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Vaginal discharge

Key history

The history should include:

• 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

• 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

• 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

Vaginal thrush (candidal vaginitis)

• 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

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

Examples:

• 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 ...