Diagnosis and treatment of gynaecological infections

01Vaginal discharge: what is normal and what signals an infection?

Vaginal discharge is normal and healthy: it cleans and protects the vagina. It becomes a concern only when its colour, smell or amount changes, or when it comes with itching, burning or pain.

Discharge that is usually normal:

• White or clear, without a strong smell.
• Thinner and stretchy around ovulation (like raw egg white).
• Thicker and creamier before a period; slightly heavier in pregnancy.
• No itching, no burning, no redness.

Discharge that needs a check-up:

• White, thick, cottage-cheese-like, with intense itching – typical of vaginal thrush.
• Thin, grey-white, with a fishy smell that gets worse after sex – typical of bacterial vaginosis.
• Yellow-green, frothy, foul-smelling, with burning – possibly trichomoniasis.
• Yellow or pus-like, with bleeding between periods or after sex – possibly chlamydia or gonorrhoea.
• Blood-stained outside your period, or with fever and abdominal pain – needs a prompt visit.

A simple rule: colour and smell point in a direction, but they are not enough for a diagnosis. According to the CDC Sexually Transmitted Infections Treatment Guidelines (2021), bacterial vaginosis is the most common cause of abnormal discharge worldwide, while many women with an infection have no symptoms at all. That is why the gynaecologist examines you and, when needed, takes a vaginal swab to identify the exact cause.

02Vaginal thrush (candidiasis): symptoms, causes and treatment

Vaginal thrush (vulvovaginal candidiasis, a «yeast infection») is a fungal infection, mostly caused by Candida albicans, which normally lives in the body in small amounts and causes problems when it overgrows. According to the CDC (2021), about 75% of women have at least one episode in their lifetime and 40–45% have two or more.

The most common symptoms:

• Intense itching of the vulva and vagina.
• White, thick, cottage-cheese-like discharge, usually without a bad smell.
• Redness, swelling and soreness, especially when passing urine or during sex.

Triggers:

• Antibiotics, which also wipe out protective lactobacilli.
• Pregnancy and hormonal changes.
• Poorly controlled diabetes, weakened immunity.
• Heat and moisture: wet swimwear, tight synthetic clothing, summer.
• Over-washing and perfumed intimate products.

Diagnosis: thrush is associated with a normal vaginal pH (below 4.5) and is confirmed by microscopy of the discharge; a culture is used when symptoms persist, when the infection keeps coming back, or when less common (non-albicans) Candida species are suspected, as they can respond differently to treatment.

Treatment: usually antifungal medication, either vaginal (pessaries or cream) or oral, depending on the case. The type and duration are decided by the doctor after the examination – in pregnancy, for example, the CDC recommends vaginal treatment only. According to the CDC, partners do not need routine treatment unless they have symptoms themselves (redness and itching of the penis).

Recurrent thrush is defined by the CDC as three or more symptomatic episodes within a year and affects fewer than 5% of women. It calls for confirmation by culture, a search for triggers and a longer, preventive treatment plan – not one over-the-counter pessary after another.

03Bacterial vaginosis: why does my discharge smell and how is it treated?

Bacterial vaginosis (BV) is an imbalance of the vaginal bacteria: protective lactobacilli decline and are replaced by anaerobic bacteria. It is not an infection «from poor hygiene» and is not considered a classic STI, although it is more common in sexually active women.

Symptoms:

• Thin, grey-white, uniform discharge.
• A fishy smell, often stronger after sex or during a period.
• Usually little or no itching – which helps tell it apart from thrush.
• Many women have no symptoms at all (CDC, 2021).

How it is diagnosed: doctors use the Amsel criteria – BV is diagnosed when at least 3 of 4 signs are present: thin uniform discharge, vaginal pH above 4.5, «clue cells» on microscopy, and a fishy odour on the KOH (whiff) test.

Treatment: specific antibiotics, oral or vaginal, prescribed after diagnosis. Recurrence is common, so a longer-term plan is sometimes needed. On partners, the CDC guidelines (2021) did not recommend routine treatment, but a randomised trial published in the New England Journal of Medicine in March 2025 (Vodstrcil et al.) found that when the regular male partner was also treated, recurrence within 12 weeks fell from 63% to 35%. Your doctor will explain whether this applies to you.

