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Vaginal Discharge - Draft

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Overview

Vaginal discharge can be physiological or pathological (1).

Physiological vaginal discharge is a white or clear, mucus-like, non-offensive discharge that varies with the menstrual cycle and in the different reproductive stages.

Pathological vaginal discharge is characterized by a change in colour, consistency, volume, and/or odour. It may be associated with symptoms such as itch, soreness, dysuria, pelvic pain, or intermenstrual or post-coital bleeding.

Abnormal vaginal discharge can be due to infective or non-infective causes.

Infective (non-sexually transmitted) causes include bacterial vaginosis and vulvovaginal candidiasis.
Infective (sexually transmitted) causes include chlamydia and gonorrhoea.
Non-infective causes include retained foreign body, dermatitis, and gynaecological cancer.

A good history and examination can give clues as to the likely cause which can guide appropriate investigations and treatment.

Please also see the following:

Causes

Causes of Vaginal Discharge

Condition	Discharge Features	Other Features
Physiological	Clear/white, non-offensive	No irritation, varies with cycle
Bacterial Vaginosis	Thin, grey-white, fishy odour	Worse after sex or menstruation
Candidiasis	Thick, white, "cottage cheese"	Itching, soreness, vulval redness
Trichomoniasis	Frothy, yellow-green, offensive	Vulvitis, strawberry cervix (±)
Chlamydia/Gonorrhoea	Mucopurulent, yellow/green	Often asymptomatic, possible PID signs
Atrophic Vaginitis	Thin, watery, possibly blood-stained	Postmenopausal, vaginal dryness
Foreign body (e.g., tampon)	Foul-smelling, brown/green	History often unclear, consider in child

Red Flags

Pelvic Inflammatory Disease

A diagnosis of Pelvic Inflammatory Disease [PID] should be made on clinical grounds. Do not delay making a diagnosis and initiating treatment whilst waiting for the results of laboratory tests. Admission may be required if a patient is systemically unwell. See the Pelvic Inflammatory Disease page for further advice.

Gynaecological Cancer

Some gynaecological cancers may present with abnormal vaginal discharge.

Vaginal discharge (unexplained) either at first presentation or with thrombocytosis or with haematuria, in women aged 55 years and over - Consider a direct access ultrasound scan (3)

See the Gynaecology - USC (2WW) page for further information.

Management in primary care

If a pathological cause for vaginal discharge is suspected then an examination and vaginal swabs should be undertaken.

Testing

Testing can be undertaken in primary care or patients living in BNSSG can use the Yuno on line consultation tool to order appropriate test kits (delivered within 48 hours).

Management

CKS gives a good step wise guide to management and when to refer: Management | Vaginal discharge | CKS | NICE

Prescribing

The BNSSG Primary Care Antimicrobial guidelines are also a useful resource and has a section on treatment of genital tract infections: Infections Guidelines (Remedy BNSSG ICB)

Further advice

If further advice is needed then consider the following resources

Yuno professional zone | Yuno sexual health
Advice & Guidance is available from the GUM service on eRS

Referral

Patients living in BNSSG can self-refer to sexual health clinics (Yuno):

Sexual health clinics | Yuno sexual health

Resources

References

(1) Vaginal discharge | Health topics A to Z | CKS | NICE

(2) STIs | Yuno sexual health

(3) Symptoms | Diagnosis | Gynaecological cancers - recognition and referral | CKS | NICE

Patient Leaflets

Vaginal discharge - NHS
Recurrent Discharge (word doc) - PIL created by Dr Rachel Brown, Gynaecology GPSI (Montpelier Health Centre)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.