Posts tagged ‘discharge’

What happens in Vegas stays in Vegas (Sometimes)

I recently went to Las Vegas for a medical conference.  Everywhere I went, I saw signs with the slogan “What happens in Vegas stays in Vegas!”.  This led me to joke to one of my gynecologist friends– “Sure.  Except if it’s herpes.” 

I guess I thought that was funny at the time.  But it occurred to me that it’s dangerous to propagate the idea that acting out (sexually or otherwise) is without consequences.  

It’s not that there’s anything wrong with Vegas.  And I’m not one to knock bachelor/bachelorette parties and a night of cocktails.  But if being forewarned is being forearmed, then using a condom is some food for thought you won’t find at the $19.99 dinner buffet.  And I’d like to give you, gentle reader, the skinny on a few souvenirs you don’t want to bring home with you.

Some sexually transmitted diseases can be cured with antibiotics.  These include gonorrhea, chlamydia, syphillis and trichomonas.  All of these can be diagnosed with simple tests available in your doctor’s office. Treatment of sexual contacts is important, and should occur for both partners at the same time.  All can be prevented with the use of latex condoms.

Gonorrhea and chlamydia are often lumped together when discussing sexually transmitted diseased (STD’s).  They are distinct diseases caused by different microbes, but are often found together in co-infections.  Both can be asymptomatic.  When symptoms occur, they often show up 2 to 3 weeks after infection.  Common complaints include

  • A yellow vaginal discharge
  • Painful or frequent urination
  • Burning or itching in the vaginal area
  • Redness, swelling, or soreness of the vulva
  • Pain in the pelvis or abdomen during sex
  • Abnormal vaginal bleeding
  • Rectal bleeding, discharge, or pain 

Gonorrhea and chlamydia are diagnosed by laboratory analysis of samples taken from the cervix using a cotten swab.  Timely treatment of gonorrhea and chlamydia can prevent infertility, which can be a complication of advanced infection.  Treatment is usually oral medication or a combination of oral medication and a shot (like a flu shot) given in the arm.  Advanced infections may need to be treated in a hospital with intravenous medication.



Syphilis first appears as a painless genital sore called a chancre (pronounced like “shank-er”). It lasts 10 days to 6 weeks after contact with an infected partner. Swollen lymph nodes in the groin m ay also occur.  A rash on the palms and soles (of hands and feet) occurs durng a second stage of infection 1 week to 3 months later.  Flat warts or a flu-like illness may occur at this time.  Syphillis can be diagnosed with a combination of physical exam and blood tests.  Early treatment is important to prevent long-term problems including birth defects in children of infected mothers.  Treatment usually consists of antibiotics given as a shot (in the arm or buttocks) and may need to be given more than once. 

Trichomonas vaginitis is a microscopic parasite that is spread through sex. Many people have no symptoms of trichomonas. When symptoms do occur, they include discharge from the vagina and vaginal itching and redness.  Trichomonas can be diagnosed on a vaginal exam (sometimes in combination with testing samples of vaginal fluid). Treatment usually consists of oral antibiotics or an antibiotic gel which is placed in the vagina. 

Some sexually transmitted diseases can’t be cured.  Usually, these are due to viruses. 

Human Immunodeficiency Virus (HIV), Human Papilloma Virus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B and C can all be sexually transmitted.  All can be treated with medication, but none can be cured.

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). Transmission can occur during intercourse.  It is possible for transmission can occur through orogenital (oral) sex too.  Anal sex is particularly risky.    Transmission rates can be significantly decreased with the use of a latex condom.  It can be diagnosed with a blood test and is treated with antiviral medications.  Untreated, it can cause compromise of the immune system, illness, and death.

Human papillomavirus (HPV) is one of the most common STDs in the United States.   There often are no signs of genital HPV. However, a few types of HPV cause warts. These can appear on the vulva, vagina, cervix, and anus. In male partners, they may occur on the penis, scrotum, or anus.

