Vaginal discharge
Synonyms and keywords: Discharge from the vagina,  Leukorrhea

# Overview
Vaginal discharge is a common patient complaint that is paired with anxiety regarding sexually transmitted diseases. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.Also there is normal vaginal discharge  depends on periodic hormonal changeVaginal discharge is a common complaint in primary care which can be a subjective complaint or an objective finding. So, it is important to differentiate between normal physiological discharge and pathological discharge. Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. It is produced by the cells of the vagina and cervix. Normal vaginal discharge changes with the menstrual cycle, such as the character of the discharge is clearer with a stretchable consistency around ovulation, then may be thicker and slightly yellow during the luteal phase. Normal healthy discharge should not be associated with symptoms such as itching, redness and swelling, and does not have a strong odor. It is important to take complete history and ask about the associated symptoms like dysuria, dyspareunia, lower abdominal pain, itching, and fever. While considering the causes, it is necessary to distinguish between infectious and non-infectious. The infectious causes are infection with Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis, Chlamydia trachomatis, Neisseria gonorrhea, Herpes Simplex Virus. Diagnosis must be confirmed by laboratory tests and cultures. Non-infectious causes include puberty, menstrual cycle, foreign body, cervical cancer, vaginal cancer, diabetes etc. Treatment depends on the cause of the discharge.

# Causes

## Common Causes
- Atrophic vaginitis or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia
- Bacterial vaginosisis mostally happen  during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora
- Cervical cancer
- Chlamydia,sexually transmitted infections.
- Foreign body vaginitis
- Gonorrhea,sexually transmitted infections
- Herpes
- Trichomoniasis,a parasitic infection typically contracted and caused by having unprotected sex
- Vaginal cancer
- Vaginal yeast infection
- Diabetes
- Drug side effect as antibiotic or steroid use as,  Amoxicillin and Clavulanic Acid  , Butoconazole Vaginal Cream  , Clotrimazole  , Combined oral contraceptive pill, Estradiol Topical  , Estradiol Transdermal  , Estrogen and Progestin (Oral Contraceptives)  ,Estrogen Injection  , Estrogen Vaginal  , Etonogestrel and Ethinyl Estradiol Vaginal Ring  , Glatiramer Injection  ,Hormone replacement therapy (trans), Letrozole, Leuprolide  , Medroxyprogesterone Injection  , Metronidazole Topical  ,Miconazole  , Nafarelin  , Natalizumab injection  , Norelgestromin and ethinyl estradiol transdermal system  , Ospemifene, Oxcarbazepine  , Pramipexole, Progesterone, Tamoxifen  , Terconazole Vaginal Cream, Vaginal Suppositories  , Toremifene, Zoledronic Acid Injection

# Classification
Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle, Pregnancy, and Menopause.
-Abnormal vaginal discharge as
- Bacterial vaginosis
- Vaginal yeast infection
- Sexually transmitted diseases
- vaginal cancer
- cervical cancer

# Laboratory findings
Initial tests include:
- CBC
- Urinalysis
- Urine culture
- Beta-hCG
- Gonorrhea culture
- Chlamydia culture

## Other Diagnostic Studies

# Diagnosis

# Treatment
'Abbreviations: QHS : Every bedtime , BID: 2 times daily, TID: Three times a day, QID: Four times a day, IM :Intramuscular
Patient should be referred to a gynecologist if following are present. 
- Retained foreign bodies.
- Recent instrumentation or surgery of the genital tract such as hysterosalpingography, dilation and curettage, hysteroscopy, termination of pregnancy/evacuation of retained products of conception, laparoscopy and major gynaecological surgical procedure.
- Suspected tumor of the genital tract.
- Cervical ectopy or polyps.
- Recurrent vulvovaginal candida infections.
- Pregnant woman with abnormal vaginal discharge
- Symptoms of upper genital tract infections as fever, lower abdominal pain
Treatment in pregnancy:
- Vulvovaginal Candidiasis: It frequently occurs during pregnancy. Only topical azole therapies for 7 days are recommended for use among pregnant women.
- Trichomoniasis: Metronidazole 2 g orally  single dose is recommended. Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment.
- Bacterial vaginosis: Treatment is recommended for all symptomatic pregnant women. Metronidazole  250-mg regimen is effective. But, Metronidazole 500 mg twice daily can be used.

# Acute pharmacotherapies

### Bacterial Vaginosis
- Metronidazole single dose for 7 days

### Candida and Chlamydia
- Azithromycin
- Doxycycline

### Gonorrhea
- Oral ciprofloxacin or IM ceftriaxone.

### Trichomonas
- Metronidazole single dose for 7 days.
- Intravaginal clotrimazole if pregnant or unable to use Metronidazole.