Vaginal discharge

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Overview
Vaginal discharge is a common patient complaint that is paired with anxiety regarding sexually transmitted diseases. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.

Laboratory Findings
Initial tests include:
 * CBC
 * urinalysis
 * urine culture
 * beta-hCG
 * gonorrhea culture
 * chlamydia culture

Differential Diagnosis of Causes of
Causes include; Physiologic Cervicitis Sexually Transmitted Disease Bacterial Vaginosis '''Alteration of normal vaginal flora and/or inflammatory response Foreign body vaginitis Noninfectious irritant/allergic contact vaginitis Vaginal trauma Puberty
 * Discharge is common, especially mid cycle and premenstrually
 * Common in patients that use oral contraceptives
 * Color, odor or consistancy change require an evaluation
 * Pregnancy results in an incerase in discharge
 * Trichomonas vaginalis
 * Gonorrhea/Chlamydia results in pelvic pain/dysmenorrhea and dyspareunia
 * Syphilis
 * Human Papillomavirus Infections
 * HIV
 * Scabies
 * Fishy Odor
 * Not an STD
 * Preterm delivery during pregancy risk elevated
 * Candida albicans
 * over growth of lactobacilli

Other

 * Retain wet mount and KOH of discharge is necessary
 * Discharge PH

Treatment
See most recent CDC guidelines for all STD's

Bacterial Vaginosis

 * Metronidazole single dose for 7 days

Candida and Chlamydia

 * Azithromycin
 * doxycycline

Gonorrhea

 * Oral ciprofloxacin or IM ceftriaxone

Trichomonas

 * Metronidazole single dose for 7 days
 * Intravaginal clotrimazole if pregnant or unable to use Metronidazole