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Vaginal discharge (Aetiology (Infection BV Candida TV, NG, CT, Trauma …
Vaginal discharge
Aetiology
Infection
BV
Candida
TV, NG, CT
Trauma
FB (tampon, condom)
Recent childbirth
Vaginal surgery
Neoplastic
Cervical ectopy
Polyps
Tumour (vulva, vagina, cervix, endometrium)
Degenerative
Atrophic vaginitis
Fistulae
Endocrine
Menses (thick and sticky mostly, clear/wet/stretchy at ovulation)
Pregnancy (heavier)
Menopause (lesser)
Drugs
OCP (heavier)
Diagnosis
Examination
Bimanual examination
Swelling/erythema/discharge,
cervical/adnexal tenderness (PID)
Abdominal examination
Tenderness (?PID), masses (?cancer)
Speculum examination
Cervicitis, vaginitis, discharge, lesions
Investigations
Swabs
HVS for MCS (candida, TV)
ECS/VVS for NAAT (NG, CT)
Swab for pH test (<5 or >5)
Bloods
BBV (HIV, HCB, HBV, syphilis)
Bedside
Obs
Urine
Dipstick, MCS (UTI)
Pregnancy test
History
DH
Current meds, allergies
Repro H
Gynae: menses, bleeding, contraception, smears
Obs: gravity/parity, delivery, complications
PMH
Previous STI, chronic medical conditions,
previous abdo/pelvic surgery
SxH
Partners (casual/regular, gender, age)
Type of sex (vaginal/anal/oral, receptive/passive)
Partners (last 3m and 12m)
Contraception (UPSI or barrier)
BBV risk (IVDU, paid for sex, blood products, abroad partners)
PC/HPC
Discharge (vol, consistency, colour, smell),
other symptoms (itch, pain, swelling, ulcers/blisters, dysuria),
red flags (fever, night sweats, weight loss),
treatments tried so far (OTC etc)
SH
Occupation (sex work), living arrangements,
smoking, alcohol, drugs (IVDU)
Definition
Normal VD
Physiological discharge from the vagina
(white/clear, non-offensive, changes consistency
during menses, pregnancy and menopause)
Abnormal VD
Change in colour, consistency,
volume, odour of discharge,
may have other symptoms
Management
Conservative
Identify and manage cause
2 week cancer referral if suspected
GUM referral for STI investigation and tx
Self care (personal hygeine, reducing transmission, etc.)
Medical
Abx (per cause)
Clinical
presentation
Discharge
Volume (more/less)
Consistency (thicker/watery)
Colour (white/grey/yellow-green)
Smell (offensive)
Epidemiology