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Dear Aunt Vadge,
Pain, yellow discharge and spotting. My gynaecologist diagnosed Doderlein’s cytolytic vaginosis and prescribed [the antibiotic] Dalacin. No improvement in 2 weeks, so what else can be done?
Regards,
Unimproved
Hi there Unimproved,
Doderlein’s cytolytic vaginosis (CV) is also called lactobacillus overgrowth syndrome – an overgrowth of certain lactobacilli, usually Lactobacillus crispatus, that grows dense enough to irritate and break down vaginal cells. Lactobacilli are normally the protective heroes of the vagina, but like any bacteria they can grow out of balance and cause trouble.
Dalacin (clindamycin) is an antibiotic that targets gram-positive bacteria, which includes lactobacilli, so the logic of the prescription makes sense on paper. When two weeks of it changes nothing, that is a useful clue in itself: it often means the picture isn’t purely CV, or it isn’t CV at all.
Your yellow discharge is part of why I’d want a closer look. Classic CV tends to bring thick, white, cottage-cheese-like discharge with itching and burning, whereas yellow discharge, pain and spotting lean more towards aerobic vaginitis (AV) or something else going on. In the cases that reach me, CV and AV flip back and forth surprisingly readily, because they share underlying drivers, so it is easy to land on one label when the other is in play.
Because your symptoms haven’t shifted – and especially because of the spotting – the most useful next step is to find out exactly what is growing before you throw more treatment at it. A comprehensive vaginal microbiome test will show whether this is a lactobacillus overgrowth, AV, an infection, or a mix, so you’re not treating blind. Persistent pain and spotting also deserve a proper in-person review with your gynaecologist – we don’t do physical exams at My Vagina, and spotting is always worth having checked on the spot.
If it really is CV, there is a simple, cheap first-pass treatment on the lactobacillus overgrowth syndrome page – a baking soda douche to nudge the vaginal pH up and discourage the overgrowth. It doesn’t work for everyone, but it costs almost nothing to try and it’s a sensible place to start once CV is actually confirmed.
If the baking soda approach doesn’t settle it, you can book a consultation with a My Vagina practitioner who works with the underlying causes of CV and AV.
This is general information, not a substitute for personalised medical advice.
Warmest regards,
Aunt Vadge
