Vaginal discharge

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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] SO

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.

Causes

Common Causes

• Atrophic vaginitis or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia.
• Bacterial vaginosis
• Cervical cancer
• Chlamydia,sexually transmitted infections.
• Foreign body vaginitis
• Gonorrhea,sexually transmitted infections
• Herpes
• Trichomoniasis,a parasitic infection typically contracted and caused by having unprotected sex
• Vaginal cancer
• Vaginal yeast infection
• 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

Classification

-Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle, Pregnancy, and Menopause. -Abnormal vaginal discharge as Bacterial vaginosis Vaginal yeast infection sexually transmitted diseases vaginal cancer cervical cancer

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

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