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Vaginal discharge

  • Common ddx

    • BV (gray, fishy, postcoital)
    • candidiasis (cheesy, itchy)
    • foreign body in kids (foul smelling)
    • physiologic leukorrhea (white, no odor)
  • Serious ddx

    • PID, STDs, endometrial cancer
  • Labs

    • wet mount, microscopy, pH
    • STD testing
    • pelvic exam, pap smear
    • endometrial biopsy if blood in discharge
  • STDs

    • trichomonas, gonorrhea (purulent), chlamydia (purulent), PID (pelvic pain)
  • Watery, bloodstained discharge

    • cervical cancer, endometrial cancer, polyp, hydatidiform mole, chronic cervicitis
  • HPI

    • onset
    • discharge quality: color, clear, purulent, bloody, foul-smelling, cheese-like
    • frequency, amount
    • aggravating factors: postcoital
    • alleviating factors: meds tried
  • ROS

    • fever
    • itch
    • pelvic pain
    • new partners
  • PMH, PSH, PGynH

  • Meds

  • Allergies

  • SH

    • sexual hx
  • FH

  • Px

    • vitals
    • pelvic exam
  • Tx

    • BV: metronidazole 500 mg po bid x 7d
    • trich: metronidazole 2g po
    • candida: miconazole cream or fluconazole 150mg po
    • gonorrhea: ceftriaxone 250mg IM
    • chlamydia: doxycycline 100mg PO bid x 14d

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.