Clinical management of Abnormal Vaginal Discharge Syndrome in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Increased quantity, abnormal colour/odour. Candida: very itchy thick/lumpy white discharge, red inflamed vulva. Trichomonas: itchy greenish-yellow frothy discharge with offensive smell. Bacterial vaginosis: thin discharge with fishy smell. Gonorrhoea/Chlamydia: cause cervicitis (purulent, thin mucoid, yellow, no smell, non-itchy).
Differential Diagnosis
Cancer of the cervix (blood-stained smelly discharge). Intra-vaginal detergents, chemicals, physical agents, herbs, chronic tampon use, allergic vaginitis.
Investigations
Speculum examination. Pus swab: microscopy, Gram stain, C&S. PH, KOH. Blood: syphilis tests (RPR/VDRL). HIV Testing.
Treatment
Lower Abdominal Tenderness
Treat as in PID.
Thick lumpy discharge, itchy, erythema (likely Candida)
Clotrimazole pessaries 100 mg; insert high in vagina once daily before bedtime for 6 days or twice daily for 3 days. OR fluconazole 200 mg tablets single dose, orally. ± Metronidazole 2 g stat dose.
Purulent discharge or high STD risk or previous tx failed
Treat for gonorrhea, chlamydia, and trichomonas. Cefixime 400 mg stat or ceftriaxone 1g IV stat. PLUS doxycycline 100 mg 12 hourly for 7 days. PLUS metronidazole 2 g stat. If pregnant: replace Doxycycline with Erythromycin 500 mg 6 hourly for 7 days.
Discharge persists
If partners treated, refer. If partners not treated, repeat Cefixime + Doxycycline (or Erythromycin if pregnant) and treat partners.
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