Are STIs different for men?
White Discharge Is Usually No Big Deal — But Here's When It Is
Having white vaginal discharge is usually akin to the sky being blue — it's normal, and even kind of a given. But, like many health-related things, there's always a range of "normal." To that point, while white discharge is typically no cause for concern, there are a few situations where it can be a red flag.
"White discharge is very common — so common that we wouldn't necessarily consider it abnormal on its own," says Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies. (Clear discharge is the same way. Green discharge, not so much.) But, because nothing in life is simple, "It can also be the sign of an infection, so you need to pay close attention to other symptoms," says Jennifer Wider, MD, a women's health expert and ob-gyn.
The good news: White discharge is rarely caused by a health issue that merits a freak out. Still, it can signal that something is off with your health. So, what's behind your white discharge and when should it be concerning? Here's what ob-gyns want you to know.
Experts Featured in This Article
Christine Greves, MD, is an ob-gyn at Orlando Health Women's Institute Center for Obstetrics & Gynecology and obstetrical and gynecological surgeon at Winnie Palmer Hospital for Women & Babies.
Jennifer Wider, MD, is a women's health expert, author, and podcast host.
What Does White Discharge Mean?
There are a few things to keep in mind when it comes to the potential causes of white discharge. Generally speaking, it's important to keep in mind any other symptoms you may (or may not) be dealing with. Here, five things white discharge can mean.
It's business as usual.
Again, white discharge falls on the spectrum of "normal." So, if you notice white discharge on any given day and you're not experiencing any unusual symptoms along with it, you're fine to pass go, collect 200 dollars, and move on with your day. "White vaginal discharge is common and can be completely normal," Dr. Wider says.
You may have a yeast infection.
A yeast infection, aka candidiasis, is a common vaginal infection caused by a fungus called Candida. While Candida is normally found in small numbers in the vagina, it can overgrow and cause uncomfortable symptoms, according to the American College of Obstetricians and Gynecologists (ACOG).
Those include itching and burning of the vulva, along with redness and swelling down there, per ACOG. But the yeast infection may also cause a white discharge, Dr. Greves points out. "That discharge can be thicker than normal, cottage cheese-like, and more clumpy," she says.
Luckily, yeast infections can usually be treated with an OTC medication like miconazole, Dr. Greves says. But if your symptoms aren't getting better after a round of treatment, it's a good idea to check in with an ob-gyn for an evaluation—you could be dealing with a particularly stubborn yeast infection, or another issue entirely.
It's at a certain time in your cycle.
You may notice white or whiter-than-usual discharge during certain times of your cycle. "Sometimes at ovulation, or 14 days after your period, the discharge can become stringy, wetter, and may have a white tint," Dr. Wider says. Dr. Greves agrees, noting that it can also take on a milky, egg white-like appearance. But you can also experience white discharge when you're approaching your period, Dr. Greves says. "At that point, it may become more white and a little thicker," she says.
You're possibly newly pregnant.
It's important to stress that, if you think you might be pregnant, the best thing to do is to take a pregnancy test. But if you're looking for little signs to suggest that there's a baby on board, white discharge could be one (of many).
"In pregnancy, the body produces more discharge as a way to protect against infection," Wider explains. "The discharge can be clear, white, or off-white." But FYI that discharge should have little, if any, odor, she says. And if you end up seeing a white discharge instead of blood when your period is due, that might also be a sign that you're pregnant, Dr. Greves points out.
It could be bacterial vaginosis.
Bacterial vaginosis, aka BV, is a condition caused by an imbalance in the types of normal bacteria that live in the vagina, per ACOG. BV is the most common vaginal condition in women aged 15 to 44, according to the Centers for Disease Control and Prevention (CDC). Douching, not using condoms, and having new or multiple sex partners all raise your risk of getting BV, per the CDC.
Symptoms include pain, itching, or burning in the vagina; a strong fish-like odor, especially after sex; a burning feeling when you pee; itching around the outside of the vagina; and a white or gray vaginal discharge, according to the CDC. "The discharge is usually thin," Dr. Greves says. "It has a strong, unmistakable odor," Dr. Wider adds.
Unfortunately, BV won't go away on its own, so you'll have to see a doctor for this one. "It needs to be treated with an antibiotic," Dr. Wider says.
Is It Normal to Have White Discharge Every Day?
While many people have fluctuations in discharge color over the course of their cycle, it can be normal to see white discharge daily. Ultimately, it all comes down to the individual. "This varies between people," Dr. Wider says. "Some people just produce more discharge than others, especially when they're pre-menopausal."
When to See a Doctor For White Discharge
White discharge on its own shouldn't be anything to freak out about. But if you're having white discharge along with itching, burning, or other irritation down there—or if it's out of the ordinary for you—Dr. Greves says it's a good idea to reach out to an ob-gyn.