A common mistake: douching and perfumed soaps. They disturb the vaginal flora even further and, according to the CDC, may increase the risk of relapse.

04Chlamydia, gonorrhoea and trichomoniasis: symptoms and stigma-free testing

Sexually transmitted infections (STIs) are very common and nothing to be ashamed of. According to the World Health Organization (WHO), more than 1 million curable STIs are acquired every day worldwide, and most cause no symptoms. In 2020 alone, the WHO estimated 129 million new cases of chlamydia, 82 million of gonorrhoea and 156 million of trichomoniasis.

Chlamydia (Chlamydia trachomatis):

• Causes no symptoms in most women.
• When it does: increased discharge, burning when passing urine, bleeding after sex or between periods, lower abdominal pain.
• Untreated, it can travel up to the womb and tubes (pelvic inflammatory disease) and cause tubal infertility or ectopic pregnancy.

Gonorrhoea (Neisseria gonorrhoeae):

• Yellow or pus-like discharge, burning when passing urine, sometimes no symptoms.
• The WHO warns of growing antibiotic resistance – treatment must follow current guidelines, never a random antibiotic.

Trichomoniasis (Trichomonas vaginalis):

• Yellow-green, frothy, foul-smelling discharge, itching and burning; often no symptoms either.

Treatment and partners: these infections are treated with specific antibiotics or antiparasitic medicines prescribed after testing. Partners must be treated at the same time and sex avoided until both have finished treatment; otherwise the infection «ping-pongs» back. Your doctor may recommend a repeat test after a few months.

Testing without stigma: at Klinika Gjata, questions about your sex life are asked only to choose the right test, never to judge. A positive test does not mean anyone was «unfaithful»: many infections stay silent for months or years. Testing is recommended if you have symptoms, a new partner, a partner with symptoms, before pregnancy or before fertility treatment.

05Mycoplasma and ureaplasma: do they always need treatment?

Not always. Mycoplasma and ureaplasma are small bacteria, but they are not all alike – and this causes a lot of confusion after a «positive» result.

• Mycoplasma genitalium is a genuine STI: it can cause cervicitis (inflammation of the cervix), bleeding after sex and pelvic inflammatory disease. It is tested for when there are symptoms or a clear indication, and treated together with the partner. The IUSTI European guideline (2021) and the British BASHH guideline (2025) stress resistance-guided treatment, as antibiotic resistance is rising.
• Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum are often found in completely healthy women. The European STI Guidelines Editorial Board (position statement, 2018) does not recommend routine testing or treatment, because symptom-free carriage is common and most people never develop disease.

What this means in practice:

• A positive ureaplasma result without symptoms usually does not call for repeated courses of antibiotics.
• The decision to treat is made by the doctor, taking into account symptoms, the examination, pregnancy or pregnancy plans, and other results.
• Unnecessary antibiotics disrupt the vaginal flora and can trigger thrush – a vicious circle we see often.

If you have a result from another laboratory, bring it to your visit and we will interpret it together.

06HPV, genital warts and genital herpes: what you need to know

HPV (human papillomavirus) is the most common viral genital infection. According to the WHO, about 300 million women have an HPV infection at any given time. Most infections are cleared by the immune system within about two years (CDC).

• Low-risk types (mainly HPV 6 and 11) cause genital warts – small, skin-coloured, cauliflower-like growths. They do not turn into cancer but are treated because of discomfort and contagiousness.
• High-risk types (e.g. HPV 16 and 18) cause no symptoms, but when they persist for years they can cause changes in the cervix. Regular screening with a Pap smear and/or HPV test is the main protection; the HPV vaccine prevents the main types.
• Warts are treated with local methods chosen by the doctor after examination. Do not use skin-wart preparations on the genital area.

Genital herpes is caused mainly by HSV-2 (sometimes HSV-1). The WHO estimates that more than 520 million people live with genital herpes.

• Symptoms: small blisters and painful sores, burning, sometimes fever during the first episode.
• There is no definitive cure, but antiviral medicines shorten outbreaks and can prevent frequent recurrences.
• In pregnancy, tell your doctor if you have ever had herpes, because the greatest risk to the baby is linked to a first episode close to delivery.

This is an overview: genital sores always need an examination, because not every sore is herpes.

