🏥 Men's Health

Vaginal Infections — BV, Thrush & Trichomoniasis

The most common vaginal infections in Nigerian women — causes, symptoms, and treatment

Vaginal infections are among the most common reasons women attend gynaecology clinics or consult pharmacists in Nigeria. The three most prevalent are bacterial vaginosis (BV), vulvovaginal candidiasis (thrush), and trichomoniasis — each with a distinct cause, characteristic symptoms, and specific treatment. Misdiagnosis leads to ineffective treatment and prolonged discomfort. BV, in particular, is frequently mistaken for a sexually transmitted infection — causing unnecessary relationship conflict. This guide helps women recognise each condition and understand appropriate management.

Signs and Symptoms

✓ Bacterial vaginosis (BV): grey-white, watery, homogeneous discharge with a strong fishy smell — especially after sex or during menstruation. Usually NO itching (distinguishes from thrush). Often asymptomatic

✓ Thrush (vulvovaginal candidiasis): thick, white, 'cottage cheese' discharge. Intense vulval and vaginal itching and burning. Vulval redness and swelling. Soreness during sex or urination. No or minimal odour

✓ Trichomoniasis (Trichomonas vaginalis): yellow-green, frothy, malodorous discharge. Vaginal and vulval itching and burning. Dysuria. Often causes no symptoms in men (male partner may be unaware)

✓ Important: normal vaginal discharge is clear/white, odourless or mild odour, changes in amount/consistency with cycle — this is NOT infection

Risk Factors

BV risk factors: multiple sexual partners, vaginal douching (most important preventable cause), new sexual partner, smoking, hormonal contraception changes, reduced Lactobacillus flora
Thrush risk factors: recent antibiotic use (kills protective bacteria), diabetes (uncontrolled), pregnancy, immunosuppression (HIV, steroids), tight synthetic underwear, hormonal changes
Trichomoniasis: sexually transmitted — unprotected sex, multiple partners. One of the most common non-viral STIs globally

When to Seek Help

Discharge with strong odour, especially fishyBV is very common and highly treatable — don't suffer in silence, and don't assume it is an STI

Intense vulval itching with white 'cottage cheese' dischargeClassic thrush presentation — OTC antifungal (clotrimazole pessary or fluconazole tablet) is first line

Yellow-green frothy dischargeTrichomoniasis — requires prescription antibiotic (metronidazole), and partner treatment is essential

Recurrent vaginal infections (> 4 episodes per year)Investigate for diabetes, HIV, hormonal factors. Consider microbiome-targeted therapy

Vaginal symptoms during pregnancyBV in pregnancy increases risk of preterm birth — always seek treatment. Thrush is common in pregnancy — topical azole treatment only (oral fluconazole avoided in first trimester)

Tests & Diagnosis

🧪 Wet mount microscopy

Swab of vaginal discharge examined under microscope — clue cells (BV), candida hyphae (thrush), trichomonads (moving protozoa)

🧪 Whiff test

KOH added to discharge — fishy amine smell released = BV (positive whiff test)

🧪 pH of vaginal discharge

Normal < 4.5 (acidic). BV: pH > 4.5. Thrush: normal pH. Trichomonas: > 4.5

🧪 Culture and sensitivity

For recurrent or treatment-resistant infections — identifies organism and confirms antibiotic sensitivity

🧪 STI screen

For trichomoniasis and if other STIs suspected (chlamydia, gonorrhoea) — NAAT testing or culture at STI clinics

🧪 Blood glucose

For recurrent thrush — exclude undiagnosed or poorly controlled diabetes

Treatment Options

BV treatment

Metronidazole 400mg twice daily for 7 days (oral) OR metronidazole gel 0.75% vaginally for 5 days. Alternative: clindamycin vaginal cream. Recurrent BV: longer courses, boric acid pessaries, Lactobacillus probiotics. AVOID vaginal douching — it destroys protective flora and causes BV

Thrush treatment — single episode

Clotrimazole pessary 500mg single dose (inserted vaginally) OR fluconazole 150mg single oral tablet. OTC at Nigerian pharmacies. Also treat vulval itching with clotrimazole cream externally

Recurrent thrush (> 4 episodes/year)

Oral fluconazole 150mg weekly for 6 months (suppressive therapy). Diabetes control if relevant. Boric acid vaginal capsules 600mg nightly for 2 weeks for azole-resistant cases

Trichomoniasis treatment

Metronidazole 2g single oral dose (both patient AND partner). Alternative: 400mg twice daily for 5–7 days. Avoid alcohol during treatment (disulfiram-like reaction). Partner must be treated — reinfection very common without this

Avoiding recurrence

Do not douche. Wear cotton underwear. Avoid tight-fitting synthetic clothing. Complete courses of antibiotics when prescribed. Use condoms to prevent STI-related infections

Frequently Asked Questions

Is bacterial vaginosis an STI?

BV is not a classic sexually transmitted infection — it is a disruption of normal vaginal flora, with a reduction in protective Lactobacillus bacteria and overgrowth of anaerobic bacteria. It is more common in sexually active women but can occur in women who have never been sexually active. Partner treatment is not routinely recommended for BV (unlike trichomoniasis). It does not mean your partner has been unfaithful.

Is vaginal douching safe?

No. Douching (rinsing inside the vagina with water, commercial products, or traditional preparations like lemon juice or vinegar) is one of the most harmful practices for vaginal health. It destroys the natural Lactobacillus bacteria that protect against infection, increases the risk of BV and STIs, and may introduce infection. The vagina is self-cleaning — it does not need douching.

Can men get trichomoniasis?

Yes — men can be infected with Trichomonas vaginalis, usually without symptoms (asymptomatic urethral carriage). This means male partners of women with trichomoniasis must be treated simultaneously even if they have no symptoms — otherwise reinfection is virtually certain. Condom use prevents transmission.

I keep getting thrush after antibiotics — what can I do?

This is extremely common — antibiotics kill both harmful and the protective Lactobacillus bacteria. Taking oral fluconazole 150mg on the first and last day of an antibiotic course, or using a Lactobacillus probiotic during and after antibiotics, significantly reduces antibiotic-associated thrush. Discuss with your doctor or pharmacist before your next antibiotic course.