Sometimes warts go away on their own. If they do not, there are several treatments for warts available at your doctor’s office. Treating yourself with over-the-counter wart medications (compound W etc.) is NOT recommended.

Even after the warts have cleared up, the virus may be present. The virus can remain in the body for weeks or years without any symptoms.

Certain types  of the HPV virus are associated with an increased risk of cervical cancer.  HPV also may be linked to cancer of the anus, vulva, vagina, penis, head, and neck. 

Some types of HPV infection and pre-cancerous changes in the cervix are detected with a Pap Smear or Pap Test.  So while your Pap Smear doesn’t test for sexually transmitted diseases per se, it can diagnose HPV-related conditions. 

If abnormalities associated with HPV are found on your Pap Smear, your doctor will discuss diagnosis and treatment options with you.  You may also want to discuss the HPV vaccine, which prevents several types of HPV infections, and can be given to most girls and women aged 9-26 regardless of whether they have had an HPV infection in the past.

Herpes Simplex Virus (HSV) causes herpes.  It also causes “cold sores” on the face and mouth.  Although people sometimes refer to the HSV 1 virus as “oral herpes” and the HSV 2 virus as “genital herpes”, both viruses can cause lesions in both areas, so this distinction  isn’t particularly useful.  The best description is to say that genital herpes is any herpes ocurring on the genitals, regardless of virus subtype (1 or 2).

The most common symptom of genital herpes is a sore on or around the genitals. These sores are often multiple, usually red or blister-like, and may be itchy or exquisitely painful.  The sores can last from a few days to a few weeks.  Herpes can be diagnosed by a combination of physical exam, viral culture of open sores, and blood tests.

The symptoms go away by themselves, but the virus remains in your body. The sores may come back at any time, usually in the same place they first occurred. Treatment can help heal the sores and reduce the number of future outbreaks, but it cannot kill the virus. 

A person who has herpes can transmit the virus even in the absence of symptoms.  If you or your partner have oral or genital herpes, avoid sex from the time of first symptoms until a few days after the scabs have gone away.

The Hepatitis B and C viruses can also be transmitted by sexual intercourse. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise.  Hepatitis is acute when it lasts less than six months and chronic when it persists longer.  Chronic hepatitis may be asymptomatic, but can cause cirrhosis (scarring of the liver), liver failure, liver cancer, and death.  Hepatitis B and C can be diagnosed by blood tests.  Treatment is directed at reducing symptoms and slowing the progression of the disease. 

The Hepatitis B vaccine reduces the risk of contracting hepatits and is widely available.  It is recommended to all children and to high-risk adults (those with multiple sexual partners, who use intravenous drugs, or who are in occupations which may involve exposure to blood or other bodily fluids).  There is no hepatitis C vaccine. 

Hepatitis A, by the way, is not sexually transmitted.  It is food-borne and does not result in chronic infection. It causes an acute gastrointestinal illness and is often contracted by eating undercooked shellfish.  So, You can still get it in Vegas.  You’re welcome.

So, remember, there are some souvenirs nobody wants to bring home from vacation (or any other encounter).  If you have a new sexual partner or have any other reason to think you may be at risk for sexually transmitted infection, visit your heathcare provider for simple tests. 

And since I started this post with a poorly conceived joke, I’ll end with one.  Practice safe sex: Use your head (and use protection when giving it)!

November 18, 2010 at 9:03 pm 4 comments

Vaginal Discharge: The Good, The Bad, and The Ugly

One of my patients’ most common gynecologic complaints is about vaginal discharge.   It’s not something most women want to talk about.  I mean, if you watch enough commercials for “feminine hygeine products” you start to think that vaginal discharge will make you a social outcast who wears loose, flowy clothing  in varying shades of mauve and gray. 

But what causes vaginal discharge?  When is it normal? What can you treat at home?   And when do you need to see a gynecologist?  Those are some of the questions I’d like to address in this post.

