GuidelinesEML (Adult Hospital STG)
Vaginal Discharge Syndrome (VDS)
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
These guidelines apply to patients who are referred from primary healthcare centres for further investigation and management of PERSISTENT STI symptoms or syndromes that have not improved or resolved and are still present 7 days after administration of standard first-line syndromic therapy. |
B37.3/N76.0/N89.8
- Abnormal vaginal discharge that persists despite appropriate syndromic management should be investigated.
- Referral letter from PHC should include all relevant information (including HIV status, treatment history and partner notification and management).
INVESTIGATIONS
- All NHLS standard laboratory forms must include the following information:
- Name and contact details (cellphone number + email address) of requesting healthcare worker.
- Genital specimen collection and test requests (to confirm presence of STI pathogens and if Neisseria gonorrhoeae is present, and determine ceftriaxone susceptibility):
- Materials: One cotton-tip swab (plastic shaft); two Dacron swabs (plastic shaft, slender tip); Amies transport medium (all obtained from local NHLS laboratory). Insert speculum to visualize cervix.
- Endocervical swab 1: Gently insert Dacron swab 2 cm into the endocervical canal, and rotate for 5-10 seconds. Place this swab immediately into Amies transport medium.
- Test request: Transport on ice to local NHLS laboratory as soon as possible, preferably within 24 hours for Neisseria gonorrhoeae culture & sensitivity testing.
- Presumptive diagnosis: Persistent cervicitis due to possible ceftriaxone-resistant gonorrhea. - Endocervical swab 2: Gently insert Dacron swab 2 cm into the endocervical canal, and rotate for 5-10 seconds. Place in sterile universal container or tube, break off plastic shaft and close the container.
- Test request: Transport on ice to NICD STI Reference laboratory as soon as possible for PCR genital discharge pathogens.
- Presumptive diagnosis: Persistent cervicitis/vaginal discharge due to possible ceftriaxone-resistant gonorrhea. - Vaginal swab 1: Gently insert the cotton-tip swab into the vagina and then dip swab in the poster fornix fluid. Place swab in sterile universal container or tube, break off plastic shaft and close the container.
- Test request: Transport to local NHLS laboratory as soon as possible for M/C/S - for bacterial vaginosis; Candida culture and sensitivity testing.
- Presumptive diagnosis: Persistent vaginal discharge due to bacterial vaginosis or candidiasis.
MEDICINE TREATMENT
Persistent cervicitis confirmed on speculum examiniation, pending results:
- Cefriaxone, IM, 1 g immediately as a single dose.
LoE:III5
- Dissolve ceftriaxone 1 g in 3.6 mL lidocaine 1% without adrenaline (epinephrine).
LoE:III6
AND
- Azithromycin, oral, 2 g as a single dose.
If metronidazole, oral was not given at PHC prior to referral, administer:
- Metronidazole, oral, 2 g as a single dose.
LoE:III7
Severe penicillin allergy: Z88.0
- Gentamicin, IM, 6 mg/kg, IM as a single dose (See Prescribing Information for Specific Medicines for Guidance on prescribing)
AND
- Azithromycin, oral, 2 g as a single dose.
LoE:III8
If metronidazole, oral was not given at PHC prior to referral, administer:
- Metronidazole, oral, 2 g as a single dose.
LoE:III9
Ask patient to return in two weeks for follow-up of laboratory results and further clinical evaluation. Treat accordingly.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition