Abnormal vaginal discharge in women

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This refers to a change of colour, odour and/or vaginal secretions usually accompanied with other signs and symptoms.

Causes

  • Vaginitis (Candida albicans, Trichomonas vaginalis and bacterial vaginosis)
  • Cervicitis (Neisseria gonorrhoea and Chlamydia trachomatis)

Types of discharge

What it might mean

Other signs and symptoms

Bloody or brown

Irregular menstrual cycles, or less often, cervical or endometrial cancer

Abnormal vaginal bleeding, pelvic pain

Cloudy or yellow

Gonorrhoea

Bleeding between periods, urinary incontinence, pelvic pain

Frothy, yellow or greenish with an offensive (bad) smell

Trichomoniasis

Pain and itching while urinating

Pink

Shedding of the uterine lining after childbirth (lochia)

 

Thick, white, cheesy

Yeast infection

Swelling and pain around the vulva, itching, painful sexual intercourse

White, gray, or yellow with fishy odour

Bacterial vaginosis

Itching or burning, redness and swelling of the vagina and vulva

Differential diagnosis

  • Cancer of the cervix (blood-stained offensive discharge)
  • Intra-vaginal use of detergents, chemicals, physical agents, herbs, chronic tampon use and allergic vaginitis

Evaluation/investigations

  • History
  • Speculum examination
  • Vaginal swab: microscopy, gram stain, culture and sensitivity testing
  • Blood: syphilis test (VDRL and if positive, do TPHA to confirm an ongoing infection)
  • HIV test

Treatment objectives

  • Restore normal vaginal secretion
  • Alleviate pain
  • Prevent complications
  • Prevent transmission of the disease

Non-pharmacological treatment

  • Advice on avoidance of alcohol consumption during treatment
  • Advice patient and partner(s) to abstain from sex while on treatment (or use condom)
  • Advice patient on personal hygiene

Pharmacological treatment

Adults:

Ceftriaxone IM

250 mg as a single dose

PLUS

Doxycycline oral

100 mg 2 times daily for 7days

OR

Azithromycin 1g single oral dose

OR

Erythromycin oral

1g two times daily or 500 mg 4 times daily for 7 day

Note:

  • Azithromycin and erythromycin can be used for pregnant women
  • Treat patients according to presentation as highlighted in the table above by referring to the appropriate section of the Standard Treatment Guidelines.

Prevention

  • Advise patient to keep vagina clean by washing regularly with mild soap and water

Referral

  • If infection persists refer for specialist care