First of all, vaginal discharge is one of the symptoms of a medical condition gynecologists call “vaginitis.”  Literally, it means inflammation of the vagina.  (And you thought taking Latin in high school would never come in handy.)

They key to vaginitis is the vaginal flora.  Vaginal flora aren’t roses and peonies blooming in your nether-regions.  They are microscopic organisms, like bacteria and yeast, who normally live in the vagina and are beneficial.  They need a certain level of moisture, acidity, and estrogen in order to function properly.  When the balance of normal vaginal flora is upset, vaginitis can result.

Normal vaginal discharge is often clear, white or yellow.  It can be thin and watery, creamy or similar to mucus in character.  Normal vaginal discharge may lack an odor or may smell musky (as opposed to abnormal discharge, which often smells foul and unpleasant).   When the vagina is in a healthy balance, it shouldn’t smell bad, burn/itch or hurt. 

The normal balance of vaginal flora may be upset by activities such as douching and tampon use.  Both can worsen the symptoms of vaginitis and should be avoided while symptoms persist.

One of the most common causes of vaginitis is a yeast infection.  These are caused by a fungus called candida which is normally found in small amounts in the vagina.  When candida overgrows, the symptoms of a yeast infection may occur.  These include itching and burning of both the vagina (inside) and the vulva (the outside skin near the vagina).  Symptoms may be worse after urination or intercourse. Some (but not all) women notice thick white discharge which may be odorless.    

Risk factors for developing a yeast infection include pregnancy, diabetes mellitus, recent antibiotic use, human immunodeficiency virus and oral contraceptive use.  Treatment is available by prescription or over-the-counter.  It usually involves antifungal medication (cream or suppository)  inserted in the vagina for 1 to 7 days.  Oral treament with a pill may also be offered, but is available by prescription only.  Longer courses of treatment may be necessary  Sexual partners do not require treatment. 

Bacterial vaginosis (BV) is caused by an overgrowth of certain vaginal bacteria, particularly gardnerella.  The main symptom of BV is increased discharge can be copious (a large quantity)and may be white, gray or even greenish in color.  A strong, fishy vaginal odor is often present.  The odor may increase after a mesntrual period or after sexual intercourse.   Itching may also occur.

Treatment is by prescription antibiotics.  Metronidazole (Flagyl) gel or oral capsules are prescribed for 5 days.  Oral metronidazole can not be taken in combination with alcohol or severe nausea/vomiting may occur.  Clindamycin suppositories or cream can be used for 3 to 7 days.   Longer courses of treatment are sometimes necessary. Sexual partners do not require treatment.

Vaginal discharge may also be a symptom of trichomoniasis.  This is a condition caused by the microscopic parasite Trichomonas vaginalis. It is a sexually transmitted disease (STD). Signs of trichomoniasis may include a yellow-gray or green vaginal discharge.  The discharge may have a fishy odor, which may lead one to confuse it with bacterial vaginosis. Burning, irritation, redness and swelling of the genitals may occur.  Pain may occur during urination. 

Trichomoniasis is usually treated with metronidazole (flagyl) by mouth.  Women who have trichomoniasis are at an increased risk of infection with other STDs, so they should be screened accordingly.  Sexual partners must be treated to avoid re-infection.  Sexual intercourse shoudl be avoided until both partners have received treatment.

Vaginal discharge may also be a sign of atrophic vaginitis.  This condition can occur when the level of estrogen in the body drops, as usually happens during breastfeeding or menopause.  Symptoms include dryness, itching and burning of the vagina.  Discharge may be present and pain may occur during sexual intercourse.  Treatment is usually aimed at restoring estrogen to the vagina through topical medications.  Water-based lubricant can also be helpful, especially during intercourse.

In summary, vaginitis and discharge are common conditions which may require special diagnostic tests and/or treatment by a gynecologist.  If you are experiencing bothersome symptoms, especially if over-the-counter treatments have failed, it is time to talk to your doctor.

October 19, 2010 at 7:39 pm 31 comments

Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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