Vaginal discharge

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Vaginal discharge
MedlinePlus	003158

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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

Complete Differential Diagnosis of the Causes of ...

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	Scabies
Drug Side Effect	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), Leuprolide , Medroxyprogesterone Injection , Metronidazole Topical , Miconazole , Nafarelin , Natalizumab injection , Norelgestromin and ethinyl estradiol transdermal system , Oxcarbazepine , Tamoxifen , Terconazole Vaginal Cream, Vaginal Suppositories , Zoledronic Acid Injection
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Colposcopy
Infectious Disease	Pelvic inflammatory disease, Urethritis, Cervicitis, Vaginitis, Vulvitis Bacteria: Bacterial Vaginosis, Chlamydia, Gonorrhea, Syphilis Viral: Herpes simplex, HIV, Human Papillomavirus infections Fungal: Candidiasis Parasitic: Trichomonas vaginalis, Trichomoniasis
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	Lochia, Menstrual cycle, Postnatal, Pregnancy
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Allergic vaginitis
Sexual	Atrophic Vaginitis, Cervical cancer, Cervical polyp, Cervicitis, Endometrial cancer, Foreign body vaginitis, Salpingitis, Uterine sarcoma, Vaginal cancer, Vaginitis, Vesicovaginal fistula, Vulvitis
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

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