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'''For patient information, click [[Vaginal discharge (patient information)|here]]'''
'''For patient information, click [[Vaginal discharge (patient information)|here]]'''


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{{SK}} Discharge from the vagina
{{SK}} Discharge from the vagina


== Overview ==
==Overview==
Vaginal discharge is a common patient complaint that is paired with [[anxiety]] regarding [[sexually transmitted diseases]]. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.Also there is normal vaginal discharge  depends on periodic hormonal change.<ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/18048541">{{cite journal| author=Spence D, Melville C| title=Vaginal discharge. | journal=BMJ | year= 2007 | volume= 335 | issue= 7630 | pages= 1147-51 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/18048541 | doi=10.1136/bmj.39378.633287.80 | pmc=2099568 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18048541  }} </ref>  
Vaginal discharge is a common patient complaint that is paired with [[anxiety]] regarding [[sexually transmitted diseases]]. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.Also there is normal vaginal discharge  depends on periodic hormonal change<ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/18048541">{{cite journal| author=Spence D, Melville C| title=Vaginal discharge. | journal=BMJ | year= 2007 | volume= 335 | issue= 7630 | pages= 1147-51 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/18048541 | doi=10.1136/bmj.39378.633287.80 | pmc=2099568 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18048541  }} </ref>  


==Causes==
==Causes==


===Common Causes===
===Common Causes===
* [[Atrophic vaginitis]] or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia.<ref name="pmid21524046">{{cite journal| author=Hainer BL, Gibson MV| title=Vaginitis. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 7 | pages= 807-15 | pmid=21524046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21524046  }} </ref>
 
