Women's health chat with Dr Sarah Brewer

A: My advice is to visit a genito-urinary medicine clinic for a full screen. They can double-check the chlamydia test, check the cervix for an obvious cause of spotting such as inflammation and, more importantly, see if you have a bacterial imbalance known as bacterial vaginosis (BV). This can often only be diagnosed by examining fresh discharge under a microscope, something GPs don't generally do. Vaginal swabs sent to the lab sometimes do show BV, but they have a high false negative result rate. BV is important to diagnose, not just because it can cause a discharge (though not usually bleeding), but also because it has been linked with an increased risk of miscarriage during the first three months of pregnancy, and an increased risk of pre-term labour. It is therefore worth having a full check-up before trying to conceive.

The cause of the bacterial imbalance found in BV is unknown, but taking some broad-spectrum antibiotics may trigger it. BV is treated with special antibiotics such as metronidazole tablets/gel or with clindamycin cream. Taking probiotic supplements containing live, friendly digestive bacteria (lactobacilli) can help to replenish levels of healthy bacteria in the vagina.
Dr Sarah Brewer