DR10.10 | Vaginal Discharge Syndromic Management — Summary & Reflection

KEY TAKEAWAYS

Vaginal discharge is a NACO syndromic category with three common causes you must differentiate: bacterial vaginosis (Gardnerella and anaerobes replacing Lactobacillus — thin grey discharge, pH >4.5, positive whiff test, clue cells; Amsel ≥3 of 4; metronidazole; partner NOT routinely treated), vulvovaginal candidiasis (Candida albicans — curdy white discharge, itch, pseudohyphae and budding yeast on KOH, normal/low pH; clotrimazole or fluconazole), and trichomoniasis (Trichomonas vaginalis — frothy yellow-green discharge, strawberry cervix when present, motile flagellates on wet mount; metronidazole AND treat the partner). Manage with NACO Kit 2 (green) — per current NACO guidance — using metronidazole (for BV and trichomoniasis) plus clotrimazole/fluconazole (for candidiasis), and always perform the cervicitis risk-stratification step that decides whether to add Kit 1 cover. Counsel on completing treatment, abstaining during treatment, and avoiding alcohol with metronidazole; offer HIV testing; follow up; and remember the partner rule — treat the partner for trichomoniasis, not for BV.

REFLECT

Reflect on how you would explain to a woman with trichomoniasis, sensitively, that her partner also needs treatment — without implying blame or jeopardising her safety if disclosure could provoke conflict at home. How would you contrast this with bacterial vaginosis, where you would reassure her that her partner does not need treatment? Consider also how you will remember, under the time pressure of a busy clinic, to perform the cervicitis risk-stratification step every single time rather than treating only the discharge in front of you. What simple habit or prompt could make that step automatic?