Leukorrhea: Causes, Symptoms & When to Seek Care

Leukorrhea is excessive white/yellow vaginal discharge. It's a symptom—not a diagnosis. The cause determines the treatment.

Common Causes

• Bacterial Vaginosis (BV): Most common. Disrupted vaginal microbiome (↓Lactobacillus, ↑anaerobes: Gardnerella, Prevotella). Thin, gray-white discharge, fishy odor (amine release), pH >4.5, clue cells on microscopy. Not an STI but sex can trigger.
• Vulvovaginal Candidiasis (Yeast): Candida albicans overgrowth. Thick, white, curdy discharge, intense itching, burning, erythema. Triggers: antibiotics, pregnancy, diabetes, immunosuppression, high estrogen.
• Trichomoniasis: STI from Trichomonas vaginalis parasite. Frothy, yellow-green, malodorous discharge, strawberry cervix, itching, dysuria. Partner treatment essential.
• Genitourinary Syndrome of Menopause (GSM): Estrogen decline → vaginal atrophy, pH rise, loss of Lactobacillus → discharge, dryness, dyspareunia, UTIs. Local estrogen reverses.
• Cervicitis: Chlamydia, gonorrhea, mycoplasma — mucopurulent discharge, cervical friability, bleeding.
• Rare: Cervical/endometrial cancer, PID, foreign body (forgotten tampon), fistula.

Diagnostic Approach

• History: discharge character, odor, itch, pain, sexual history, medications
• Exam: vulva, vagina, cervix, bimanual
• Microscopy: saline wet mount (motile trichomonads, clue cells, WBCs), KOH prep (hyphae/pseudohyphae), pH, amine test
• NAAT testing: Chlamydia, gonorrhea, trichomonas (gold standard)
• Culture if recurrent/unresponsive

Treatment Is Cause-Specific

• BV: Metronidazole (oral/vaginal) or clindamycin vaginal
• Yeast: Fluconazole oral or topical azoles (clotrimazole, miconazole)
• Trich: Metronidazole (single dose or 7-day) — treat partner(s)
• GSM: Vaginal estrogen (cream, tablet, ring), moisturizers/lubricants
• STIs: Targeted antibiotics per guidelines

Don't self-treat blindly. Wrong treatment delays relief and can worsen imbalance. See a clinician for accurate diagnosis.