Spotting represents a small amount of blood coming from your reproductive tract. Occasional spotting during your childbearing years is relatively common, and can occur for a wide variety of reasons -- many of which represent no significant health threat. Spotting is more concerning, however, if you're postmenopausal. Infections are among the many possible causes of spotting. Minor bleeding leading to spotting can come from your external genitals, vagina, cervix, uterus, ovarian tubes or ovaries. Some of the infections that can cause spotting are sexually transmitted, but others are not.
Vaginal Yeast Infection
Vaginal yeast infections are extremely common and can cause limited spotting. Approximately 75 percent of women experience at least 1 vaginal yeast infection during their lifetime, according to the Centers for Disease Control and Prevention (CDC). Also known as vulvovaginal candidiasis (VVC), this condition occurs when yeast overgrowth develops in the vagina and on the vulva. The infection typically causes painful inflammation and intense itchiness, usually accompanied by burning and a thick, white vaginal discharge that often resembles cottage cheese. Inflammation of the vaginal and vulvar tissues and scratching the area -- which is almost impossible avoid with VVC -- can cause mild bleeding and spotting.
A variety of bacteria inhabit the vagina and Lactobacillus species normally predominate. Bacterial vaginosis (BV) is a common vaginal infection caused by a decreased level of Lactobacillus and overgrowth of other bacterial species. BV is the most common type of vaginal infection, according to CDC. Typical symptoms of BV include a watery grayish or white discharge with a fishy odor, accompanied by itchiness and burning -- although the itchiness is usually less intense than with VVC. Similar to a vaginal yeast infection, BV sometimes causes spotting due to tissue inflammation and scratching. With both VVC and BV, spotting might be more likely after intercourse due to frictional irritation of the inflamed vaginal tissue.
Trichomoniasis -- commonly known as trich -- is the most common nonviral, sexually-transmitted disease in the U.S., reports CDC. Trich is caused by a microscopic parasite, which can infect the vagina, cervix and urethra, the tube through which urine flows from the bladder. Approximately 50 percent of women with trich experience no symptoms. When symptoms do occur, they typically include mild to severe itchiness, burning and irritation that may be accompanied by thin, foul-smelling vaginal discharge. Inflammation of the vagina, vulva and cervix and scratching can lead to spotting -- especially after intercourse. Interestingly, symptoms associated with trich can fluctuate over time, sometimes disappearing only to reappear later.
Chlamydia, Gonorrhea and Pelvic Inflammatory Disease
Chlamydia and gonorrhea are common, bacterial sexually-transmitted diseases (STDs) that often occur together. Most women with one or both of these STDs experience no symptoms, which is problematic because the bacteria can spread from the vagina to the cervix, uterus, ovarian tubes, ovaries and abdomen. Infection of the cervix causes inflammation, or cervicitis, which might cause spotting between periods and after intercourse. Untreated chlamydia or gonorrhea, or both, can progress to pelvic inflammatory disease (PID), a serious infection of a woman's upper reproductive tract that can lead to infertility and increase her risk for ectopic pregnancy, which is potentially life-threatening. Spotting is one of several signs and symptoms that can occur with PID.
Warnings and Precautions
Occasional, infrequent spotting in a reproductive-aged woman without other symptoms and who has no risk factors for an STD is usually not cause for concern. However, if you experience symptoms that might indicate an infection or may have been exposed to an STD, see a healthcare provider as soon as possible. It's also important to seek prompt medical care if you experience frequent spotting or are postmenopausal. Seek urgent medical care if you think you might be pregnant or have any warning signs or symptoms, including:
-- fever or chills
-- moderate to severe abdominal or pelvic pain
-- unexpected vaginal bleeding
Reviewed and revised by: Tina M. St. John, M.D.