Vaginal discharge

Abstract

Abnormal vaginal discharge is a common clinical presentation, and causes can be physiological, infectious, and non-infectious. Infections are the leading cause of abnormal vaginal discharge; bacterial vaginosis (BV) is the most common, followed by vulvovaginal candidiasis (VVC). Sexually transmitted infections (STIs) such as Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis can also alter vaginal discharge and should be excluded in sexually active patients. Management has changed and ‘triple swabs’ are no longer recommended. If symptoms suggest acute BV or VVC, empirical treatment can be given without microbiological testing once nucleic acid amplification testing for STIs has been performed, if the individual is sexually active. If there is diagnostic uncertainty, or if the symptoms are recurrent or associated with vaginitis, pain, bleeding or pregnancy, examination should be offered. pH testing of vaginal discharge with narrow-range litmus paper can help guide diagnosis. If uncertainty remains, a high vaginal swab for culture should be obtained and/or specialist advice sought. Less common causes include genital tract malignancies, dermatoses, foreign bodies, and vaginal fistulas. Accurate diagnosis requires a clinical history, examination, and targeted investigations, as well as patient education and preventive measures.