What could be causing my night sweats, spinal cyst, and bad vaginal odor?

Evaluation of Night Sweats, Spinal Cyst, and Vaginal Odor

Your symptoms represent three distinct clinical problems that require separate evaluation, with the vaginal odor being the most straightforward to address through testing for bacterial vaginosis, trichomoniasis, and candidiasis, while the night sweats and spinal cyst need independent medical assessment as they are unlikely to be related to the vaginal symptoms.

Addressing the Vaginal Odor

The bad vaginal odor is most likely caused by bacterial vaginosis (BV), which accounts for 40-50% of identified vaginitis cases and is the most common cause of vaginal malodor 1, 2.

Diagnostic Testing Required

• You need vaginal pH testing and microscopy - normal vaginal pH is 3.8-4.5, and elevated pH (>4.5) strongly suggests BV or trichomoniasis 3, 4.
• The "whiff test" should be performed - a fishy/amine odor detected after applying 10% KOH to vaginal discharge indicates BV or trichomoniasis 5, 3.
• Wet mount microscopy with both saline and KOH preparations should visualize clue cells (BV), motile trichomonads (trichomoniasis), or yeast/pseudohyphae (candidiasis) 5, 3.
• If initial testing is negative but symptoms persist, request Gram stain with Nugent criteria, as standard clinical testing misses 20-30% of BV cases 6.

Treatment Based on Diagnosis

• For confirmed bacterial vaginosis: metronidazole 500 mg orally twice daily for 7 days (cure rate 80-95%) is the CDC-recommended treatment 6, 1.
• For trichomoniasis: oral metronidazole or tinidazole, with treatment of sexual partners required 1, 7.
• For vulvovaginal candidiasis: oral fluconazole or topical azoles 1, 7.

Important Caveat About Normal Discharge

If all testing is negative, reassurance and no treatment is appropriate, as physiologic vaginal discharge is normal and treating it may disrupt healthy vaginal flora 3. Laboratory testing fails to identify a pathologic cause in a substantial minority of women with discharge complaints 5, 3.

Night Sweats Require Separate Evaluation

Night sweats are not caused by vaginal infections and represent a distinct symptom requiring evaluation for:

• Infectious causes (tuberculosis, HIV, endocarditis)
• Malignancy (lymphoma, leukemia)
• Endocrine disorders (hyperthyroidism, carcinoid syndrome)
• Medications or hormonal changes (menopause)

This symptom needs blood work, imaging, and potentially specialist referral depending on associated symptoms.

Spinal Cyst Requires Imaging and Neurosurgical Assessment

The spinal cyst is unrelated to either the vaginal odor or night sweats and requires:

• MRI imaging to characterize the cyst type, size, and location
• Neurosurgical consultation if causing neurological symptoms or spinal cord compression
• Monitoring if asymptomatic and incidental

Critical Clinical Pitfalls to Avoid

• Do not assume these three symptoms are related - they represent separate pathologies requiring independent workups 3, 1.
• Avoid empiric treatment without testing - 42% of women with vaginitis symptoms receive inappropriate treatment in community practice, and women without infections who receive empiric treatment have more recurrent visits within 90 days 8.
• Do not ignore persistent vaginal symptoms with negative initial testing - consider retesting with Gram stain, as standard testing misses 20-30% of BV cases 6.
• Discontinue potential vaginal irritants (scented products, douching, harsh soaps) as chemical irritation can mimic infection 3, 4.