Clinical Review

Clinical review

Vaginal discharge

BMJ 2007; 335 doi: 10.1136/bmj.39378.633287.80 (Published 29 November 2007)
Cite this as: BMJ 2007;335:1147

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  1. Des Spence, general practitioner1,
  2. Catriona Melville, specialist registrar, sexual and reproductive healthcare2
  1. 1Maryhill Health Centre, Glasgow G20 9DR
  2. 2Sandyford Initiative, Glasgow G3 7NB
  1. Correspondence to: D Spence destwo{at}yahoo.co.uk

    Although many cases of vaginal discharge are not caused by sexually transmitted infections and do not need to be treated, common curable sexually transmitted infections can present with this symptom. Controlling the spread of sexually transmitted infections and HIV are key public health priorities worldwide.1 Recent advances are changing investigation techniques and the management of vaginal discharge. Clinicians need to be aware of emerging epidemiological data, the different presentations of vaginal discharge, and how to approach their management so that the symptom can be treated according to its aetiology (box 1).

    Box 1 Causes of vaginal discharge

    Non-infective

    • Physiological

    • Cervical ectopy

    • Foreign bodies, such as retained tampon

    • Vulval dermatitis

    Non-sexually transmitted infection

    • Bacterial vaginosis

    • Candida infections

    Sexually transmitted infection

    • Chlamydia trachomatis

    • Neisseria gonorrhoeae

    • Trichomonas vaginalis

    What is a physiological (normal) vaginal discharge?

    Many women have what they perceive as an abnormal vaginal discharge at some point in their lives, but usually it is just a normal physiological discharge. This is a white or clear, non-offensive discharge that varies with the menstrual cycle. Cervical ectopy can be associated with a mucoid discharge and if symptomatic is widely treated with cryotherapy or diathermy, although evidence to support the effectiveness of these treatments is poor.

    Sources and selection criteria

    We searched various sources to identify evidence on the aetiology, diagnosis, and treatment of vaginal discharge. Searches of the Cochrane databases, Clinical Evidence, Bandolier, and Medline were undertaken using the keywords “vaginal discharge” and “bacterial vaginosis”, “candidiasis”, “Chlamydia trachomatis”, “gonorrhoea”, “Trichomonas vaginalis”, “nucleic acid amplification techniques”, “polymerase chain reaction”, and “ligase chain reaction”. We consulted generalist and specialist colleagues regarding clinical areas of uncertainty or those lacking evidence.

    What non-sexually transmitted infections cause discharge?

    Bacterial vaginosis and vulvovaginal candidiasis are common; these conditions are thought to by caused by a disturbance of the normal vaginal flora. They are not sexually transmitted and the male partner does not need to be treated. A retrospective study of patients with vaginal …

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