Evaluation of vaginal discharge

Last reviewed: 6 Apr 2025
Last updated: 07 Jan 2025

Summary

Differentials

Common

  • Bacterial vaginosis
  • Trichomoniasis
  • Vulvovaginal candidiasis
  • Chlamydia trachomatis infection
  • Neisseria gonorrhoeae infection
  • Mycoplasma genitalium
  • Irritant and allergic vaginitis
  • Physiologic discharge in adults
  • Foreign body in children
  • Nonspecific vaginitis
  • Physiologic discharge in children
Full details

Uncommon

  • Herpes simplex virus (HSV) infection
  • Streptococcal vaginitis in adults
  • Genital schistosomiasis
  • Entamoeba gingivalis plus intrauterine device (IUD)
  • Inadequate hygiene
  • Foreign body in adults
  • Combined contraceptive or hormonal vaginal ring-related
  • Genitourinary syndrome of menopause
  • Postpuerperal atrophic vaginitis; lochia
  • Behcet syndrome
  • Desquamative inflammatory vaginitis
  • Erosive lichen planus
  • Postoperative sling/mesh procedure
  • Postradiation
  • Cervical cancer
  • Carcinoma of the fallopian tube
  • Pinworm infection
  • Streptococcal vaginitis in children
  • Sexual abuse
  • Transmitted maternal birth canal infection
  • Prolapsing fibroid
  • Vaginal fistula
  • Lymphoma of genital tract
Full details

Contributors

Authors

Jenell S. Coleman, MD, MPH, FACOG

Associate Professor

Division Director, Gynecologic Specialties

Medical Director, JHOC Women’s Health Center

Director, JHOC Resident Continuity Clinic

Co-Director, JHOC Colposcopy Clinic

Department of Gynecology & Obstetrics

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

JC is an author of a reference cited in this topic and received research grants from Hologic, Gilead, and Merck.

Acknowledgements

Dr Jenell Coleman would like to gratefully acknowledge Dr Veronica Gomez-Lobo and Dr Isabelle Guichard, previous contributors to this topic.

Disclosures

VGL and IG declare that they have no competing interests.

Peer reviewers

Susie Logan, MB ChB, MD, FRCOG, FFSRH

Senior Consultant, Department of Obstetrics and Gynaecology, National University Hospital, NUHS

Director of Residency Obstetrics and Gynaecology, National University Hospital, NUHS

Co-Lead for Women's Health, Alexandra Hospital

Assistant Professor, National University of Singapore

Singapore

Disclosures

SL is a member of the Examination Committee of the Membership of the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists.

David Chelmow, MD

Chair

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

VA

Disclosures

DC declares that he has no competing interests.

Lesley Bacon, FFSRH, MRCGP

Consultant in Sexual and Reproductive Health

Lewisham Primary Care Trust

Waldron Health Centre

London

UK

Disclosures

LB was a member of the group that produced the 2006 Faculty of Sexual and Reproductive Health guidance on the management of women with vaginal discharge presenting in a non-genitourinary setting.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication].Full text

Sherrard J, Wilson J, Donders G, et al. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS. 2018 Nov;29(13):1258-72. Abstract

Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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