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Investigating and treating cases of vaginal discharge

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It is common to see women of child-bearing age presenting with vaginal discharge in general practice and genitourinary medicine clinics.

Eliciting a history of the presenting complaint is key, especially as the woman may have specific concerns regarding the cause of the vaginal discharge.

Questions should explore when the discharge started, its colour, when it is present, if it varies according to the menstrual cycle, its consistency and whether there is a smell associated with it. It is helpful to clarify how the discharge has changed from what is usual for the woman. Systemic review may reveal itching, urinary symptoms, abdominal pain, bleeding, dyspareunia and/or fever.1

It is important to consider whether a sexually transmitted disease (STI) may be causing the vaginal discharge. The risk of STIs is higher in those under 25 years old and those who have recently changed sexual partner or have had more than one partner in the last year.2

A full obstetric and medical history should be obtained, as well as checking antibiotic use, immunosuppressive therapy or over-the-counter treatments. The history may indicate an obvious non-infective cause of vaginal discharge, such as a foreign body. There may also be a history of a cervical ectropion or malignancy that can be a factor.1

Psychosexual problems may occur with recurrent episodes of vaginal discharge.1

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