Vaginal discharge is secreted by glands on the cervix and is a normal physiological process that cleans and moistens the vagina. The amount and consistency of discharge is dependent on the age of the woman and stage of menstrual cycle (see flow chart.) Prescribed contraception methods can also affect vaginal discharge. Normal discharge is white or clear and non-offensive smelling.
Many factors can cause a change in the amount and consistency of discharge, these factors can be categorised as infective or non-infective. Infective causes are further categorised into sexually transmitted and non-sexually transmitted.
When a woman presents complaining of abnormal vaginal discharge it is important to ask about the nature of the discharge (see spider diagram below).
A sexual history, past-medical history and a list of the patient’s current medications aid in diagnosis.
Patients who present with symptoms of Candida infection (white, thick and curdy discharge) or bacterial vaginosis (fishy smelling discharge) can be treated without sampling.
Candidiasis – Candida albicans → Clotrimazol 500mg pessary once at night and clotrimazol cream 12-hourly
Bacterial vaginosis - Gardenella Vaginalis → Metronidazole 400mg twice a day for 5-7 days or Metronidazole 2g once only dose
For patients with other symptoms triple swabs should be taken.
Treatment depends on the cause. A thorough history should be taken and if the cause of the discharge is thought to be due to a gynaecological problem (cervical ectopy, malignancy) the patient should be referred to a gynaecology clinic. Some women’s symptoms may disappear on stopping using vaginal sprays and highly perfumed soaps. If the history suggests that the patient has a sexually transmitted infection, the patient should be referred to the genitourinary (GUM) clinic, where they should be investigated for all STI’s and receive education and counselling about STD’s and sexual contact tracing.
Trichomonas vaginalis → Metronidazole 400mg BD for 5 to 7 days or Metronidazole 2g once only dose
Gonorrhoea → Cefixime 400mg single dose
Chlamydia trachomatis → Doxycycline 100mg BD for 7 days
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