Green Vaginal Discharge: Causes, Treatment, and When to Worry

• Green discharge is essentially never physiological — fresh, bright green or pus-like discharge signals an infection and needs a clinic visit, ideally within 48 hours.
• The commonest causes are trichomoniasis, bacterial vaginosis (sometimes with co-infection), chlamydia, gonorrhoea, and pelvic inflammatory disease (PID).
• Diagnosis is simple and cheap: history, speculum exam, vaginal pH, wet-mount microscopy, and NAAT swabs for chlamydia and gonorrhoea.
• Treatment is inexpensive and curable — metronidazole, tinidazole, azithromycin, or ceftriaxone depending on the cause. NACO clinics test and treat for free.
• For sexually transmitted causes, the partner must be treated too, or reinfection is almost guaranteed.
• Seek same-day care for fever, severe pelvic pain, a forgotten tampon, or any green discharge in pregnancy.

Vaginal discharge gets its colour from the cells and substances suspended in cervical and vaginal secretions. Healthy clear or white discharge is mostly water, shed epithelial cells, and protective lactobacilli.

When the immune system detects an infection, white blood cells called neutrophils flood the area. As they break down they release a greenish pigment (myeloperoxidase) — the same pigment that gives pus its colour. Bacterial by-products and tissue debris deepen the hue. Trichomonas vaginalis, an anaerobic parasite, also releases gas as it metabolises, which is why trichomoniasis discharge is often described as frothy or bubbly.

A faint yellow-green tint in discharge that has dried on underwear for hours can occasionally be harmless oxidation. But fresh, bright green or pus-like discharge coming from the vagina itself is not normal. FOGSI guidance lists green discharge among the abnormal patterns that warrant laboratory workup rather than guesswork. This matters in India, where syndromic management was historically used in low-resource settings; current advice favours microscopy and NAAT testing where available, to avoid missed STIs and antimicrobial resistance. To compare colours, see our guides on all the types of vaginal discharge and on yellow discharge, which can shade into green.

• Frothy yellow-green or yellow-orange discharge with a strong fishy odour
• Intense vulval itching and burning
• Redness and swelling of the labia
• Pain during sex (dyspareunia)
• Burning during urination
• Sometimes a 'strawberry' appearance of the cervix on speculum exam

Bacterial vaginosis (BV) is the most common cause of abnormal discharge in women of reproductive age. It is not strictly a sexually transmitted infection, though it is more common in those with new sexual partners. BV is a disturbance of the vaginal microbiome in which protective lactobacilli are crowded out by anaerobic bacteria such as Gardnerella vaginalis.

Typical BV discharge is thin, grey-white or off-white, with a strong fishy odour that is often worse after sex. The discharge can take on a yellow-green tint in more advanced cases or when BV coexists with trichomoniasis or chlamydia. If odour is your main concern, our guides on vaginal odour and on discharge that smells like vinegar explain the difference between normal and fishy smells.

FOGSI diagnoses BV using the Amsel criteria: thin homogeneous discharge, vaginal pH above 4.5, a positive whiff test, and clue cells on microscopy. First-line treatment is oral metronidazole 500 mg twice daily for 7 days, or vaginal metronidazole gel 0.75% for 5 nights; both are cheap and widely available. Clindamycin cream is an alternative for those who cannot tolerate metronidazole.

Importantly, FOGSI and ACOG advise against routine use of scented intimate washes such as V-Wash, Clean & Dry, and Everteen — they disrupt lactobacilli and can trigger recurrent BV. For recurrent cases, restoring a healthy microbiome with probiotics is sometimes suggested. BV is easily confused with thrush and urinary infection; our comparison of yeast infection vs UTI vs BV helps you tell them apart.

Both chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) can cause green or yellow-green discharge from an inflamed cervix (cervicitis) — but they are often completely silent. The cervix may look red and bleed easily when touched during a speculum exam.

When symptoms occur, they include green or yellow discharge, bleeding between periods or after sex, pelvic pain, painful urination, and lower abdominal discomfort. Untreated, these infections are leading preventable causes of tubal infertility and ectopic pregnancy in India.

NACO-supported clinics offer free NAAT testing on a vaginal swab or first-catch urine. Private labs in India charge roughly ₹600–₹1,800 per test, or ₹3,000–₹5,000 for a comprehensive STI panel. Chlamydia is treated with a single oral dose of azithromycin 1 g, or doxycycline 100 mg twice daily for 7 days. Gonorrhoea now requires an intramuscular injection of ceftriaxone 500 mg, because resistance has emerged to older oral options.

Partner treatment is essential, and a test of cure at 3 months is recommended. ACOG, RCOG, and the Indian Council of Medical Research all recommend annual chlamydia screening for sexually active women under 25 and for older women with new partners. For the bigger picture, see our guide to STIs in Indian women. Note that a tender, easily bleeding cervix is not always infection — cervical erosion (ectropion) is a common benign mimic.

