Vaginal discharge

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All women have some vaginal discharge. Physiological discharge varies considerably and is affected by the menstrual cycle.
• Before ovulation—mucus is clearer, wetter, stretchy, and slippery
• After ovulation—mucus is thicker and stickier

Causes of ‘abnormal’ discharge 5 causes account for 95% cases:

  • Excessive normal secretions
  • Bacterial vaginosis (BV)
  • Candida albicans
  • Cervicitis (gonococcal, chlamydial, or herpetic)
  • Trichomonas vaginalis (TV)

Rarer causes Cervical ectropion/polyp; IUCD/IUS; chemical vaginitis  (avoid perfumed or disinfectant bath additives and vaginal douches); foreign body (e.g. retained tampon—remove and treat with metronidazole); genital tract tumour; fistula.

History Ask about:
Symptoms Vaginal discharge (itchy, offensive, colour, duration), vulval soreness and irritation, lower abdominal pain, dyspareunia, heavy periods, intermenstrual bleeding, fever, vulval pain
Sexual history Recent sexual contact with new partner, multiple partners, presence of symptoms in partner, worries about STIs
• Medical history Pregnancy, diabetes mellitus, recent antibiotics
• Attempts at self-medication

Examination Always offer examination if:
• High risk for STI—age <25y; new sexual partner or >1 sexual partner in the past year; diagnosis of STI in the past 12mo
• Upper reproductive tract symptoms—abnormal bleeding (heavy, post-coital ± intermenstrual); pelvic/abdominal pain; deep dyspareunia; fever
• Pregnant, postpartum, or after miscarriage/termination
• After instrumentation (e.g. insertion of IUS/IUCD, after colposcopy)
• Recurrent infection or failed treatment
• Requesting examination/STI testing
Do an abdominal, bimanual pelvic, and vaginal speculum examination. look for tenderness on lower abdominal or bimanual palpation, cervical erosion/contact bleeding, discharge, foreign bodies, warts, or ulcers.

Investigation Check pH of secretions with narrow-range pH paper. If >4.5, BV or TV is likely; pH is 4.5 with physiological discharge and candida infection. Other investigations to consider:
• High vaginal swab for M,C&S—only if symptoms/signs and/or pH consistent with specific diagnosis; the patient is pregnant, postpartum, or after miscarriage/termination; after instrumentation; or if there is recurrent infection/treatment has failed
• Endocervical swabs for gonorrhoea and chlamydia
• Viral swab if herpes is suspected (if not available, refer to GUM)
• Opportunistic cervical smear if indicated
• Self-taken vulvovaginal swab if examination is declined

Management Treat the cause. If unclear refer to GUM or gynaecology.

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Hello! I am Dukagjin Zeqiraj from Kosovo. I have finished Medical Faculty in Prishtina ( capital city of Kosovo). Now I live in Pristina and I work in QKMF Podujeve (family medicine center). Tel: +38344311154