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Initial approach to evaluation of vaginal discharge in adults*

Initial approach to evaluation of vaginal discharge in adults*
BV, VVC, and trichomoniasis are among the most common causes of abnormal vaginal discharge and account for approximately 70% of cases. While certain clinical findings may suggest one of these infections over another, these findings are ultimately nonspecific. Therefore we evaluate all patients in-clinic to obtain samples for testing and exclude alternate causes. Empiric treatment can result in misdiagnosis and worsening of symptoms.

BV: bacterial vaginosis; VVC: vulvovaginal candidiasis; GC: neisseria gonorrhoeae coccus; CHL: chlamydia trachomatis; NAAT: nucleic acid amplification test; KOH: potassium hydroxide.

* Vulvovaginal symptoms, including vaginal discharge, may result from multiple etiologies. Infection is a common working diagnosis but is not the only cause that must be considered.

¶ Physical examination of the patient is needed before any treatment is started. Treatment based on symptoms or patient self-diagnosis is not adequate.

Δ Microscopy and laboratory findings, and resultant diagnoses, may be altered by active menstruation, recent vaginal intercourse, and/or over-the-counter treatment.

◊ Those with risk factors for HIV acquisition are offered HIV testing.

§ Additional discussion of the differential diagnosis and evaluation of vaginal discharge based on persistent symptoms is presented in related UpToDate content.
Courtesy of Jack Sobel, MD.
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