Pelvic inflammatory disease (PID) is an ascending infection of the upper genital tract, usually a complication of untreated chlamydia, gonorrhoea, or BV. It causes green or pus-like discharge, lower abdominal pain, fever, painful sex, irregular bleeding, and tenderness on pelvic exam. PID is a leading cause of chronic pelvic pain, tubal infertility, and ectopic pregnancy in India.

Mild cases are treated with outpatient antibiotics (a combination of ceftriaxone, doxycycline, and metronidazole). Severe cases need hospital admission for intravenous antibiotics and sometimes surgical drainage of a tubo-ovarian abscess. You can read more in our dedicated guide to pelvic inflammatory disease in India.

Another important cause of green discharge is a retained foreign body — most often a forgotten tampon, condom fragment, or piece of menstrual product. The discharge is typically dark green-brown with an overpowering foul smell and needs urgent removal plus antibiotic cover; in rare cases this can progress to toxic shock syndrome. Tropical infections such as schistosomiasis are rare in India but possible in travellers.

• History — discharge colour, smell, itching, sexual activity, contraception, last period, and any recent antibiotics or washes
• Speculum examination — to inspect the cervix and vaginal walls for friability, ectropion, or a visible foreign body
• Vaginal pH strip — a pH above 4.5 supports BV or trichomoniasis; a normal pH (below 4.5) makes thrush or physiological discharge more likely
• Wet-mount microscopy — to look for clue cells (BV), yeast hyphae (Candida), and moving parasites (Trichomonas)
• NAAT swabs for chlamydia and gonorrhoea, with an offer of HIV, syphilis, and hepatitis B testing
• Urine pregnancy test if a period is missed, and a transvaginal ultrasound if PID is suspected

• Do not douche — it pushes pathogens higher into the uterus and tubes and is a recognised risk factor for PID
• Stop using scented intimate washes (V-Wash, Clean & Dry, Everteen); plain warm water on the external vulva is enough
• Wear breathable cotton underwear and change it twice daily in humid weather; avoid wet swimwear and sweaty gym clothes
• Do not self-medicate with leftover antibiotics or single-dose fluconazole — treating trichomoniasis with a yeast tablet will not work and delays correct diagnosis
• Avoid penetrative sex until the cause is identified and treated, to protect your partner and let inflamed tissue heal
• For pain, paracetamol 500 mg every 6 hours is gentler on the stomach than NSAIDs
• Keep a simple symptom log — discharge colour, smell, and any bleeding — to share at the consultation

Treatment for the common causes of green discharge is inexpensive and widely available across India, and the right diagnosis means the right drug, dose, and duration.

Metronidazole 500 mg tablets cost ₹3–₹10 each; a full 7-day twice-daily course is under ₹150. Tinidazole 2 g single dose costs ₹40–₹80. Vaginal metronidazole gel 0.75% (Metrogyl V, Flagyl gel) costs ₹100–₹250 per tube. Azithromycin 1 g for chlamydia costs ₹50–₹150. Intramuscular ceftriaxone 500 mg for gonorrhoea costs ₹40–₹120 and is given in the clinic. Single-dose fluconazole 150 mg for thrush costs ₹15–₹50; topical clotrimazole cream (Candid V6) is ₹150–₹300.

A FOGSI gynaecology consultation costs ₹600–₹2,500; lab tests range from about ₹400 for a simple vaginal swab to ₹3,000–₹5,000 for a full STI panel. NACO integrated counselling and testing centres provide free testing and treatment for trichomoniasis, BV, chlamydia, gonorrhoea, HIV, syphilis, and hepatitis B.

After treatment, a test of cure at 3 months is recommended for chlamydia and gonorrhoea, and a follow-up at 2 weeks for symptomatic relief of BV or trichomoniasis. Partner treatment is non-negotiable for STIs — reinfection from an untreated partner is the leading reason treatment fails. If you are concerned about an STI but unsure where to start, HIV testing and care pathways and routine Pap smear screening are both confidential and widely available.

• Fever above 38°C
• Severe lower abdominal or pelvic pain
• Vomiting
• Heavy bleeding outside a period
• Foul-smelling discharge with a forgotten tampon
• Fainting
• A positive pregnancy test with bleeding or pain

• WHO — Trichomoniasis (sexually transmitted infections fact sheet))
• ACOG — Vaginitis (FAQ and Practice Bulletin)
• NHS — Trichomoniasis
• NHS — Pelvic inflammatory disease (PID)
• NACO (National AIDS Control Organisation) — STI/RTI services and guidelines
• CDC — Bacterial Vaginosis Treatment Guidelines (STI Treatment Guidelines)