* [[Bacterial vaginosis]]is mostally happen  during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora.<ref name="pmidhttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688">{{cite journal| author=Cettl L, Dvorak J, Felkel H, Feuereisl R| title=Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement. | journal=Int J Biomed Comput | year= 1979 | volume= 10 | issue= 1 | pages= 67-74 | pmid=http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 | doi=10.1016/0020-7101(79)90042-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=478688  }} </ref>
*[[Atrophic vaginitis]] or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia<ref name="pmid21524046">{{cite journal| author=Hainer BL, Gibson MV| title=Vaginitis. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 7 | pages= 807-15 | pmid=21524046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21524046  }} </ref>
* [[Cervical cancer]]<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*[[Bacterial vaginosis]]is mostally happen  during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora<ref name="pmidhttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688">{{cite journal| author=Cettl L, Dvorak J, Felkel H, Feuereisl R| title=Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement. | journal=Int J Biomed Comput | year= 1979 | volume= 10 | issue= 1 | pages= 67-74 | pmid=http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 | doi=10.1016/0020-7101(79)90042-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=478688  }} </ref>
* [[Chlamydia]],sexually transmitted infections.
*[[Cervical cancer]]<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
* [[Foreign body vaginitis]]
*[[Chlamydia]],sexually transmitted infections.
*[[Foreign body vaginitis]]
*[[Gonorrhea (patient information)|Gonorrhea]],sexually transmitted infections<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*[[Gonorrhea (patient information)|Gonorrhea]],sexually transmitted infections<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
* [[Herpes]]<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/7817733">{{cite journal| author=Wathne B, Holst E, Hovelius B, Mårdh PA| title=Vaginal discharge--comparison of clinical, laboratory and microbiological findings. | journal=Acta Obstet Gynecol Scand | year= 1994 | volume= 73 | issue= 10 | pages= 802-8 | pmid=https://pubmed.ncbi.nlm.nih.gov/7817733 | doi=10.3109/00016349409072509 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7817733  }} </ref>
*[[Herpes]]<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/7817733">{{cite journal| author=Wathne B, Holst E, Hovelius B, Mårdh PA| title=Vaginal discharge--comparison of clinical, laboratory and microbiological findings. | journal=Acta Obstet Gynecol Scand | year= 1994 | volume= 73 | issue= 10 | pages= 802-8 | pmid=https://pubmed.ncbi.nlm.nih.gov/7817733 | doi=10.3109/00016349409072509 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7817733  }} </ref>
* [[Trichomoniasis]],a parasitic infection typically contracted and caused by having unprotected sex<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/18048541">{{cite journal| author=Spence D, Melville C| title=Vaginal discharge. | journal=BMJ | year= 2007 | volume= 335 | issue= 7630 | pages= 1147-51 | pmid=https://pubmed.ncbi.nlm.nih.gov/18048541 | doi=10.1136/bmj.39378.633287.80 | pmc=2099568 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18048541  }} </ref>
*[[Trichomoniasis]],a parasitic infection typically contracted and caused by having unprotected sex<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/18048541">{{cite journal| author=Spence D, Melville C| title=Vaginal discharge. | journal=BMJ | year= 2007 | volume= 335 | issue= 7630 | pages= 1147-51 | pmid=https://pubmed.ncbi.nlm.nih.gov/18048541 | doi=10.1136/bmj.39378.633287.80 | pmc=2099568 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18048541  }} </ref>
* [[Vaginal cancer]]
*[[Vaginal cancer]]
* [[Vaginal yeast infection]]
*[[Vaginal yeast infection]]
* [[Diabetes]]
*[[Diabetes]]
* [[drug side effect]] as antibiotic or [[steroid]] use as,  [[Amoxicillin and Clavulanic Acid ]], [[Butoconazole Vaginal Cream ]], [[Clotrimazole ]], [[Combined oral contraceptive pill]], [[Estradiol Topical ]], [[Estradiol Transdermal ]], [[Estrogen and Progestin (Oral Contraceptives) ]],[[Estrogen Injection ]], [[Estrogen Vaginal ]], [[Etonogestrel and Ethinyl Estradiol Vaginal Ring ]], [[Glatiramer Injection ]],[[Hormone replacement therapy (trans)]], [[Letrozole]], [[Leuprolide ]], [[Medroxyprogesterone Injection ]], [[Metronidazole Topical ]],[[Miconazole ]], [[Nafarelin ]], [[Natalizumab injection ]], [[Norelgestromin and ethinyl estradiol transdermal system ]], [[Ospemifene]], [[Oxcarbazepine ]], [[Pramipexole]], [[Progesterone]], [[Tamoxifen ]], [[Terconazole Vaginal Cream, Vaginal Suppositories ]], [[Toremifene]], [[Zoledronic Acid Injection ]]
*Drug side effect as [[antibiotic]] or [[steroid]] use as,  [[Amoxicillin and Clavulanic Acid ]] , [[Butoconazole Vaginal Cream ]] , [[Clotrimazole ]] , [[Combined oral contraceptive pill]], [[Estradiol Topical ]] , [[Estradiol Transdermal ]] , [[Estrogen and Progestin (Oral Contraceptives) ]] ,[[Estrogen Injection ]] , [[Estrogen Vaginal ]] , [[Etonogestrel and Ethinyl Estradiol Vaginal Ring ]] , [[Glatiramer Injection ]] ,[[Hormone replacement therapy (trans)]], [[Letrozole]], [[Leuprolide ]] , [[Medroxyprogesterone Injection ]] , [[Metronidazole Topical ]] ,[[Miconazole ]] , [[Nafarelin ]] , [[Natalizumab injection ]] , [[Norelgestromin and ethinyl estradiol transdermal system ]] , [[Ospemifene]], [[Oxcarbazepine ]] , [[Pramipexole]], [[Progesterone]], [[Tamoxifen ]] , [[Terconazole Vaginal Cream, Vaginal Suppositories ]] , [[Toremifene]], [[Zoledronic Acid Injection ]]
 
==Classification==
==Classification==
-Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/25905282">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=https://pubmed.ncbi.nlm.nih.gov/25905282 | doi= | pmc= | url= }} </ref>, Pregnancy, and Menopause.
Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/25905282">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=https://pubmed.ncbi.nlm.nih.gov/25905282 | doi= | pmc= | url= }} </ref>, Pregnancy, and Menopause.
-Abnormal vaginal discharge as  
-Abnormal vaginal discharge as  


* [[Bacterial vaginosis]]
*[[Bacterial vaginosis]]
 
* [[Vaginal yeast infection]]


* [[sexually transmitted diseases]]<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*[[Vaginal yeast infection]]


* [[vaginal cancer]]
*[[Sexually transmitted disease|Sexually transmitted diseases]]<ref name="pmidhttps://doi.org/10.1016/j.ogrm.2016.08.002">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.ogrm.2016.08.002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>


* [[cervical cancer]]
*[[vaginal cancer]]


*[[cervical cancer]]


== Laboratory Findings ==
==Laboratory findings==


Initial tests include:
Initial tests include:


* [[CBC]]
*[[CBC]]
* [[Urinalysis]]
*[[Urinalysis]]
* [[Urine]] culture
*[[Urine culture]]
* [[Beta-hCG]]
*[[Beta-hCG]]
* [[Gonorrhea]] culture
*[[Gonorrhea]] culture
* [[Chlamydia]] culture
*[[Chlamydia]] culture


