Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • purulent vaginal or cervical discharge
  • dysuria and urinary frequency
  • intermenstrual/postcoital bleeding
  • easily induced cervical bleeding

Other diagnostic factors

  • dyspareunia
  • vulval and/or vaginal inflammation
  • strawberry cervix

Risk factors

  • age 15 to 25 years
  • inconsistent condom use
  • multiple sexual relationships
  • previous sexually transmitted infections (STIs)
  • bacterial vaginosis (BV)
  • sex worker
  • absence of hydrogen peroxide-producing lactobacilli
  • infertility
  • education <12 years

Diagnostic investigations

1st investigations to order

  • pregnancy test
  • wet mount examination of cervical discharge
  • nucleic acid amplification testing (NAAT)
  • rapid tests (OSOM Trichomonas, AFFIRM VPIII)
  • Thayer-Martin agar cervical culture
  • Gram stain of cervical discharge
Full details

Investigations to consider

  • Pap smear
  • HSV serology
  • HIV serology
  • hepatitis B and C serologies
  • RPR testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

M. Jonathon Solnik

Associate Professor of Obstetrics & Gynaecology

Head of Gynaecology & Minimally Invasive Surgery

University of Toronto Faculty of Medicine

Mount Sinai Hospital

Toronto

Canada

Disclosures

MJS serves as a consultant for Medtronic and on the advisory board for Abbvie.

Dr M. Jonathon Solnik would like to gratefully acknowledge Dr Sharon Jakus, a previous contributor to this monograph. SJ declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Professor and Chief

Gynecology and Reconstructive Pelvic Surgery

University of Chicago

Chicago

IL

Disclosures

SRV declares that she has no competing interests.

Associate Division Director

Gynecologic Oncology

Crozer Chester Medical Center

Upland

PA

Disclosures

JCC declares that he has no competing interests.

Consultant Physician

GUM/HIV Camden Primary Care Trust

Archway Sexual Health Clinic

London

UK

Disclosures

EJ declares that she has no competing interests.

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