Common Sense Pathology

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"Abnormal" vaginal discharge is defined as an increased amount, abnormal colour, or yellow colour.

Conduct a detailed sexual history with an emphasis on possible exposure to sexually transmitted diseases. It is also important to determine the relationship of the discharge to menstrual cycle.

The physical examination should be focused and based on the results of the medical history and includes inspection of the external genitalia, perirectal region, vulva for evidence of lesions, ulceration and erythema. Conduct a speculum examination to inspect the vaginal mucosa and cervix, and look for sources of secretions i.e. try to establish whether discharge is of cervical or vaginal origin 

Initial laboratory investigations 

High vaginal swabs for: - 

  • pH and "whiff” test (side room tests),
  • microscopy (wet film and Gram stain), 
  • bacterial and fungal culture for specific pathogens 

Endocervical swabs or first-void urine samples , if gonorrhoea, chlamydia, or mucopurulent cervicitis is suspected for: - 
Endocervical swab for MCS
First void urine for PCR to detect 
Chlamydia trachomatis and/or Neisseria gonorrhoeae

Cytological examination in the post-pubertal 
patient and patients with chronic 

Lesion biopsy
, if necessary






Trichomonas vaginalis infection 

Genital swab - microscopy (and/or culture; requires specialised media) for Trichomonas vaginalis.  Cervical cytology. Other sexually transmitted diseases should be excluded. 

Candida albicans infection 

High vaginal specimen from lesion for fungal microscopy and culture.  

Gardnerella vaginalis infection 

Microscopy and culture of vaginal secretion. "Whiff" test by addition of KOH.

Haemophilus influenzae type B infection (in children)

Microscopy and culture secretion from vagina 




Cervical or a high vaginal swab Gram stain and culture for Neisseria gonorrhoeae . PCR on cervical swabs or urine samples  is an alternative method of detecting the gonococcus. Consider possibility of concurrent infection with HIV, Chlamydia trachomatis, syphilis

Chlamydia trachomatis infection

Swabs or urine for PCR - this is the test of choice. Chlamydia antibodies - this is a screening test which does not differentiate between the respiratory chlamydias (i.e. C. pneumoniae and C. pssittaci) and the sexually transmitted chlamydias (i.e. C. trachomatis). In addition, the test does not differentiate between recent and past exposure to chlamydia species. Chlamydia trachomatis-specific antibodies

Other cervical lesions
Herpes simplex virus

Virus detection, culture or PCR for herpes 
simplex virus if there is a suspicious lesion

Cervical carcinoma 

Cervical cytology; cervical biopsy 
(colposcopically directed) of any suspicious lesion, as cervical cytology fails to detect a serious lesion (incl. malignancy) in up to 50% of patients.  There is a strong association between infection with some strains of human papillomavirus and cervical carcinoma, however, the place of human papillomavirus testing is not yet defined.

Cervix Retained foreign body e.g. Tampon 

A thorough vaginal examination, including visualisation of the cervix is always necessary in all patients with a vaginal discharge.




Contact or allergic vaginitis e.g.
Soaps Detergents Chemically treated water (found in Jacuzzis etc)

Atrophic vaginitis occurs in: Postmenopausal women Hyoestrogenic adolescents

Uterine fibroids
Uterine carcinoma


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