Bad smell of vaginal discharge

Whether leucorrhea is normal is worthy of attention for women, because many people will experience abnormal leucorrhea when they have some inflammation. If the leucorrhea smells bad, it is most likely caused by bacterial vaginosis. Bacterial vaginosis is also a disease caused by bacterial infection. Next, I will introduce you to some relevant knowledge about bacterial vaginosis!

1. What is bacterial vaginosis?

Bacterial vaginosis (BV) is a mixed infection caused by the imbalance of normal vaginal flora. In a normal vagina, lactobacilli that produce hydrogen peroxide are dominant. When suffering from bacterial vaginosis, the number of lactobacilli that can produce hydrogen peroxide in the vagina decreases, leading to the massive reproduction of other microorganisms, mainly Gardnerella, anaerobic bacteria and Mycoplasma hominis, among which anaerobic bacteria are the majority, and the number of anaerobic bacteria can increase by 100-1000 times. The reasons for changes in vaginal flora remain unclear, but it is speculated that they may be related to frequent sexual intercourse, multiple sexual partners, or vaginal douching that causes alkalinization of the vagina.

In addition to causing vaginal inflammation, bacterial vaginosis can also cause other adverse outcomes. For example, bacterial vaginosis during pregnancy can lead to chorioamnionitis, premature rupture of membranes, and premature birth; in non-pregnant women, it can cause endometritis, pelvic inflammatory disease, and vaginal cuff infection after hysterectomy.

2. Symptoms of bacterial vaginosis

What are the symptoms of bacterial vaginosis? 10%-40% of patients have no clinical symptoms. Those with symptoms mainly present with increased vaginal discharge with a fishy odor, which is especially aggravated after sexual intercourse and may be accompanied by mild vulvar itching or burning sensation. The fishy odor of the discharge is due to the production of amines during the reproduction of anaerobic bacteria. Examination showed no signs of congestion or inflammation in the vaginal mucosa. The secretions were grayish white, uniform, thin, and often adhered to the vaginal wall. However, the viscosity was very low, and the secretions were easily wiped off the vaginal wall.

Treatment of bacterial vaginosis

The principle of treatment is to use anti-anaerobic drugs, mainly metronidazole, tinidazole, and clindamycin. Metronidazole inhibits the growth of anaerobic bacteria and does not affect the growth of lactobacilli. It is an ideal therapeutic drug, but it is less effective against mycoplasma.

1. Oral medication

The first choice is metronidazole 400 mg, orally, twice a day for 7 days. Alternative options: tinidazole 2 g, orally, once a day for 3 days; or tinidazole 1 g, orally, once a day for 5 days; or clindamycin 300 mg, twice a day for 7 days. Metronidazole 2 g taken all at once has poor therapeutic effect and is no longer recommended.

2. Local drug treatment

Suppository containing metronidazole 200 mg, once every night for 7 consecutive days; or vaginally apply 2% clindamycin ointment, 5 g each time, once every night for 7 consecutive days. Oral medications have similar efficacy to topical medications, with a cure rate of around 80%.

3. Follow-up

Patients who are asymptomatic after treatment do not require routine follow-up. Recurrence of bacterial vaginosis is common, and patients should be informed to return for follow-up visits and receive treatment if symptoms persist or recur. You can choose an anti-anaerobic drug different from the initial treatment, or try a vaginal lactobacillus preparation.