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Vaginal discharge

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Table V1

Vaginal discharge: diagnostic strategy model (modified)

++ Key history
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The history should include:

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  • nature of discharge: colour, odour, quantity, relation to menstrual cycle, associated symptoms

  • exact nature and location of irritation

  • sexual history: arousal, previous STIs, number of partners and any presence of irritation or discharge in them

  • use of chemicals, such as soaps, deodorants, pessaries and douches

  • pregnancy possibility

  • drug therapy

  • associated medical conditions (e.g. diabetes)

++ Key examination
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  • Inspection with good light includes viewing the vulva, introitus, urethra, vagina and cervix

  • Look for the discharge and specific problems such as polyps, warts, ectropion, prolapses and fistulas

  • Full pelvic examination in a postmenopausal woman

++ Key investigations
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  • pH test with paper of range 4–6

  • Amine or ‘whiff’ test

  • Wet film microscopy of a drop of vaginal secretions

  • Full STI workup including vaginal swab

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Table V2

Characteristics of discharge

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Vaginal thrush (candidal vaginitis)
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  • Bathe genital area bd or tds with sodium bicarbonate (esp. before using treatment).

  • Dry area thoroughly.

  • Wear loose-fitting cotton underwear.

  • Avoid wearing tight clothing or using tampons.

  • Avoid vaginal douches, powders or deodorants.

++ Treatment
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Can use an azole (clotrimazole, isoconazole, butoconazole, miconazole, ketoconazole or fluconazole), amphotericin, nystatin.

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Examples:

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  • first line: clotrimazole 500 mg vaginal tab statim, or 100 mg for 6 nights and/or clotrimazole 2% cream applied to vagina and vulva (for symptomatic relief) or (esp. if recurrent)

  • nystatin pessaries, once daily for 7 d and/or nystatin vaginal cream, 4 g once daily for 7 d or (if recalcitrant)

  • fluconazole 150 mg (o) as a single dose or ketoconazole 200 ...

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