Female Vaginal Discharge

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Questions to be asked

  • duration?
  • colour?
  • smell?
  • itchy/sore/painful?
  • intermenstrual bleeding? (IMB)
  • itchy/sore/painful?
  • dyspareunia
  • abnormal vaginal bleeding


  • note colour + consistency of discharge
  • signs of soreness, rash or fissures?
  • test vaginal ph
  • be prepared, speculum, lubricant, swabs, light source

NB: Chlamydia is the most common curable Sexually Transmitted Infection (STI )

  • asymptomatic in approx 80%
  • post-coital or intermenstrual bleeding (IMB)
  • lower abdominal pain
  • purulent discharge
  • mucopurulent cervicitis and/or contact bleeding
  • dysuria

For treatment suggestions, see chlamydia guidelines for:

  • Complicated Chlamydia Infection (symptomatic)
  • Uncomplicated Chlamydia Infection (asymptomatic)
Physiological discharge Candida Albicans Bacterial Vaginosis Trichomonas Vaginalis Gonorrhoea
  • present > 6 months
  • smooth, creamy yellow
  • not itchy or smelly
  • itchy or sore
  • may have rash or fissures
  • ‘curd’ like discharge/lumpy
  • ph < 4.5
  • smooth, creamy yellow discharge
  • not associated with soreness/itching
  • smelly – ‘fishy’ odour
  • ph of vaginal fluid > 4.5
  • offensive, yellow, frothy discharge in 30% of cases
  • vaginal discharge, varying consistency
  • vulvitis & vaginitis
  • ‘strawberrycervix’ appearance to the naked eye
  • green or creamy discharge coming out of cervix
  • intermenstrual bleeding of menorrhagia
  • pelvic/ lower abdominal pain
  • dysuria

(commonly no abnormal findings are present on examination)


There is now NO requirement to examine asymptomatic patients, unless you identify a clinical indication. For female patients, ask them to obtain a self obtained low vaginal swab (purple swab)

Offer routine resting for Chlamydia and bacterial infection, i.e purple swab and black charcoal swab if there is a clinical indication i.e unprotected sexual intercourse and risk of infection


If Candida albicans is suspected, take a black charcoal transport swab from vaginal discharge and on the request form ask laboratory staff to make a Gram stain and to culture for Candida species

Action – swabs to be taken

If bacterial vaginosis is suspected, ask the laboratory to make a Gram slide for a Hay-Ison score. You may also wish to perform pH testing, amine testing etc, but the diagnosis of BV is clinical. Culture is not routine

Action – swabs to be taken

If Trichomonas vaginalis (TV) is suspected, take a black charcoal transport swab from vaginal discharge and on the request form ask laboratory staff to make a wet preparation for TV. Request culture on Finebergs medium if available

Action - Swabs To Be taken
If gonorrhoea is suspected, take a black charcoal transport swab from the endocervix, and make a microscope slide for the laboratories to Gram stain and read. Alternatively, you can ask Lab staff to prepare slide from your transport swab.

Reassure + Await Results


  • recommend use of vulval moisturiser as a soap substitute
  • avoid tight fitting synthetic clothing
  • avoid local irritants e.g. perfumed products
  • OFFER: clotrimazole pessary 500mg stat. and clotimazole cream. Effect on latex condoms and diaphragms not known With this treatment- please advise patient of this.
  • Alternatively - Oral therapy – Fluconazole Capsule 150mg stat Note -AVOID IN PREGNANCY


  • advice stop using perfumed soaps, vaginal douches etc
  • offer metronidazole 400mg-500mg B.D. course for 5-7days
  • or intravaginal clindamycin cream (2%) once daily for 7days

Recommended Regimes: metronidazole 2g orallyin a single dose
metronidazole 400-500mg twice daily for 5-7 days

Alternative Regimens
Tinidazole 2g orally in a single dose

  • sexual partner(s) should be treated simultaneously
  • avoid sexual intercourse including oral sex until they & their partner(s) have completed treatment and follow up
  • screening for coexistent sexually transmitted infections should be undertaken in both men and women
  • Discuss Partner Notification - Current partners and any partner(s) within the 4 weeks prior to presentation should be screened for the full range of STIs and treated for TV irrespective of the results of investigations or Refer to HSH using SCI Gateway – using referral option HSH/PARTNER NOTIFICATION (preferred method of referral) or use other means of referral
  • Email referral form or Telephone referral leaving all relevant information – Tel 01471 820340 (ansaphone facility)
  • f you do not have access to email facility send completed postal referral form to Broadford, Isle of Skye, IV49 9BL

Offer: Ceftriaxone 500 mg intramuscularly as a single dose with azithromycin 1 g oral as a single dose - (as genital infection with Chlamydia trachomatis commonly accompanies genital gonococcal infection) * Ceftriaxone is supplied as a powder which needs to be reconstituted with lidocaine solution. It should be given by deep intramuscular injection.

Alternative regime :- Cefixime 400 mg oral as a single dose and azithromycin 1 g stat. Only advisable if an intramuscular injection is contraindicated or refused by the patient


Patients should be advised to abstain from sexual intercourse until they and their partner(s) have completed treatment

Refer to Highland Sexual Health. Tel. 01463 888300 or by SCI Gateway – using referral option HSH/PARTNER NOTIFICATION (preferred method of referral) *Partner Notification should be pursued in all patients with gonococcal infection, preferrably by a trained Health Advisor in Genito-urinary Medicine

Editorial Information

Last reviewed: 31 August 2015

Next review: 31 August 2017

Author(s): Senior Nurse - Sexual Health

Version: 8

Approved By: high-uhb.tam@nhs.net

Reviewer Name(s): Lynn Chalmers