Vaginal Discharge

Question 1

Sequence of events

Answer 1

Open question

Timeline

Question 2

Symptom analysis

Answer 2

Onset
Colour
Odour
Amount

Question 3

Systems review

Answer 3

Gynae systems review

Constitutional- FWARJNL

Question 4

Patients perspective

Answer 4

Feeling and impact on life

ICE

Question 5

Background Information

Answer 5

PMH (have you ever had an STI- which one, when, how treated, was the partner treated)
DH
FH
SH

Question 6

Physiological discharge (normal)

Answer 6

Creamy, thin and stringy

Typically increases with pregnancy, COCP, ovulation, sexual arousal

Question 7

STI

Answer 7

Chlamydia trachomatis- purulent discharge and dysuria

Trichomonas vaginalis- fishy discharge

Neisseria gonorrhoea- purulent discharge

NB- STI’s “hunt in packs”- if they have one, they may have another

Question 8

Non-STI

Answer 8

Thrush- thick white cottage cheese like discharge with a red itchy vagina

Bacterial vaginosis- grey white, fishy smelling

Question 9

PID

Answer 9

abdominal/pelvic pain, dyspareunia, abnormal vaginal bleeding
subfertility or menstrual disorder
may have history of previous STI’s

Question 10

Foreign body

Answer 10

forgetting to remove tampon
foul smelling
toxic shock syndrome

Question 11

Genital tract malignancy

Answer 11

red/brown discharge (likely smelly)

Question 12

Investigations

Answer 12

Bedside- pelvic exam, vaginal swabs, cervical smear

Bloods-

Imaging-

NB- same day referral to GUM clinic for suspected PID/ admission if systemically unwell