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Pre and post-menopausal vaginal discharge.
Discharge may be accompanied by itch, odour, or bleeding
If empirical treatment fails then examination, endo-cervical and high vaginal swabs are indicated
In the absence of red flag symptoms empirical treatment and a self-taken Lower Vaginal Swab for chlamydia in sexually active women are appropriate first line investigations.
Failure of empirical treatment should prompt examination, Endo-cervical Swab and High Vaginal Swab - ensure that adequate clinical details are available to microbiology on the request form e.g. 'post-menopausal vaginal discharge, no response to clotrimazole'
If symptoms persist and there is a strong clinical suspicion of infection, based on examination, and microbiology results have not identified a cause, then consider discussing with the local laboratory about the need to do more extended testing on a repeat swab
If empirical treatment is successful, but recurrent symptoms, retreat.
See formulary treatment of vulvovaginal candida, treatment of bacterial vaginosis, and Recurrent Vulvo-Vaginal Candidiasis
Post-menopausal discharge - both bacterial overgrowth and atrophy are likely to be reduced with use of topical oestrogens.
Treat as guided by microbiology, if this fails discuss with microbiology and consider referral to GUM.
Any bleeding or blood-stained discharge, or concern about malignancy on examination - use appropriate 2WW proforma or Clinical Referral Guidelines to refer.
GUM referrals- patient self-referral, if has already undergone examination and investigation in primary care a supporting letter from GP is helpful
2ww referral see – Gynaecology 2ww guideline
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This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.
Publication date: November 2018