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Highlights risks of polypharmacy and adverse drug reactions in complex patients and provides documentation principles when deviating from guidance. Includes patient triage by discharge duration and symptoms, STI risk stratification, OTC self-management when appropriate, and indications for face-to-face assessment. Outlines investigations (examination, pH, microscopy, swabs, NAAT) and result-based management, plus an Aerobic Vaginitis assessment and advice on maintaining vaginal health.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/vaginal-discharge-guideline-version-1-11th-march-2025/401209/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/vaginal-discharge-guideline-version-1-11th-march-2025/401209.png","ImageObject",300,407,{"name":92,"@type":93},"Danger Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"When should clinicians consider not following the guideline and record the reasons?","Question",{"text":113,"@type":114},"After discussion with the patient or carer, if there are good reasons for not following the guideline, record these reasons and communicate them to others involved in the patient’s care.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does the guideline distinguish low versus increased STI risk for new or regular partners?",{"text":118,"@type":114},"Increased risk applies when a new partner is reported in the last 3/12 and/or the regular partner has had a new partner or is a known STI contact. Low risk applies when no new partner is reported in the last 3/12 and the regular partner has not had new partners.",{"name":120,"@type":111,"acceptedAnswer":121},"What investigations are recommended for persistent (>4 weeks) or recurrent vaginal discharge symptoms?",{"text":122,"@type":114},"Offer an appropriate face-to-face appointment and include investigations such as examination and pH, microscopy (dry slide/wet prep), endocervical GC culture when available, high vaginal swab, and vulvovaginal CT/GC NAAT.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},401209,1790793963,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":105,"preview_page_count":4},962090769052,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","CLINICAL GUIDELINE  \nVaginal Discharge  \nA guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.  \nClinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.  \nIf, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.  \n\n| Version Number: | 1 |\n| --- | --- |\n| Does this version include changes to clinical advice: | N/A |\n| Date Approved: | 11th March 2025 |\n| Date of Next Review: | 16th March 2027 |\n| Lead Author: | Kay McAllister |\n| Approval Group: | Sandyford Governance Group |\n| Guideline ID number: | 1244 |\n\nImportant Note:  \nThe online version of this document is the only version that is maintained.  \nAny printed copies should therefore be viewed as ‘Uncontrolled’ and as such, may not necessarily contain the latest updates and amendments.  \n\n| | Sandyford Guidelines |\n| --- | --- |\n| VAGINAL DISCHARGE\u003Cbr>Please see the individual guidelines for the specific treatments for Vulvovaginal Candida, Trichomoniasis, Mycoplasma Genitalium and\u003Cbr>Bacterial Vaginosis.\u003Cbr>New Vaginal discharge \u003C4 weeks |  |\n| \u003Cbr>Smelly discharge? BV\u003Cbr>Buy OTC Balance Activ or equivalent Vaginal health advice If they have a known history of BV consider postal metronidazole treatment If symptoms fail to resolve after 1 month patient can callback for testing\u003Cbr>\u003Cbr>If no other symptoms than increased volume reassure no action needed. Vaginal health advice\u003Cbr>\u003Cbr>Itchy/ thick white discharge?candida\u003Cbr>Advise to buy OTC treatment Vaginal health advice If fails to resolve after 1 month patient to call back for testing\u003Cbr>New (\u003C4 weeks) vaginal discharge and no other issues (no abdominal pain/change in bleeding/dysuria/recent IUD/not pregnant/ulcerative lesions)\u003Cbr>INCREASED RISK OF STI\u003Cbr>If new partner in last 3/12 and/ or regular partner has had new partner or they are a known STI contact they are at increased risk of and STI.\u003Cbr>LOW RISK OF STI\u003Cbr>If no new partner in last 3/12 and/or regular partner hasn’t had new partner they are at low risk of an STI.\u003Cbr>\u003Cbr>Book for a Grab kit self test of\u003Cbr>CT/ GC\u003Cbr>If patient reports symptoms classic of BV or candida advise also try self treatment.\u003Cbr>\u003Cbr>|  |\n| Vaginal Discharge CEG March 2025 Page 1 of 4 |  |\n\n\n| | Sandyford Guidelines |\n| --- | --- |\n| Persistent (>4 weeks) or recurrent vaginal discharge symptoms, symptoms of PID, postpartum or post abortion, post gynaecological instrumentation or pregnant - Offer face to face appointment in an appropriate clinic, i.e. Urgent Care / TOPAR/ GU Complex. Advise postpartum women to attend their postnatal check if this is due.\u003Cbr>Investigations\u003Cbr>- Examination and pH\u003Cbr>- Microscopy (*dry slide for Gram staining and **wet prep)\u003Cbr>- Endocervical GC culture (if plates available)\u003Cbr>- High Vaginal Swab (􀀁HVS)\u003Cbr>- Vulvovaginal CT/GC NAAT\u003Cbr>Management of results (please refer to appropriate guidelines)\u003Cbr>- Trichomonas Vaginalis (TV) seen – TV\u003Cbr>- pH >4 .5 +/-Clue cells and abnormal flora – BV\u003Cbr>- pH \u003C4 .5 +/-Yeast cells – Candida\u003Cbr>- Gram Negative Diplococci (GNDC) seen – GC\u003Cbr>- High AV score: discuss with senior\u003Cbr>*Dry slide (vaginal and cervix) for Gram stain.\u003Cbr>**Wet prep taken from the vaginal posterior fornix. In connects an HVS is taken using a charcoal swab for wet prep.\u003Cbr>􀀁 HVS – taken from lateral vaginal wall. Stored at 4°C for maximum 48 hours.\u003Cbr>Microscopy venue: Sandyford Central.\u003Cbr>CONNECT: If microscopy requested please leave the registration form of client with the Connect nurse to follow up client with result.\u003Cbr>Vaginal Discharge CEG March 2025 Page 2 of 4 |  |\n\nSandyford Guidelines  \nAerobic Vagini","cbCaijivRL6PR6QR","https://ap.wps.com/l/cbCaijivRL6PR6QR","pdf",146741,"English","# Clinical guideline\n## Scope and clinical judgement\n## Version, approval, and identifiers\n## Triage and symptom-based management\n## Investigations and result management\n## Aerobic Vaginitis (AV) assessment and severity\n## Vaginal health advice","[{\"question\":\"When should clinicians consider not following the guideline and record the reasons?\",\"answer\":\"After discussion with the patient or carer, if there are good reasons for not following the guideline, record these reasons and communicate them to others involved in the patient’s care.\"},{\"question\":\"How does the guideline distinguish low versus increased STI risk for new or regular partners?\",\"answer\":\"Increased risk applies when a new partner is reported in the last 3/12 and/or the regular partner has had a new partner or is a known STI contact. Low risk applies when no new partner is reported in the last 3/12 and the regular partner has not had new partners.\"},{\"question\":\"What investigations are recommended for persistent (\\u003e4 weeks) or recurrent vaginal discharge symptoms?\",\"answer\":\"Offer an appropriate face-to-face appointment and include investigations such as examination and pH, microscopy (dry slide/wet prep), endocervical GC culture when available, high vaginal swab, and vulvovaginal CT/GC NAAT.\"}]","Vaginal Discharge - Guideline - Version 1 - 11th March 2025 | PDF",1790517649]