Purulent vaginal discharge is the appearance of thick yellow-green pus from the patient’s genitals. The symptom is combined with pain in the perineum and lower abdomen, an increase in body temperature, discomfort during sexual intercourse. Greenish discharge with a putrid odor is characteristic of genital infections, severe inflammatory processes of the genitals. To verify the cause of purulent whites, an examination in mirrors, ultrasound examinations, and bacteriological analysis of the discharge are carried out. Medications are used after the establishment of the etiological factor of pus-like whites.
Causes of purulent vaginal discharge
Gynecological infections
With gonorrhea, thick yellow or green pus with an unpleasant putrid smell is released from the vagina. The number of purulent whites may increase after sexual intercourse. Yellow-green discharge from the vagina is accompanied by pain in the perineum with irradiation into the sacrum and coccyx. With the upward spread of infection to the overlying genitals, abundant purulent creamy discharge with a characteristic odor is observed, sometimes streaks of blood are visible in them. Other infectious pathologies (mycoplasmosis, ureaplasmosis) may occur with scanty greenish whites.
Pathology of the uterus and appendages
Purulent vaginal discharge is characteristic of severe lesions of the uterus and its appendages – pyometra, pyosalpinx. Women note the constant discharge of thick pus from the vagina with a fetid odor, in which fragments of necrotic tissues or blood are found. The symptom is accompanied by severe pain in the lower abdomen, fever, impaired urination and defecation. The inflammatory causes of the disorder are endometritis (including postpartum) and endocervicitis, in which scanty purulent discharge is observed.
Bartholinitis
When the bartholin gland is affected (bartholinitis), patients are concerned about the periodic leakage of yellow or greenish pus with a specific odor from the vagina. In the posterior third of the labia majora, the woman feels the seal, when pressing on it, suppuration increases. There may be throbbing pain in the perineum, which worsens during walking. The lack of timely treatment and other unfavorable causes provoke the formation of an abscess of the bartholin gland, with spontaneous opening of which there are abundant purulent secretions with a pungent odor.
Rare reasons
- Staphylococcal infections of the genital tract: bacterial vaginitis, cervicitis.
- Intestinal-vaginal fistulas.
- Boils and carbuncles of the skin of the perineum.
Diagnostics
Purulent vaginal discharge with an unpleasant odor is a serious reason for contacting an obstetrician-gynecologist in order to find out the causes of suppuration. Examination of patients involves physical and instrumental examination of the genitals, various laboratory methods aimed at clarifying the etiological factor. The greatest diagnostic value have:
- Gynecological examination. To get a complete picture of the disease, examination of patients with purulent whites is carried out without preliminary preparation and toilet of the external genitalia. When examined in mirrors on the walls of the vagina, you can find accumulations of thick pus, typical hyperemia and swelling of the mucous membrane.
- Ultrasound examination. Ultrasound of the pelvic organs allows you to find out the causes associated with purulent vaginal discharge. During standard or transvaginal sonography, the condition of the genitals is assessed, an accumulation of hypoechoic fluid in the uterine cavity is detected, signs of an inflammatory process are detected.
- Endoscopic methods. To determine the cause of poor purulent discharge with streaks of blood, colposcopy is necessary for a targeted examination of the cervix and cervical canal. The method helps to identify erosive changes, areas of tissue atypia.
- Bacteriological method. In order to identify the causative agent of gynecological infection, a vaginal smear microscopy is performed after staining, then the secretions are seeded on nutrient media. Modern methods – ELISA, RSC, PCR – are designed for rapid diagnosis of the cause of suppuration.
To detect laboratory signs of inflammation, general and biochemical blood tests are performed. Serological reactions help to confirm the etiological factor of vaginal whites with a sharp putrid odor. To exclude lesions of other pelvic organs, CT or MRI of the pelvic cavity is used. Diagnostic laparoscopy is prescribed if it is impossible to determine the causes that provoked purulent discharge using other methods.
Treatment
Help before diagnosis
The discharge of pus from the vagina is a symptom of serious disorders of the reproductive system, in which it is necessary to seek medical help as soon as possible. Self-medication can lead to the spread of the process to other pelvic organs or the peritoneum. Before finding out the reasons why purulent fetid secretions appeared, taking analgesics is acceptable to reduce pain. With high febrile fever, antipyretics are used.
Conservative therapy
Medical tactics depend on the prevalence of purulent inflammation, the etiological factor of the disease and the presence of concomitant pathology in the patient. In the acute period, physiotherapy methods are not used, after the main manifestations subside, medication therapy is supplemented with UHF, electrophoresis, UFOs. Local treatment includes instillation into the vagina of antiseptic solutions (miramistin, chlorhexidine). In case of venereal infections, medications are prescribed to both sexual partners. Of the medications most often shown:
- Antibiotics. They are selected taking into account the causative agent of the infection and its antibiotic sensitivity. If severe purulent processes are detected in the uterus and appendages, a combination of 2-3 drugs with a wide spectrum of action is necessary.
- Detoxification solutions. Diseases combined with suppuration are characterized by pronounced intoxication of the body. Glucose-salt agents for parenteral administration are used to eliminate intoxication.
- Immunomodulators. Medications increase the overall reactivity of the body, stimulate local immunity, accelerate the healing process. In chronic gonorrhea, a gonococcal vaccine is used for the purpose of immunostimulation.
Surgical treatment
Purulent vaginal discharge with a noticeable putrid odor caused by the accumulation of pus in the uterus is an indication for evacuation of contents, sanitation and drainage. In case of an abscess of the bartholin gland, its surgical dissection is performed with washing with antibiotic solutions. In most cases, it is possible to limit organ-preserving operations, with diffuse purulent melting of tissues, supravaginal amputation of the uterus, tubectomy or adnexectomy is resorted to.
