If there is a bad odor, give Flagyl. If it itches and has a bad odor, give both Monistat and Flagyl. You will solve most of the vaginal discharge problems and will miss nothing important because you will look closely at those women whose symptoms persist despite this expedient treatment. For women whose symptoms persist, the diagnosis of vaginal discharge is based on a History, Physical Exam, and a few simple diagnostic tests. History Ask the patient about itching, odor, color of discharge, painful intercourse, or spotting after intercourse.
Yeast causes intense itching with a cheesy, dry discharge.
Gardnerella causes a foul-smelling, thin white discharge. Trichomonas gives irritation and frothy white discharge. Cervicitis causes a nondescript discharge with deep dysparunia Chlamydia may cause a purulent vaginal discharge, post-coital spotting, and deep dysparunia. Gonorrhea may cause a purulent vaginal discharge and deep dysparunia. Cervical ectropion causes a mucousy, asymptomatic discharge.