"Be in touch with your body," she says. "If you don't know what's going on, talk to your doctor."
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.
What Causes Gray Discharge? 2 MDs Explain.
There are certain vaginal discharge colors that'll set off some serious alarm bells (looking at you, green). But then there are others that fall into a confusing middle ground, like gray discharge.
After all, it's different from your usual discharge color, but gray also doesn't seem all that far from a more "normal" white hue. So, should you be concerned about 50 shades of gray or not?
At the end of the day, any kind of gray discharge isn't ideal. "It can mean that you have an infection," says Christine Greves, MD, an ob-gyn at Orlando Health Women's Institute Center for Obstetrics & Gynecology and obstetrical and gynecological surgeon at Winnie Palmer Hospital for Women & Babies. That's not a guarantee, of course, which is why it's important to be evaluated by a medical professional, just to be sure.
While you're waiting to be seen, keep reading for more on some of the most common causes of gray discharge, according to ob-gyns. Worth noting: they're all treatable.
Experts Featured in This Article
Christine Greves, MD, is an ob-gyn at Orlando Health Women's Institute Center for Obstetrics & Gynecology and obstetrical and gynecological surgeon at Winnie Palmer Hospital for Women & Babies.
Jennifer Wider, MD, is a women's health expert, author, and podcast host.
What Does Gray Discharge Mean?
Gray discharge can indicate a few different things. "It's usually a signal that something is wrong, as normal discharge is clear, white, or off white," says Jennifer Wider, MD, a women's health expert and ob-gyn. There are a few different things that could be behind it, although all signs point to some type of infection which is why it's so important to see a doctor. Here's what could be going on, plus other symptoms to keep an eye out for.
You might have bacterial vaginosis.
Bacterial vaginosis, aka BV, is the most common vaginal condition experienced by women between the ages of 15 and 44, according to the Centers for Disease Control and Prevention (CDC). It happens when there's too much of a certain bacteria in the vagina. While several forms of bacteria can lead to BV, Gardnerella vaginalis is the most common culprit.
Bacterial vaginosis usually causes more than gray discharge. It typically also comes along with symptoms like a strong fishy or musty odor, itching or burning around the vagina, and burning while you pee, according to the World Health Organization (WHO). The discharge itself can be thin and light gray, per the WHO, although it can also be green.
BV can be cleared up with the antibiotic metronidazole but, if it's left untreated, can lead to problems in pregnancy, a higher risk of sexually transmitted infections (STIs), and pelvic inflammatory disease, per the WHO. "It needs to be treated with an antibiotic," Dr. Wider stresses.
It could be trichomoniasis.
Trichomoniasis, or trich, is an STI caused by the parasite trichomonas vaginalis, per the CDC. According to the CDC, there are more than 2.6 million trichomoniasis infections in the U.S., although only about 30% of those come with symptoms. One of the hallmark signs is a gray discharge coupled with a foul odor, explains Dr. Wider. (Said discharge may also be thin or higher in volume than your usual.) Women are more likely than men to develop trichomoniasis and may also notice itching, burning, redness, or soreness of the genitals, along with discomfort while peeing and uncomfortable sex, per the CDC. The good news: Trichomoniasis can also be treated with metronidazole, the same medication used to treat BV, Dr. Wider says.
It may be another sexually transmitted infection.
At baseline, gray discharge can be a sign of an infection, Dr. Greves points out. More specifically, both chlamydia and gonorrhea can also cause gray discharge. Chlamydia is an STI caused by the bacteria Chlamydia trachomatis, according to the U.S. National Library of Medicine. While it can cause no symptoms, it can also lead to white, yellow or gray discharge with a strong odor, pain during sex, a burning sensation when you pee, and bleeding between periods, according to the Cleveland Clinic. It's treated with antibiotics.
Gonorrhea is an STI caused by the bacterium Neisseria gonorrhoeae, per the U.S. National Library of Medicine. It can cause discharge that's gray, green, or yellow, pain during sex, a burning sensation when you pee, and bleeding between periods, according to Northwestern Medicine. And yep, you guessed it, it's also treated with antibiotics.
It's potentially a yeast infection.
Yeast infections have a classic white "cottage cheese-like" discharge, but that discharge can also be gray, Dr. Wider says, although she notes that gray is less common. Either way, the discharge is usually thick, she adds.
"Yeast infections are caused by overgrowth of the fungus Candida, according to the American College of Obstetricians and Gynecologists (ACOG). You also raise your risk of getting a yeast infection when you wear tight-fitting bottoms, sit around in wet clothes, take antibiotics unnecessarily, and use scented feminine products down there, Dr. Greves explains. In addition to the discharge, you may also have itching and burning of the vulva that gest worse when you pee or have sex, along with redness and swelling.
