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Female with heavy vaginal discharge

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Female with heavy vaginal discharge. Has a foul smell. Yellow in color. Diagnosed and treated repeatedly with Flagyl and Clindamycin but symptoms return as soon as medication is stopped.
STDs negative (tested twice) but can't find results for gonorrhea. Slight amine odor when mixed with KOH. Other symptoms include some vulva irritation and light labia atrophy.
You will find attached a microscopic view of a vaginal swab (blue stain - low resolution, sorry). What would likely be the cause of the discharge? Do you see anything wrong in the attached pictures?

Category: Internal Medicine Specialist

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Category: Family Physician-GP
Dr. John Fuller is online now

Expert:  Dr. John Fuller replied 4 Days.

Thank you for using Ask a Doctor Service from Doctor spring.

I can understand how bothersome this problem could be, and I will try to help you the best possible

From your description about the vaginal discharge and the vaginal swab microscopy report  it is quite typical of vaginal infection with a protozoan organism called trichomonasvaginalis. It usually presents with yellowish heavy foul smelling discharge. And you have been treated repeatedly with flagyl and clindamycin, this could have caused you develop resistance for these medications which is used to treat this protozoan infection. Due to resistance, these medicines may not be effective and will typically lead to treatment failure as it might have happened in your case. Usually with two standard course of treatment with flagyl the infection resolves, but you still persist to be symptomatic, the next level of therapy is to increase the dosage and duration of the flagyl, however this can cause certain side effects.

So you might need an alternative therapy to treat this infection. But before you opt for alternative treatment, you will have to confirm the resistance to metronidazole(flagyl) through culture susceptibility test which will be done in any medical laboratory. However, there are other reasons for treatment failure with flagyl such as not taking the medicine as prescribed regularly and repeated reinfection through your sexual partner if he is not treated concurrently. It is important to rule out these two factors before we think about treatment failure with flagyl. Alternative therapy consists of short term treatment with a similar drug called tinidazole. Tinidazole is generally an expensive alternative to metronidazole for the treatment of trichomoniasis. If the symptoms worsen and persist, then I would advise you to go for culture susceptibility test with flagyl and discuss with your doctor for alternative therapies. I would like to advise you to use condom to prevent re infection and also spread of infection when you have sexual contact in future.

Hope this helps. Feel free to ask if you have any further questions.

Thank you

Dr. John Fuller
Category: Family Physician-GP
MD - New York Institute of Technology, New York College of Osteopathic Medicine
Internship, Family Medicine - Lutheran Medical Center
Residency, Family Medicine - The Mount Sinai Hospital
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