07Urinary tract infection in women and pelvic inflammatory disease (PID): symptoms

A urinary tract infection (cystitis) is one of the most common infections in women, because the short urethra lets bacteria – most often E. coli from the bowel – easily reach the bladder.

Symptoms of a UTI:

• Burning or pain when passing urine.
• Needing to urinate often and urgently, even with little urine.
• Cloudy, strong-smelling or bloody urine.
• Pain above the pubic bone.
• Fever, chills or pain in the back or side may mean the infection has reached the kidneys – this needs a same-day visit.

Diagnosis is made with a urine test and, when needed, a urine culture with antibiogram, which shows which antibiotic works. This matters a lot in recurrent infections: an antibiotic taken «on a friend’s advice» increases resistance and triggers thrush. Burning when passing urine can also come from thrush, trichomoniasis or chlamydia, so the gynaecologist looks at the whole picture.

Pelvic inflammatory disease (PID) is an infection of the womb, fallopian tubes and sometimes ovaries, usually from untreated chlamydia or gonorrhoea travelling upwards.

• Symptoms: lower abdominal pain, pain during sex, abnormal discharge, irregular bleeding, fever.
• Possible consequences when treatment is delayed: tubal infertility, ectopic pregnancy, chronic pelvic pain.
• The CDC guidelines (2021) advise starting treatment without delay when PID is clinically suspected. Ultrasound helps rule out other causes and check for a collection (abscess).

08Why does my vaginal infection keep coming back? Prevention, hygiene and summer

An infection that «keeps coming back» is rarely bad luck: there is usually a reason – an inaccurate diagnosis, treatment stopped early, an untreated partner (in STIs), a trigger that has not been removed, or overuse of antibiotics and intimate products.

Common hygiene myths:

• «The more you wash, the better» – no. Water and, if you like, a mild unperfumed cleanser on the outside only, once a day, are enough.
• «Douching clears an infection» – no. The CDC and ACOG advise against it: it disrupts the flora and increases the risk of BV.
• «Intimate wipes and sprays keep you fresh» – they often irritate and promote infections.
• «I caught it from a public toilet» – very rarely; the real causes are usually internal or sexual.

What actually helps:

• Cotton underwear that is not too tight; changing out of wet swimwear and sportswear quickly.
• Wiping front to back after using the toilet.
• Passing urine after sex (helps against cystitis).
• Condoms protect against STIs and may reduce BV recurrence.
• Antibiotics only when prescribed – every unnecessary course raises the risk of thrush.
• Keeping diabetes under control, if you have it.

Summer and swimming pools: heat, humidity, swimwear kept wet for hours and a change in daily routine all raise the risk of thrush. Assoc. Prof. Dr. Elinda Gjata has spoken about this on Report TV’s «Klinika 24» programme on vaginal infections in summer. Pool chlorine itself rarely causes infection but can irritate – a rinse with clean water and drying well after swimming help.

Probiotics: the CDC (2021) notes there is no strong evidence that they prevent thrush. They are usually harmless, but they do not replace diagnosis and treatment.

09Infections in pregnancy: why they matter and what is done

Infections are more common in pregnancy and matter more, because some are linked to complications for mother and baby. The good news: most are easily diagnosed and safely treated when the treatment is chosen by your doctor.

• Thrush is more common because of hormones. It is treated, but not with just any medicine: the CDC (2021) recommends vaginal treatment only in pregnancy and advises avoiding a commonly used oral antifungal.
• Symptomatic bacterial vaginosis is linked, according to the CDC, to premature rupture of membranes, preterm birth and infections after delivery – so it is treated when it causes symptoms.
• Urinary infection, even without symptoms (asymptomatic bacteriuria), should be looked for with a urine test: the US Preventive Services Task Force (USPSTF, 2019) recommends screening all pregnant women, because untreated it can progress to a kidney infection.
• Chlamydia, gonorrhoea and trichomoniasis can affect the course of pregnancy and pass to the newborn; they are tested for and treated together with the partner.
• Genital herpes: tell your doctor about any previous episode.
• Group B streptococcus (GBS): ACOG (2020) recommends a GBS swab at around 36–37 weeks.