Yeast infections are treated by placing anti-fungal medication like miconazole into the vagina or by taking an oral medication, Dr. Greves says. Happily, these treatments will usually help you feel better within a day or two.
When to See a Doctor For Gray Discharge
Again, gray is not a typical discharge color. So, if you're seeing it constantly, it's a good idea to talk to a doctor. That's especially true if you've never had gray discharge before and it's not going away after a few days. "If you notice a change from your normal discharge, go see your doctor," Dr. Greves advises.
Dr. Wider agrees. "Gray discharge is usually the sign of an infection, especially if it comes along with other symptoms," she says. "It should always be checked out by a medical professional."
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.
Vaginal Sex And The Risk Of HIV Transmission
Key pointsIf the HIV-positive partner is taking antiretroviral treatment and has a fully suppressed viral load ('undetectable'), the risk of HIV transmission through condomless vaginal intercourse is zero.
The PARTNER study recruited 548 heterosexual couples where one partner had HIV and fully suppressed viral load on antiretroviral treatment. During a median follow-up period of 1.3 years, the couples reported over 36,000 vaginal sex acts without condoms. No HIV transmissions occurred. The investigators concluded that the risk of HIV transmission through vaginal intercourse in these circumstances was effectively zero (Rodger).
When HIV is not suppressed by antiretroviral treatment, vaginal intercourse without a condom is a highly efficient route of HIV transmission because high concentrations of HIV can occur in semen and vaginal fluids, and because the genital tissues are very susceptible to infection. HIV can pass through the cells of the vaginal lining (epithelium) by migrating through specific cells and/or by passing through non-intact tissue. This allows the virus to reach the inner vaginal lining, which is rich in immune cells through which it can establish systemic infection.
Cells located beneath the surface of the cervix are particularly vulnerable to HIV infection, especially during adolescence and during a woman's first pregnancy, or due to infection with human papillomavirus and chlamydia.
A meta-analysis of studies of heterosexual HIV transmission found that, in high-income countries prior to the introduction of combination therapy, the risk per sexual act was 0.04% if the female partner was HIV positive and the male partner was HIV negative. The risk was 0.08% when the male partner was HIV positive and the female partner HIV negative. However, these rates were considerably higher when the source partner was in either the very early or the late stage of HIV infection, when one partner had a sexually transmitted infection that causes genital sores, and also in studies done in lower-income countries (Boily).
A woman is usually at greater risk of HIV infection from an HIV-positive man than vice versa. This may be due to several factors. Compared with the penis, the amounts of tissue cells susceptible to infection and/or damage are likely higher within the vagina. A woman may often take large quantities of semen into her vagina, which quickly comes into contact with the more vulnerable tissue of the cervix and may remain there for a period of time.
While women are at greater risk of infection from an HIV-positive male partner, condomless vaginal intercourse is also high risk for men, because damaged penile tissue and the mucous membranes in the urethra and on the head of the penis – particularly underneath the foreskin – form a point of infection.
Many other factors affect the level of risk associated with vaginal intercourse, including recent infection, sexually transmitted infections and male circumcision.
Recent infectionThe first few weeks or months after HIV has entered a person's body, their viral load is usually extremely high and they are very infectious.
Viral load is the term used to describe the amount of HIV circulating in the body. As viral load rises, so does infectiousness. On the other hand, when viral load is so low as to be undetectable, there is no risk at all of HIV transmission.
For example, a study of heterosexual couples in Rakai, Uganda, where one partner was HIV positive and the other HIV negative at the start of the study, showed that the likelihood of HIV transmission is highest in the first two and a half months following initial infection with HIV, and that this correlated with higher viral load levels in early HIV infection. The researchers estimated that relative to chronic infection, infectiousness during primary infection was enhanced 26-fold (Hollingsworth).
As people are usually unaware of their infection at this stage, they are not taking treatment and may inadvertently expose sexual partners to HIV. People who have HIV without realising it are much more likely to be involved in HIV transmission than people who know they have HIV, as the latter can receive treatment.
Sexually transmitted infectionsMost sexually transmitted infections, especially those which cause ulceration, including herpes simplex 2 (HSV-2), syphilis, gonorrhoea, and chlamydia, increase HIV-negative partners' risk of acquiring HIV during vaginal intercourse. HIV-negative people with recurrent STIs may be at increased ongoing risk of HIV infection.
In people living with HIV who are not taking HIV treatment, STIs also lead to increased genital shedding of HIV, which increases the risk of transmitting HIV to others. Nonetheless, STIs do not increase the risk of HIV transmission from people who are taking effective HIV treatment and have an undetectable viral load. In the PARTNER study, there was not a single HIV transmission even though many study participants had STIs.
