Vaginal discharge

Vaginal discharge

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

Laboratory Findings

Initial tests include:

• CBC
• urinalysis
• urine culture
• beta-hCG
• gonorrhea culture
• chlamydia culture

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

Differential Diagnosis of Causes of Vaginal discharge

Causes include;

Physiologic

• Discharge is common, especially mid cycle and premenstrually
• Common in patients that use oral contraceptives
• Color, odor or consistancy change require an evaluation
  
• Pregnancy results in an incerase in discharge

Cervicitis
Sexually Transmitted Disease

• Trichomonas vaginalis
• Gonorrhea/Chlamydia results in pelvic pain/dysmenorrhea and dyspareunia
• Syphilis
• Human Papillomavirus Infections
• HIV
• Scabies

Bacterial Vaginosis

• Fishy Odor
• Not an STD
• Preterm delivery during pregancy risk elevated

Alteration of normal vaginal flora and/or inflammatory response

• Candida albicans
• over growth of lactobacilli
  

Foreign body vaginitis
Noninfectious irritant/allergic contact vaginitis
Vaginal trauma Puberty

Other

• Retain wet mount and KOH of discharge is necessary
• Discharge PH

Treatment

See most recent CDC guidelines for all STD's

Acute Pharmacotherapies

Bacterial Vaginosis

• Metronidazole single dose for 7 days

Candida and Chlamydia

• Azithromycin
• doxycycline

Gonorrhea

• Oral ciprofloxacin or IM ceftriaxone

Trichomonas

• Metronidazole single dose for 7 days
• Intravaginal clotrimazole if pregnant or unable to use Metronidazole