What is abnormal vaginal discharge? – Vaginal discharge becomes abnormal when it changes in quantity, consistency, colour and odour. Every woman is familiar with her typical vaginal discharge. When there is deviation from this, it becomes abnormal. Other characteristics of abnormal vaginal discharge include association with vulvar itching, rashes, pain during intercourse, lower abdominal pain or pain while urinating.

Causes of abnormal vaginal discharge

Abnormal vaginal discharge may result from infection of the vagina, cervix or uterus. Organisms that cause these infections include bacteria, fungi, viruses or parasites. These organisms could be contracted through sexual intercourse, poor perineal hygiene, vaginal douching etc.

Bacteria

Conditions caused by bacteria, leading to abnormal vaginal discharge, include bacteria vaginosis, gonorrhoea and Chlamydia infection

1. Bacteria vaginosis (BV): This results from the imbalance between the normal bacteria that defend the vagina against infection and the bacteria that cause infection. It is not strictly a sexually transmitted infection, as any condition that leads to reduction in the population of normal bacteria against disease-causing bacteria in the vagina (such as douching, prolonged use of antibiotics and immunosuppressive conditions) can result in bacteria vaginosis. Bacteria vaginosis puts a woman at risk of having sexually transmitted infection such as gonorrhoea and Chlamydia. 

1. Symptoms of BV: Bacteria vaginosis presents with copious gray-coloured watery foul-smelling / fishy odour vaginal discharge, with the odour being intensified during sexual intercourse.
2. Treatment for BV: Bacteria vaginosis is treated with antibiotics such as metronidazole or clindamycin which may be taken by mouth or applied locally to the vagina.

2. Gonorrhoea and Chlamydia - These bacteria are transmitted sexually and result in sexually transmitted infection which may affect the cervix, uterus and the fallopian tubes.

1. Symptoms: Both gonorrhoea and Chlamydia present with similar symptoms. These include: vaginal discharge, which may be greenish, yellowish or cloudy. Other symptoms include: lower abdominal pain, pain while urinating and irregular menstrual bleeding. Some affected women, especially those with Chlamydia, may not present with any symptom.
2. Treatment for gonorrhioea and Chlamydia: Treatment for both infections is with antibiotics, prescribed after evaluation by doctors, including testing for microbial sensitivity, in order to determine suitable antibiotics for the infection. Prompt presentation for evaluation and treatment is important in order to preserve the reproductive function of affected women. The sexual partner(s) should be treated along with the woman in order to avoid re-infection. 

Parasites

Trichomonas vaginalis is a parasite associated with vaginal discharge. It is commonly sexually transmitted but can also be contracted through other means such as sharing towels or bathing place.

1. Symptoms: Infection with Trichomonals vaginalis is characterised by yellowish or greenish discharge with unpleasant odour. There may be pain and itching around the vulva and when passing urine. Significant number of persons infected, however, may not present with any symptom. 
2. Treatment for trichomonas vaginalis: This infection is treated with antibiotics to kill the parasite. The drug commonly used for treatment is metronidazole or tinidazole. Both partners need to be treated in order to clear the infection. Sexual intercourse should be avoided during the period of treatment and up to a week after treatment in order to avoid re-infection. Retesting may be necessary in three months to check for recurrence.

Fungal (yeast) infection

This occurs when there is overgrowth of the fungi (yeast) resident in the vagina. This may be precipitated by any condition that leads to imbalance between the normal microorganisms that prevent infection in the vagina and those bacteria that cause infection.

Such conditions include: prolonged use of antibiotics, immune-suppressive conditions (such as HIV, use of certain drugs like steroids, diabetes mellitus), pregnancy, birth control pills etc,

1. Symptoms: Yeast infection presents with thick whitish vaginal discharge without odour. There may be burning sensation, itching or rashes on the vulva.
2. Treatment of fungal infection – Treatment is with antifungal drugs which may be local (i.e. applied vaginally) or tablets. The underlying cause should also be treated. In case of pregnancy, local drugs in form of cream or vaginal tablets are used in order to avoid its effects on pregnancy.

Viral infection

Genital herpes is a viral infection that is sexually transmitted and causes vaginal discharge.

1. Symptoms: Genital herpes presents with thick vaginal discharge with strong smell which gets stronger after sexual intercourse. Other symptoms include blisters / sores around the vulva, and burning sensation when passing urine. However, majority of affected patients do not present with any symptom.  
2. Treatment of genital herpes: Treatment is with antiviral drugs. Treatment of genital herpes is aimed at ameliorating the symptoms (such as vaginal discharge and genital sores) as cure cannot be achieved. Treatment also reduces the viral load and the frequency of recurrence, thereby reducing the risk of transmission to others.

Prevention of abnormal vaginal discharge

Abnormal vaginal discharge can be prevented by taking the following steps:

1. Good perineal hygiene: Good perineal hygiene should be maintained by wiping the anus from front to back after defecation in order not to transfer bacteria from the anus into the vagina. Public bathing place should be kept as clean as possible as trichomonas infection could be contracted from there.
2. Barrier protection during sexual intercourse: When having sexual intercourse with different sexual partners, it is safe to use barrier protection like condom (male or female). This reduces the chances of contracting sexually transmitted infection from such partners.
3. Avoid douching: Douching reduces the population of protective bacteria in the vagina thereby giving room to proliferation of harmful bacteria that cause infection resulting in abnormal vaginal discharge.
4. Avoid irritants around the vagina: These include perfumed soaps, gels etc. These irritants, just like douching reduce the population of good bacteria in the vagina. 
5. Avoid sharing towels: Infection with Trichomonas vaginalis can be prevented by avoiding sharing of body contact materials like towels.