1.

VAGINAL DISCHARGE
0 1 2
1 Introduction to the patient + Consent
2 Increase in amount of vaginal discharge
3 odor
4 Color/blood
5 Itching / irritation
6 Dysuria
7 Asks if she is pregnant now
8 Ask about if she took drugs before or if she use hygiene products
7 Abdominal pain/pelvic
8 Dyspareunia (painful sexual intercourse)
9 Fever, malaise
10 Recently changed sexual partner and whether her partner has any sx
11 Asks what form of contraception the uses
12 Asks the date of LMP/ any menstrual problems
13 Smear tests/abnormal tests
14 Asks whether the patient have ever had any sexually transmitted
infections in the past or recent illness
15 Asks whether the patient is on antibiotics for any reason
Asks about any previous similar problems
16 Thank patient

DDx: BV; Candida vaginitis; Trichomonas vaginitis; STD; PID; Poly/Malignancy

2. Physiological causes of increased discharge: -puberty –pregnancy –

ovulation –OCP
Pathological causes of include: - infection – foreign body – ectropion –
poly/malignancy
3. BV is associated with a fishy smelling discharge
4. - BV causes thin grey discharge
- Candida vaginitis causes curdy and white
- Trichomonas vaginitis causes frothy green
- Gonorrhea causes a white/yellowish discharge
 - Chlamydia isn’t usually associated with a discharge, but if it ascends to
cause PID, a watery or muco-purulent discharge can occur.
- A bloody discharge can be a feature of an ectropion or
endocervical polyp.
5. Candida and Trichomonas can both cause itching
6. Gonorrhea can cause urethritis which can lead to dysuria
7. PID ( mostly due to chlamydia infection) causes low abdominal pain
8. Dyspareunia can be associated with vulvo-vaginitis of any cause but it’s
common in PID
9. Patients with PID will be systemically unwell
10. This suggests STD
11. Good opportunity to offer contraceptive advise if needed
12. It is important to establish whether the patient might be pregnant
13. Cervical cancer is very rare cause of vaginal discharge
14. Broad spectrum antibiotics predispose to candida infection

INVESTIGATIONS: Visual inspection; Vaginal PH (PH nitrazine paper);

Microscopic exam ( Speculum smear test)