=== Other Diagnostic Studies ===
===Other Diagnostic Studies===


{| style="background:silver; color:black"
{| style="background:silver; color:black"
|-
|-
| Type
|Type
| pH
|pH
| Discharge
|Discharge
| Odor
|Odor
| Wet Mount
|Wet Mount
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| Trich
|Trich
| >4.5
|>4.5
| yellow-green, copious
|yellow-green, copious
| present
|present
| motile, flagellated
|motile, flagellated
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| BV
|BV
| >4.5
|>4.5
| white-grey
|white-grey
| fishy
|fishy
| clue cells
|clue cells
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| Candida
|Candida
| <4.5
|<4.5
| white, curd-like
|white, curd-like
| none
|none
| pseudo-hyphae
|pseudo-hyphae
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| GC
|GC
|
|
| mucopurulent
|mucopurulent
| varies
|varies
| PMNs
|PMNs
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| A.V.
|A.V.
|
|
| thin, gray, watery
|thin, gray, watery
| none
|none
| few epithelial cells
|few epithelial cells
|}
|}


== Treatment ==
==Treatment==


'''See most recent CDC guidelines for all STD's'''
'''See most recent CDC guidelines for all STD's'''


== Acute Pharmacotherapies ==
==Acute pharmacotherapies==


==== Bacterial Vaginosis ====
====Bacterial Vaginosis====


* [[Metronidazole]] single dose for 7 days
*[[Metronidazole]] single dose for 7 days


==== [[Candida]] and [[Chlamydia]] ====
====[[Candida]] and [[Chlamydia]]====


* [[Azithromycin]]
*[[Azithromycin]]
* [[Doxycycline]]
*[[Doxycycline]]


==== Gonorrhea ====
====Gonorrhea====


* Oral [[ciprofloxacin]] or IM [[ceftriaxone]]
*Oral [[ciprofloxacin]] or IM [[ceftriaxone]]


==== Trichomonas ====
====Trichomonas====


* [[Metronidazole]] single dose for 7 days
*[[Metronidazole]] single dose for 7 days
* Intravaginal [[clotrimazole]] if pregnant or unable to use [[Metronidazole]]
*Intravaginal [[clotrimazole]] if pregnant or unable to use [[Metronidazole]]


== References ==
==References==
{{Reflist|2}}
{{Reflist|2}}


Revision as of 18:51, 21 May 2021


For patient information, click here

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2] Samah Obaiah

Synonyms and keywords: Discharge from the vagina

Overview

Vaginal discharge is a common patient complaint that is paired with anxiety regarding sexually transmitted diseases. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.Also there is normal vaginal discharge depends on periodic hormonal change[1]

Causes

Common Causes

Classification

Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle[7], Pregnancy, and Menopause. -Abnormal vaginal discharge as

Laboratory findings

Initial tests include:

Other Diagnostic Studies

Type pH Discharge Odor Wet Mount
Trich >4.5 yellow-green, copious present motile, flagellated
BV >4.5 white-grey fishy clue cells
Candida <4.5 white, curd-like none pseudo-hyphae
GC mucopurulent varies PMNs
A.V. thin, gray, watery none few epithelial cells

Treatment

See most recent CDC guidelines for all STD's

Acute pharmacotherapies

Bacterial Vaginosis

Candida and Chlamydia

Gonorrhea

Trichomonas

References

  1. ↑ Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://www.ncbi.nlm.nih.gov/pubmed/18048541 Check |pmid= value (help).
  2. ↑ Hainer BL, Gibson MV (2011). "Vaginitis". Am Fam Physician. 83 (7): 807–15. PMID 21524046.
  3. ↑ Cettl L, Dvorak J, Felkel H, Feuereisl R (1979). "Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement". Int J Biomed Comput. 10 (1): 67–74. doi:10.1016/0020-7101(79)90042-4. PMID http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 Check |pmid= value (help).
  4. ↑ 4.0 4.1 4.2 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/j.ogrm.2016.08.002 Check |pmid= value (help).
  5. ↑ Wathne B, Holst E, Hovelius B, Mårdh PA (1994). "Vaginal discharge--comparison of clinical, laboratory and microbiological findings". Acta Obstet Gynecol Scand. 73 (10): 802–8. doi:10.3109/00016349409072509. PMID https://pubmed.ncbi.nlm.nih.gov/7817733 Check |pmid= value (help).
  6. ↑ Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://pubmed.ncbi.nlm.nih.gov/18048541 Check |pmid= value (help).
  7. ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID https://pubmed.ncbi.nlm.nih.gov/25905282 Check |pmid= value (help).

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