Vaginal Discharge (PVD)

Vaginal candidiasis

• Caused by Candida albicans/ glabrata/ cerviciensis
• Clotrimazole long-acting pessary (Canesten ‘1’) single dose
• Alternatives clotrimazole, econazole (Pevaryl) or miconazole (Daktarin) vaginal creams, applied daily before bedtime for 7 days

Trichomoniasis

• profuse offensive discharge
• classical ‘strawberry cervix’ on speculum and Frothy greyish discharge
• Metronidazole 2 g orally as a single dose, or 400 mg orally twice daily for 7 days.

Bacterial vaginosis

• represents overgrowth of the vagina with bacteria- mainly anaerobic bacteria
• complaint may be of a fishy smelling vagina
• Metronidazole 2 g orally as a single dose, or 400 mg orally twice daily for 7 days OR
• Clindamycin 300mg bd po for 7 days.
• Recurrence-refer GOPD

Mucopurulent cervicitis and gonococcal cervicitis

• Gonorrhoea or Chlamydia cause cervicitis
• The discharge is yellowish and non-offensive
• Ceftriaxone 1g daily im as a single dose for gonorrhoea plus either
• Azithromycin 1G as a stat dose or
• Doxycycline 100 mg orally twice daily for 10 days (which will also cover chlamydia)
• Metronidazole 400 mg orally twice daily for 10 days may be added

Pelvic inflammatory disease
Cervical or endometrial malignancy

• A blood stained and foul-smelling discharge may be caused by malignancy.
• A speculum examination is always mandatory.
• Any suspicious lesion seen to be discussed with Gynae Team On-Call
• Consider cervical biopsy, endometrial biopsy and/or transvaginal ultrasound for women over the age of 45 years.

Cervical ectropion

• called a ‘cervical erosion’
• The cervix looks reddened at the centre since the mucus-producing epithelium of the endocervix is exposed at the external os
• Complaint is of a profuse in-offensive clear or cloudy discharge
• Do not confuse with cancer
• Discuss cases with a consultant to avoid missing a malignancy – seek Gynae review

Physiological vaginal discharge

• Normal discharge varies between individuals, within individuals, with the menstrual cycle and with pregnancy
• The discharge is whitish and is not fishy or foul-smelling
• If in doubt about infection, prescribe:
• Doxycycline 100 mg orally twice daily and
• Metronidazole 400 mg orally three times daily for 10 days
• Note this may not always be helpful

Foreign Body

• usually presents with a foul-smelling or blood-stained vaginal discharge
• Broad spectrum antibiotics if necessary, e.g. amoxicillin 500 mg orally 3 times daily, with metronidazole 400 mg orally 3 times daily
• Vaginal oestrogen cream for a child less than 8 years old