Clinical Review ABC of sexually transmitted infections

Vaginal discharge—causes, diagnosis, and treatment

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7451.1306 (Published 27 May 2004) Cite this as: BMJ 2004;328:1306
  1. Helen Mitchell, consultant physician in sexual and reproductive health (hmitchell@gum.ucl.ac.uk)
  1. Mortimer Market Centre, Camden Primary Care Trust, London

    Introduction

    Vaginal discharge is a common presenting symptom seen by doctors in many services (primary care, gynaecology, family planning, and departments of genitourinary medicine). Vaginal discharge may be physiological or pathological. Although abnormal vaginal discharge often prompts women to seek screening for sexually transmitted infections (STIs), vaginal discharge is poorly predictive of the presence of an STI. This article focuses on the causes and diagnosis of vaginal discharge and treatment of the most common infective causes.

    Aetiology

    Physiological discharge

    Normal vaginal flora (lactobacilli) colonise the vaginal epithelium and may have a role in defence against infection. They maintain the normal vaginal pH between 3.8 and 4.4. The quality and quantity of vaginal discharge may alter in the same woman in cycles and over time; each woman has her own sense of normality and what is acceptable or excessive for her.

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    What can influence physiological discharge?

    Pathological vaginal discharge

    Vulvovaginal candidiasis is a common infective cause of vaginal discharge that affects about 75% of women at some time during their reproductive life, with 40-50% having two or more episodes. Bacterial vaginosis is one of the most common diagnoses in women attending genitourinary medicine clinics. As 50% of cases of bacterial vaginosis are asymptomatic, the true prevalence of this condition in the community is uncertain. Bacterial vaginosis is associated with a new sexual partner and frequent change of sexual partners. A reduced rate of bacterial vaginosis is seen among women in monogamous sexual relationships, but it can occur in virginal women. Increased rates of bacterial vaginosis occur in certain groups of women, such as black African women, lesbians, and smokers.

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    Pathological vaginal discharge

    Recurrence of bacterial vaginosis after treatment is common and can be increased by personal hygiene practices, such as vaginal douching, that disrupt the normal vaginal flora. Bacterial vaginosis may also be associated with concurrent STIs, commonly …

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