In pregnancy, the key rule is: no pessary, antibiotic or «natural remedy» without asking your gynaecologist. Slightly heavier discharge is normal, but a constant watery leak, bleeding, fever or burning when passing urine needs a prompt check. An ultrasound at the clinic can assess the pregnancy at the same visit.

10How is an infection diagnosed at the visit? The vaginal swab step by step

An accurate diagnosis is half the treatment. This is how a visit for a gynaecological infection usually goes at Klinika Gjata:

1. Conversation (medical history): your symptoms and when they started, your cycle, contraception, possible pregnancy, recent antibiotics, treatments you have tried, previous episodes. Questions about your partner are asked discreetly and only to choose the right tests.
2. Gynaecological examination: the doctor looks at the vulva, the vaginal walls and the cervix using a speculum, and at the appearance, amount and smell of the discharge.
3. Vaginal pH: a small strip shows acidity – a normal pH (below 4.5) is typical of thrush; a pH above 4.5 points towards bacterial vaginosis or trichomoniasis.
4. Vaginal or cervical swab: a soft swab is wiped for a few seconds inside the vagina or at the cervix. It usually does not hurt.
5. Microscopy and tests: the discharge is examined for yeast, «clue cells» or trichomonas; as appropriate, it is sent for culture (e.g. recurrent thrush, with species identification) or for molecular tests for chlamydia, gonorrhoea or Mycoplasma genitalium. If a UTI is suspected, a urine test and urine culture are done.
6. Ultrasound, when needed: for pelvic pain, suspected PID, or to check a pregnancy.
7. Results and plan: some findings are discussed at the same visit; cultures and lab tests usually come back within a few days. Treatment is prescribed according to the cause, with instructions for your partner and for follow-up when needed.

For the most accurate result: avoid pessaries, vaginal creams and douching for 24–48 hours before the visit and, if possible, avoid sex the day before. If you are on your period, call us: it is often better to come afterwards, unless symptoms are severe.

11When should you see a gynaecologist urgently?

Most vaginal infections are not emergencies, but some signs should not wait. Seek a same-day visit, or go to the emergency department out of hours, if you have:

• Fever above 38°C together with lower abdominal pain or abnormal discharge.
• Severe pelvic pain, especially on one side, or pain that is getting worse quickly.
• A positive pregnancy test with abdominal pain or bleeding (ectopic pregnancy must be ruled out).
• Pregnancy with fever, burning when passing urine, leaking fluid, bleeding or pain.
• Burning when passing urine with fever, chills or back/side pain (suspected kidney infection).
• Painful genital sores with fever or difficulty passing urine.
• Vomiting, dizziness or feeling seriously unwell.

Book a visit within a few days if:

• Symptoms do not improve after treatment or return within two months (the CDC advises evaluation and testing in this case).
• You have had four or more episodes of «thrush» in a year.
• Your partner has an STI diagnosis or symptoms.
• You have bleeding after sex.

To book at Klinika Gjata: +355 4 234 0059.

12Why Klinika Gjata for gynaecological infections – and what affects the cost?

Klinika Gjata has been operating in Tirana since 2009 and is led by Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc., an obstetrician-gynaecologist with more than 25 years of experience and Associate Professor at the University of Medicine, Tirana.

• Specific expertise: Dr. Gjata’s postgraduate research (SHPU, 2004–2005) was on fungal infections and their treatment, with a focus on recurrent candidiasis – exactly the cases that «won’t clear» with standard pessaries.
• Diagnosis before treatment: examination, vaginal swab or culture as needed, and ultrasound in the same clinic.
• Discretion: conversations are respectful and non-judgemental, and your information stays confidential.
• Continuity: the same doctor follows the diagnosis, treatment, partner (when needed) and follow-up – important in recurrent infections, in pregnancy and before fertility treatment.
• Public health communication: Dr. Gjata has spoken about summer vaginal infections on Report TV’s «Klinika 24».

What affects the cost? We do not publish fixed prices online because every case is different. The cost depends on:

• The gynaecological consultation itself and whether an ultrasound is needed.
• The number and type of tests: swab for microscopy, culture, molecular STI tests, urine test or urine culture.
• Whether a follow-up visit or partner testing is needed.
• The prescribed medicines, which are bought at a pharmacy.

For accurate information before your visit, call +355 4 234 0059. The clinic is on Rruga Hasan Sufa, Tirana.