Vaginal discharge

• Bacterial Vaginosis: Thin, grey-white discharge, fishy odour, pH > 4.5.
• Candidiasis (Thrush): Thick, white, curd-like discharge, intense pruritus, erythema.
• Trichomoniasis: Frothy, yellow-green discharge, foul odour, strawberry cervix.
• Gonorrhoea: Purulent discharge, dysuria, lower abdominal pain, recent unprotected intercourse.
• Chlamydia: Mucopurulent discharge, intermenstrual bleeding, dysuria, pelvic pain.
• Herpes Simplex Virus: Clear discharge with painful vesicles or ulcers, dysuria.
• Pelvic Inflammatory Disease (PID): Purulent discharge, lower abdominal pain, dyspareunia, fever.

• Physiological Discharge: Clear or white, non-odorous, varies with menstrual cycle.
• Atrophic Vaginitis: Thin, watery discharge, vaginal dryness, postmenopausal status.
• Foreign Body (e.g., tampon): Foul-smelling discharge, history of retained object.
• Cervical Ectopy: Clear discharge, history of recent hormonal contraceptive use.
• Malignancy (Cervical or Endometrial Cancer): Blood-stained discharge, postcoital bleeding, postmenopausal bleeding.

• Allergic Reaction to Products (e.g., soaps, condoms): Clear discharge, vulvar irritation, history of new product use.
• Chemical Irritants: Vaginal dryness or irritation, history of douching or use of intravaginal agents.

Assess the specific symptoms presented by the patient:

• Discharge Characteristics: Colour, consistency, odour, amount.
• Associated Symptoms: Itching, burning, pain during urination, pelvic pain.
• Menstrual History: Relation of symptoms to menstrual cycle, intermenstrual bleeding, postcoital bleeding.
• Sexual History: Recent sexual activity, use of contraception, number of partners, history of sexually transmitted infections.

Gather a detailed background including:

• Past Medical History: Previous episodes of similar symptoms, history of sexually transmitted infections, any underlying conditions like diabetes that may predispose to infections.
• Drug History: Recent antibiotic use (predisposes to candidiasis), use of hormonal contraceptives, immunosuppressive therapy.
• Family History: Any familial predisposition to conditions like autoimmune disorders or diabetes.
• Social History: Smoking, alcohol use, recent travel, use of new hygiene products or douching.

• High Vaginal Swab (HVS): Microscopy, culture, and sensitivity to identify causative organisms (e.g., Candida, Trichomonas).
• Nucleic Acid Amplification Tests (NAATs): For chlamydia and gonorrhoea detection.
• Wet Mount Microscopy: To identify Trichomonas, clue cells (bacterial vaginosis), or yeast.
• Vaginal pH Testing: Elevated pH (> 4.5) suggests bacterial vaginosis or trichomoniasis.
• Gram Stain: To detect bacterial vaginosis, gonorrhoea, or other bacterial infections.

• Pelvic Ultrasound: To assess for complications of pelvic inflammatory disease or to exclude other pelvic pathology (e.g., ovarian cysts, fibroids).