A vaginal discharge that smells different — fishy, sour, or strong — is almost always an infection that is treatable with the right antibiotic or antifungal. This page explains the most common causes, how to tell them apart, and what to do at Mascot Healthcare.
The smell, colour, and consistency of vaginal discharge change with different infections. Most are caused by an imbalance of normal vaginal bacteria (bacterial vaginosis) or an STI — and all are treatable.
The most common cause — a fishy-smelling, grey or white, thin, watery discharge. Caused by overgrowth of anaerobic bacteria. Not an STI but can occur after sexual activity. Treated with metronidazole.
Frothy, yellow-green, strong-smelling discharge with vulval itching — a sexually transmitted parasitic infection. Treated with metronidazole.
Yellow or green discharge, sometimes with pelvic pain or burning urination — an STI that requires antibiotic treatment and partner notification.
Often no smell or symptoms — but can cause increased yellow discharge. A very common STI; 70% of women have no symptoms at all.
White, thick, cottage cheese–like discharge with vulval itching and redness — NOT usually smelly. Caused by yeast, not bacteria. Treated with antifungal.
Abnormal discharge plus lower abdominal pain, fever, and pain during sex — infection has ascended into the uterus/tubes. Requires urgent antibiotics.
High Vaginal Swab (HVS) — Swab of vaginal secretions — identifies BV, candida, and trichomoniasis under microscopy and culture.
Chlamydia + Gonorrhoea NAAT — Urine or swab test — the most accurate way to detect these two common STIs, even when asymptomatic.
Full STI Panel — HIV, syphilis, hepatitis B — a full sexual health screen alongside swabs.
Pelvic Ultrasound (if PID suspected) — Assesses for tubo-ovarian abscess if pelvic pain or fever accompanies the discharge.
Canesten (clotrimazole) treats candida only. If your discharge smells fishy or is yellow/green, it is almost certainly not candida and antifungal cream will not work.
A high vaginal swab identifies the exact organism and its sensitivity — enabling the right antibiotic, not a guessed one.
STIs require partner testing and treatment. Treating yourself without treating your partner results in re-infection.
Gonorrhoea and chlamydia are often asymptomatic alongside other discharge symptoms. A full STI panel gives the complete picture.
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