Vaginal discharge

The complaint of vaginal discharge is very common in primary care settings. Symptoms include discharge with or without odor, which may be accompanied by dysuria, vulvar, and/or vaginal itching or burning. A careful history that includes inquiry about new or multiple sexual partners, type of birth control, sexually transmitted infection prevention measures, current health status, medications used, and vaginal preparations used will help with the diagnosis. The practitioner must evaluate the vaginal mucosa with a speculum exam and obtain a sample of the vaginal discharge. In addition, it is important to determine whether the woman may have an upper tract infection by performing a bimanual examination. The discharge should be evaluated by doing a pH test, a whiff test, and saline and potassium hydroxide (KOH) wet mount slides viewed under the microscope. There are several commercial kits available that help to identify the most common causes of vaginal discharge; examples of these include Affirm® (Becton, Dickinson, & Co, Franklin Lakes, NJ) and FemExam® (Cooper Surgical, Trumbull, CT).