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“Doc, My Menses Smells”

Updated: Jul 25, 2020

She looked worried and upset when she stepped into my consultation room. “Doc, my menses has a fishy smell for the past 2 months.” She said. “Am I having a growth in my vagina?”

T, a 32-year-old housewife had been married for 5 years. Her husband worked in a neighboring country and returned home for a week every 2 to 3 months. She last had sexual intercourse with him 2 months ago.

On further questioning, T also noticed yellowish, sometimes greenish vaginal discharge on and off for the past 6 months. The discharge was accompanied by occasional itchiness and burning sensation around her vulva.

On examination, her vulva was inflamed and red. The vaginal discharge was creamy yellow and foul-smelling. The cervix was angry looking with red hemorrhagic spots. A microscopic examination of the vaginal discharge demonstrated the presence of the parasite, trichomoniasis vaginalis as shown in Figure 1 below.

Figure 1

T was suffering from trichomoniasis, a disease caused by the micro-organism, Trichomonas vaginalis. The parasite is approximately the size of a human white blood cell. The fishy smell in the vaginal discharge and the menses is due to the presence of a chemical compound known as trimethylamine.

How common is trichomoniasis?

Trichomoniasis is one of the common sexually transmitted disease (STD). It occurs more often in women than in men. Risks factors of the infection include:

  • Multiple sexual partners

  • Sex workers

  • Drug abuse

  • Older women

  • Poverty

How is it transmitted?

The parasite lives in the semen and vaginal fluids. It is transmitted between couple during unprotected vaginal sex. In women, the most commonly infected area is the lower genital tract (vulva, vagina and cervix). Other body parts, like the hands, mouth, or anus are usually spared. Occasionally, the infection can be spread by sharing sex toys. Very rarely, it can be transmitted through objects like wet towels and toilet seats.

What are the  symptoms of trichomoniasis?

Only about 30% of infected patients have symptoms. It is unclear why the rest remain asymptomatic. Probably this is related to the person’s age and overall health. The symptoms vary and can occur sporadically. They can present as a mild irritation or severe infection. The incubation period ranges from 5 to 28 days or longer. If untreated, the infection can last for months or  years.

For women, the common symptoms are:

  • White, yellowish, or greenish with an unusual fishy smell.

  • Itching, burning, redness or soreness of the genitals;

  • Discomfort with urination

  • Pain during  sexual intercourse.

  • Urinary frequency

  • Lower abdominal pain

What are the complications of trichomoniasis?

Trichomoniasis increases the risks of getting or spreading other sexually transmitted infections such as chlamydia and gonorrhea. Pelvic inflammatory disease and infertility may result. If it occurs during pregnancy, there is an increased incidence of premature birth ,intrauterine growth restriction (IUGR) and baby with  low birth weight.

What is the treatment for trichomoniasis?

Trichomoniasis can be easily treated with medication. To avoid getting reinfection, both sexual partners should be treated  at the same time. It is advisable to have a review 3 months later to make sure the infection is completely cleared. 

T was treated with medication for 5 days. She noticed drastic improvement in her symptoms the next day and her menses was not smelly on her next cycle. However, reinfection occurred as her husband refused to be treated as he was asymptomatic. After much counseling and persuasion, he finally agreed to take the medication together with T who had remained symptom free since.

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