) and a vaginal tablet containing dequalinium chloride (Fluomizin®). Alternatively, pH correction gels/pessaries (eg, Balance Activ®, Multi-Gyn ActiGel®, Relactagel®) can be used.

Trichomoniasis can also be treated with antiprotozoal-antibacterial tablets containing either tinidazole (Fasigyn®) or metronidazole (eg, Flagyl®).

Gonorrhoea is usually treated with an antibiotic called ceftriaxone given as a single injection plus a single dose of another antibiotic called azithromycin given by mouth. If you are allergic to ceftriaxone another type of antibiotic (eg, ciprofloxacin or ofloxacin) will be prescribed. Effective treatment will ensure a cure of this condition.

Chlamydia is treated with antibiotics. The antibiotics usually prescribed include azithromycin, and doxycycline.

Further information available from:

Your local hospital - ask for the Genito-Urinary Medicine (GUM) or Sexual Health Clinic.

FPA (Sexual Health Charity)
23-28 Penn Street
London N1 5DL
Tel: 020 7608 5240

Fact sheet provided by MIMS

Date last reviewed: September 2014

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