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]]

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.

Causes

Common Causes

• Atrophic vaginitis
• Bacterial vaginosis
• Cervical cancer
• Chlamydia
• Foreign body vaginitis
• Gonorrhea
• Herpes
• Trichomoniasis
• Vaginal cancer
• Vaginal yeast infection

Causes 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	Cervical cancer, Endometrial cancer, Uterine sarcoma, Vaginal cancer
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,Colposcopy, Pelvic inflammatory disease, Allergic vaginitis, Vaginal trauma, Bacterial Vaginosis,Candidiasis
Trauma	Vaginal trauma
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Allergic vaginitis Amoxicillin and Clavulanic Acid Atrophic Vaginitis Bacterial Vaginosis Butoconazole Vaginal Cream Candidiasis Cervical cancer Cervical polyp Cervicitis Chlamydia Clotrimazole Colposcopy Combined oral contraceptive pill Endometrial cancer Estradiol Topical Estradiol Transdermal Estrogen and Progestin (Oral Contraceptives) Estrogen Injection Estrogen Vaginal Etonogestrel and Ethinyl Estradiol Vaginal Ring Foreign body vaginitis Glatiramer Injection Gonorrhea Herpes simplex HIV Hormone replacement therapy (trans) Human Papillomavirus infections

Leuprolide Lochia Medroxyprogesterone Injection Menstrual cycle Metronidazole Topical Miconazole Nafarelin Natalizumab injection Norelgestromin and ethinyl estradiol transdermal system Oxcarbazepine Pelvic inflammatory disease Postnatal Pregnancy Salpingitis Scabies Syphilis Tamoxifen Terconazole Vaginal Cream, Vaginal Suppositories Trichomonas vaginalis Trichomoniasis Urethritis Uterine sarcoma Vaginal cancer Vaginal trauma Vaginitis Vesicovaginal fistula Vulvitis Zoledronic Acid Injection

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