Vaginal Discharge and Vaginal Discharge Syndrome
Vaginal Discharge and Vaginal Discharge Syndrome
The presence of vaginal a discharge in females is not always abnormal. Abnormal discharge can cause itchiness, and are different in colour and smell. The management of a vaginal discharge is based on the most likely underlying cause. This can be determined by a thorough history and examination, including gynaecological examination (see below):
Management
If the vulva is red, scratched and inflamed with a curd like discharge – treat for Vaginal candidiasis:
- Clotrimazole vaginal tablet 500 mg single dose inserted at night, or clotrimazole cream 12 hourly using vaginal applicator, for 7 days
- If severe, add Clotrimazole cream applied to vulva 12 hourly for 3 days after symptoms have resolved (maximum use two weeks)
- Advise to avoid washing with soap
- If persistent after treatment, look at underlying causes of immune compromise, diabetes, HIV, immunosuppressive treatment, recent use of antibiotics
If clinically not candidiasis and no abdominal pain or tenderness: is the client sexually active/does her partner have symptoms of genital infection?
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Yes Treat for Vaginal discharge syndrome (VDS) - including pregnant women - Ceftriaxone 250mg IM as a single dose*** and - Azithromycin 1g oral as a single dose - Metronidazole 2g oral as a single dose - If severe penicillin allergy, omit ceftriaxone and give Azithromycin 2g oral as a single dose - Treat partner/s, no intercourse till symptoms resolved and partner/s treated |
No Treat for Bacterial vaginosis (BV): - Metronidazole 2g p.o stat* - Can add treatment for Candidiasis as above BV can be confirmed with - Amine test (Whiff Test) add one drop discharge to one drop KOH - If fishy smell present BV - Or the presence of Clue Cells on wet mount microscopy
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*Review client in 7 days, if symptoms persists: Give metronidazole 400mg 12 hourly for 7 days
If lower abdominal pain or cervical excitation tenderness present, but no systemic symptoms, peritonitis or masses:
- Treat for VDS, as above, add Ibuprofen 400mg 8 hourly as needed for 5 days. Review client in 3 days.
NB:
All cases that does not fall into the above categories needs discussion with Tygerberg
Hospital Gynaecology Department
- Registrar/Consultant GOPD 021 938 4436 8:00 – 16: 00 weekdays
- Registrar on call for gynaecology: 021 938 4716 or via hospital switch board 021 938 4911
Always discuss cases of vaginal discharge with:
- Recent miscarriage, delivery, termination of pregnancy, gynaecological procedures or surgery
- Peritonitis, abdominal masses
- SIRS response: Temp > 38 °C, Pulse rate >90/min RR >20/min
- Females younger than 16, or post-menopausal, where candidiasis has been treated and excluded
- Abnormal vaginal bleeding
- Any masses or erosions of the cervix, vulva, vagina
- Unresolved symptoms after completion of treatment
Please have the following information ready prior to discussion with registrar:
- Full history: Regarding discharge, treatment, other symptoms, gynaecological history, LNMP, contraception, last cervical cytology smear, obstetric history. Full medical and surgical history. HIV and Syphilis status (Do rapid tests)
- Examination: Vitals, Temp, Pulse, Respiratory Rate, urine pregnancy test. Systemic evaluation, abdominal examination, masses, tenderness, peritonitis.
- Gynaecological Examination: Condition of vulva, vagina and cervix. Nature of discharge, presences of cervical excitation tenderness.
** For ceftriaxone, dissolve 250 mg in 0.9 ml lignocaine 1% (without Adrenaline)
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Tygerberg Hospital, Department of Obstetrics and Gynaecology; Vaginal Discharge and Vaginal Discharge Syndrome; Version: May 2013; Last checked for updates by EMGuidance: Oct 2023