Vaginal Discharge

Vaginal discharge is a common complaint that is often accompanied by concerns about the presence of a sexually transmitted disease. Candida may present with extremely intense, often unbearable itch. Whenever one sexually transmitted disease is identified, a search for all other STDs is indicated in an effort to treat the individual patient as well as to prevent spread to others in the community or beyond. If an STD is identified, the patient should be encouraged to inform all sexual partners of the diagnosis.

Differential Diagnosis

• Physiologic
  –Many women will have a consistent, slightly clear, non-odor-producing discharge, either midcycle or premenstrually, particularly if they are on oral contraceptives
  –A change in odor, consistency, or color of discharge may signify that evaluation is necessary
  –Increased discharge is associated with pregnancy
• Sexually transmitted disease
  –Trichomonas vaginalis: “Strawberry cervix” with punctate erythema, flagellated oval organisms on wet mount
  –Gonorrhea/Chlamydia may be associated with pelvic pain/dysmenorrhea and dyspareunia
• Bacterial vaginosis
  –Various organisms and changes in normal flora with a characteristic fishy odor
  –Not considered an STD
  –Increases the risk of preterm delivery in pregnant women

• Alteration of normal vaginal flora and/or inflammatory response
  –Candida albicans overgrowth is more common with recent antibiotic use, poorly controlled diabetes, and/or pregnancy; presents with intensely pruritic, inflamed, and erythematous introitus
  –Doderlein's cytolysis (caused by an overgrowth of lactobacilli)

• Atrophic vaginitis
  –Common in postmenopausal women, especially those not on HRT
  –Poor coital lubrication, dyspareunia
  –Dysuria due to atrophic urethral tissue
• Foreign body vaginitis (e.g., retained tampon)
• Noninfectious irritant/allergic contact vaginitis (e.g., soaps, feminine pads, perfumes)
• Cervicitis (usually due to gonorrhea or Chlamydia)
• Cervical dysplasia, cancer, or polyps
• Vaginal or vulvar trauma or cancer

Workup and Diagnosis

• A focused history and physical examination are crucial, including a complete sexual and exposure history, and full abdominal and pelvic examination
  –A wet mount and KOH of the discharge are imperative
  –pH of the discharge may aid in diagnosis
  –A whiff test is done by smelling the discharge after KOH is added; a positive test reveals a fishy odor characteristic of bacterial vaginosis
• Initial labs may include CBC, urinalysis, urine culture, β-hCG, and gonorrhea and Chlamydia cultures
• Test and treat for other STDs when one STD is found (HIV, hepatitis B and C, syphilis)

Treatment

• See most recent CDC guidelines for all STDs
• Trichomonas
  –Metronidazole single dose or for 7 days (avoid alcohol with metronidazole use)
  –Intravaginal clotrimazole if pregnant or unable to use metronidazole

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Vaginal odor

Read excerpts from these other book chapters related to Vaginal odor:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Vaginal odor

• Back to symptom: Vaginal odor: Introduction (review 25 causes)
• Next Book Extract About Vaginal odor: Vaginal Discharge (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Vaginal odor

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Vaginal Discharge (In A Page: Pediatric Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Vaginal Discharge (In A Page: Pediatric Signs and Symptoms)
• VAGINAL DISCHARGE (Differential Diagnosis in Primary Care)
• ANOSMIA OR UNUSUAL ODOR (Differential Diagnosis in Primary Care)
• HALITOSIS AND OTHER BREATH ODORS (Differential Diagnosis in Primary Care)
• Vaginal discharge (Handbook of Signs & Symptoms (Third Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Vaginal odor
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City