[19F] Persistent fishy odor and itching post-BV treatment

Patient Description

A 19-year-old female reports a persistent fishy odor from the vaginal area for the past couple of days, despite completing treatment for bacterial vaginosis (BV). This is the first time she is experiencing this odor. Along with the odor, she has noticed intermittent itching on her vaginal lips, which started suddenly a couple of days ago and is somewhat relieved by showering. She also observed intermittent brown vaginal discharge since completing the treatment for BV. She has not been in contact with her sexual partner since completing the treatment and has not noticed any swelling, redness, or pain during urination. She recently took medications for BV, STI, and UTI and completed the full course as prescribed. During the treatment, her symptoms improved, but the fishy odor and itching returned afterward. She has not used any new personal hygiene products or changed her diet recently, and there have been no changes in her menstrual cycle. She has not had any new sexual partners or unprotected sexual activity since completing her treatment. She experienced side effects from the medications, including diarrhea and drowsiness. She has not noticed any changes in her immune system, frequent infections, or feeling generally unwell. She has not been exposed to any new environments or traveled recently. She does not have any pre-existing conditions or chronic illnesses and is not currently taking any medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, the most likely diagnoses are:

  • Recurrent Bacterial Vaginosis (BV): BV is a common vaginal infection caused by an imbalance of bacteria in the vagina. It often presents with a fishy odor and can cause itching and discharge. Even after treatment, BV can recur, especially if the underlying imbalance is not fully corrected.

    • Treatment: Typically involves antibiotics, either oral or topical. If BV recurs frequently, your doctor might suggest a longer course of treatment or maintenance therapy.

  • Vaginal Yeast Infection: This is another common cause of vaginal itching and discharge. While it usually presents with a thick, white discharge, it can sometimes cause a brownish discharge, especially if there is some irritation or minor bleeding.

    • Treatment: Antifungal medications, which can be taken orally or applied topically.

  • Trichomoniasis: This is a sexually transmitted infection (STI) that can cause a fishy odor, itching, and discharge. It is less common but should be considered, especially if symptoms persist after treatment for BV.

    • Treatment: Typically involves a single dose of an antibiotic like metronidazole.

What you can do

  1. Consult Your Doctor: It's important to follow up with your healthcare provider to discuss your persistent symptoms. They may need to perform additional tests or adjust your treatment plan.
  2. Maintain Good Hygiene: Keep the vaginal area clean and dry. Avoid using scented soaps, douches, or other products that can disrupt the natural balance of bacteria in the vagina.
  3. Probiotics: Consider taking probiotics, which can help restore the natural balance of bacteria in your body. You can find these in yogurt or as supplements.
  4. Avoid Irritants: Wear cotton underwear and avoid tight-fitting clothing to reduce irritation. Also, avoid using new personal hygiene products that could cause irritation.
  5. Track Symptoms: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your provider. This can help identify patterns and triggers.

What you should look out for

  • Worsening Symptoms: If your symptoms worsen or do not improve with treatment, it's important to seek medical attention.
  • New Symptoms: If you develop new symptoms such as fever, severe abdominal pain, or pain during urination, contact your healthcare provider immediately.
  • Recurrent Infections: If you experience recurrent infections, discuss this with your doctor. They may need to investigate underlying causes or provide a different treatment approach.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to ask!

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3 mo ago

People Also Ask

What are the common symptoms of recurrent bacterial vaginosis (BV)?

Common symptoms of recurrent BV include a fishy vaginal odor, thin gray or white discharge, and sometimes itching or irritation. These symptoms can persist or return after treatment if the bacterial imbalance is not fully corrected.

How can I differentiate between a yeast infection and bacterial vaginosis?

A yeast infection typically causes thick, white, cottage cheese-like discharge and intense itching, while BV usually presents with a thin, gray or white discharge and a fishy odor. Itching can occur in both conditions, but the type of discharge and odor can help differentiate them.

What are the possible reasons for a fishy odor returning after BV treatment?

A fishy odor returning after BV treatment could be due to an incomplete resolution of the bacterial imbalance, reinfection, or another underlying condition such as trichomoniasis. It's important to consult a healthcare provider for further evaluation.

Can probiotics help in preventing recurrent BV or yeast infections?

Probiotics can help restore the natural balance of bacteria in the vagina and may reduce the risk of recurrent BV or yeast infections. They can be found in yogurt or as dietary supplements, but it's best to discuss their use with a healthcare provider.

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