Vaginal discharge
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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:
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
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
- 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
Gonorrhea
- Oral ciprofloxacin or IM ceftriaxone
Trichomonas
- Metronidazole single dose for 7 days
- Intravaginal clotrimazole if pregnant or unable to use Metronidazole
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
