Management of Vaginal discharge in Female

Causative Organisms - Vaginitis Causative Organisms - Cervicitis

Trichomonas vaginalis (TV) Neisseria Gonorrheae
Candida albicans Chlamydia trachomatis
Gardenella vaginalis, Mycoplasma Trichomonas vaginalis
causing Bacterial vaginosis (BV) Herpes simplex virus

Examination
History: Laboratory Investigations
Menstrual
Per speculum
history to examination
rule out to differentiate (if available)
between vaginitis and cervicitis.
pregnancy
a) Vaginitis: Treatment of Vaginitis (TV + BV + Candida]
Nature and type of discharge
Trichomoniasis greenish2gm
frothy discharge Wet mount microscopy of the
Tab. Secnidazole orally, single doseManagement
or Tab. Tinidazole 500mgwomen
in Pregnant orally, twice daily for 5 days.
(amount,Candidiasis
smell, colour, discharge for Trichomonas
Tab.Metoclopropramide
curdy white dischargetaken 30 minutesPerbefore Tab. examination
speculum Secnidazole, should
to prevent gastricto
be done intolerance
rule out pregnancy
Guidelines for partnercomplications
management
Bacterial Vaginosis adherent discharge
consistency) vaginalis and Clue cells
Tab Fluconazole 150mg orally single dose likeorabortion, premature
Clotrimazole 500mgrupture of membranes
vaginal pessary once (to treat candidiasis)
Mixed
Genitalinfections
itchingmay present with atypical discharge 10% KOH preparation for
Treatment for vaginitis (TV + BV + Candida) Treat current partner only if no
Burning while passing urine, Candida albicans
b) Cervicitis: Treatment for cervical infection (Chlamydia In and
first Gonorrhea)
trimester of pregnancy: Oral Fluconazole isimprovement
contraindicatedafterininitial
pregnancy.
treatment
external dysuria
Cervicalerosion Gram stain of vaginal smear
Tab/Cefixime
cervical ulcer
400 mg/ mucopurulent
orally, single dose + Local treatment with Clotrimazole vaginal pessary/cream
If partner only for
is symptomatic, treat client
Presence of any ulcer,
cervical discharge for clue cells seen in Bacterial
Tab. Azithromycin 1 gram, 1 hour before lunch. candidiasis.
If vomiting within 1 hour, give anti-emeticand andpartner
repeatusing above protocols
swelling
Bimanual pelvic
on the examination
vulval or to rule out pelvic vaginosis

If vaginitis and cervicitis are present, treat for bothpessaries or cream intra vaginally
Metronidazole Adviseif trichomoniasis
sexual abstinence or BVduring
is the
inflammatory
inguinal region disease Gram stain of endocervical
Genital
If Speculum Advise abstinence or use of condomsuspected.
during the course of treatment and Instruct the course of to
client treatment
avoid douching
complaintsexamination
in sexual is not possible or smear to detect intracellular
both for diabetes,
Pregnancy,
client is hesitant, treat and mayIn
vaginitis HIV second
also and third trimester
be influencing oral
factors and metronidazole
should can
be considered be given the
in recurrent
Demonstrate infections
use of condoms,
partners gonococci
cervicitis Follow-up after one week Tab. Secnidazole 2gm orally, single dose or educate about correct and consistent use
Low backache Tab. Tinidazole 500 mg orally, twice daily forSchedule
5 days return visit after 7 days
Tab. Metoclopropramide taken 30 minutes before Tab. Metronidazole, to
prevent gastric intolerance