Symptomatic increase or change in vaginal secretions due to physiological, infective, or other causes.
History taking
- • Onset, colour, odour, amount, itching, dyspareunia, dysuria
- • Sexual history, contraception, recent antibiotics, hygiene products
- • Pregnancy status, comorbidities (diabetes)
Examination
- • External genitalia, speculum (discharge characteristics, cervix), bimanual
- • STI screening if indicated
Red flags
- • Lower abdominal pain, fever — suspect PID
- • Postcoital bleeding, friable cervix — exclude cervical pathology
Differential diagnosis
- • Bacterial vaginosis, candidiasis, trichomoniasis
- • Cervicitis (gonorrhoea, chlamydia), atrophic vaginitis, foreign body
Recommended investigations
- • pH testing, whiff test, wet mount, KOH prep
- • NAAT/Gram stain for GC, chlamydia, trichomonas
- • HIV, syphilis screening as appropriate
Diagnosis
- • BV: thin grey, fishy odour, clue cells, pH >4.5
- • Candidiasis: thick white, cottage-cheese, pruritus, pH <4.5
- • Trichomoniasis: yellow-green frothy, strawberry cervix
Initial treatment / management
- • BV: Metronidazole 500 mg PO BD x 7 d
- • Candidiasis: Fluconazole 150 mg PO single dose or topical clotrimazole
- • Trichomoniasis: Metronidazole 2 g PO single dose; treat partner
- • PID: outpatient ceftriaxone + doxycycline ± metronidazole
Prescription examples
- • Tab Metronidazole 500 mg PO BD x 7 d (BV)
- • Tab Fluconazole 150 mg PO single dose (candidiasis)
- • Tab Metronidazole 2 g PO stat (trichomoniasis) — treat partner
- • Inj Ceftriaxone 500 mg IM + Tab Doxycycline 100 mg BD x 14 d ± Tab Metronidazole 500 mg BD x 14 d (PID)
Follow-up advice
- • Review at 1 week if not resolved
- • Partner notification and treatment in STIs
Patient counselling
- • Avoid douching, scented hygiene products
- • Safe sex practices, partner treatment in STIs
Referral criteria
- • Recurrent/refractory infections, suspected malignancy, PID with severe disease
Clinical pearls
- • BV is not an STI but recurrent BV may need long-term suppressive therapy
- • Recurrent candidiasis: consider diabetes, immunocompromise
References
- • CDC STI Treatment Guidelines 2021
- • BASHH Guidelines on STIs
Educational outpatient guide — verify against local guidelines before clinical use.