There are two main reasons for the effect of STIs on HIV transmission. Firstly, many (although not all) STIs can cause ulcers, sores or lesions. They provide a direct physical route of entry for HIV in an uninfected person. Secondly, immune cells that are, themselves, prone to HIV infection – such as activated T-cells and dendritic cells – are prone to be present in greater numbers at the site of an infection.
Glossary sexually transmitted infections (STIs)Although HIV can be sexually transmitted, the term is most often used to refer to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc.
circumcisionThe surgical removal of the foreskin of the penis (the retractable fold of tissue that covers the head of the penis) to reduce the risk of HIV infection in men.
viral loadMeasurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. Viral load is an important indicator of HIV progression and of how well treatment is working.
The strongest evidence is for herpes simplex virus type 2 (HSV-2). A meta-analysis found that having HSV-2 was associated with an increased risk of acquiring HIV both in the general population (an increase of 270%) and in higher risk groups such as sex workers and men who have sex with men (170%). Having a recent HSV-2 infection was associated with an almost five-fold (470%) increased risk of acquiring HIV, probably because genital ulceration, viral shedding and inflammation in the genital tract are most severe in new HSV-2 infections and tend to decrease over time (Looker).
Gonorrhoea, chlamydia and trichomoniasis have been shown to increase risk of HIV infection in women (Laga). Trichomonas vaginalis increases the risk of HIV acquisition for women (Masha).
Human papillomavirus, the cause of genital warts, is associated with an increased risk of HIV infection in women regardless of whether it is an HPV type that causes genital warts or a type associated with cervical cancer (Houlihan). The presence of human papillomavirus in cells in the penis also increases the risk of acquisition in men (Rositch).
Male circumcisionMen are less likely to acquire HIV through vaginal intercourse if they are circumcised. There is strong biological and epidemiological evidence for this.
Circumcision is believed to reduce the risk of male infection because it removes the vulnerable tissue inside the foreskin, which contains Langerhans cells (a type of cell particularly vulnerable to HIV infection). The area under the foreskin is also vulnerable to trauma, and is more likely to become abraded if sufficient lubrication is not present. Also, uncircumcised men may be more vulnerable to sexually transmitted infections (STIs), because the area under the foreskin can retain bacteria acquired during sex, thus increasing the chance that an infection will become established.
Three randomised controlled trials of circumcision demonstrated that circumcision lowers HIV-negative men's risk of acquiring HIV by between 51 and 60%. They also showed benefits in terms of lowering rates of sexually transmitted infections. The studies were conducted in South Africa (Auvert), Kenya (Bailey) and Uganda (Gray).
The World Health Organization recommends that circumcision programmes should be an integral part of HIV prevention programmes in countries with generalised HIV epidemics. In the United States, the Centers for Disease Control and Prevention (CDC) recommends that healthcare providers can inform their patients that medical male circumcision "male circumcision reduces, but does not eliminate, the risk of acquiring HIV" by men during vaginal sex.
Male circumcision does not reduce the risk of HIV transmission from men to female partners.
SchistosomiasisSchistosomiasis (also known as bilharzia) is a widespread infection in sub-Saharan Africa and other tropical countries. Schistosomiasis is caused by a parasitic worm that lives in fresh water and is acquired by bathing in infested water. The infection can cause a localised immune response and genital lesions, increasing the risk of HIV transmission and acquisition.
In a study of over 1000 HIV-serodiscordant couples in Zambia (Wall), women who had schistosomiasis had an 40% increased risk of acquiring HIV. In addition, when an HIV-positive man or woman had schistosomiasis, there was a greater risk of HIV transmission to their sexual partner.
Bacterial vaginosisBacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance. Signs and symptoms may include a discharge, an odour, itching and burning during urination.
It appears that bacterial vaginosis is associated with an increased risk of acquiring HIV. A meta-analysis of four prospective studies conducted in sub-Saharan Africa found a 61% increased risk of HIV acquisition in women (Atashhili). In a Kenyan study, bacterial vaginosis and HSV-2 infection were the two strongest risk factors measured for HIV acquisition over a 20-year period (Masese).
Practices such as douching, washing and drying the vagina may undermine the body's innate defences and make bacterial vaginosis more common.
Withdrawal before ejaculationThe chances of infection may be lessened during condomless vaginal intercourse if ejaculation does not take place. An early study found that after 20 months, none of the heterosexual couples who had consistently practised withdrawal experienced the seroconversion of the HIV-negative partner (De Vincenzi).
Vaginal drynessRougher sex and/or vaginal dryness may lead to vaginal or penile abrasions, which may increase the chances of infection.
Reduction of vaginal lubrication becomes more common with age, possibly increasing risk in post-menopausal women. Younger women in early puberty may also produce less vaginal and cervical secretions, perhaps increasing their vulnerability to HIV infection and contributing to the disproportionate prevalence of HIV amongst adolescent women (Holmberg).
How you can reduce the riskEffective protective measures are:
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