OG22.2 | Common Vaginal Discharge Syndromes — Summary & Reflection

KEY TAKEAWAYS

Three syndromes account for most pathological vaginal discharge. Bacterial vaginosis (BV): polymicrobial ecological dysbiosis, thin grey-white homogeneous discharge, fishy amine odour, pH >4.5, no pruritus; diagnosed by Amsel ≥3/4 criteria (discharge + pH >4.5 + positive whiff + clue cells); treated with metronidazole 400–500 mg BD × 7 days; partner treatment not routine; treat in pregnancy to prevent preterm birth. Vulvovaginal candidiasis: Candida albicans in 80–90%; thick white curdy discharge, intense pruritus, erythema, pH ≤4.5, no odour; pseudohyphae on KOH preparation; treated with fluconazole 150 mg single dose (uncomplicated) or extended regimen for complicated/recurrent disease; partner treatment not routine. Trichomoniasis: Trichomonas vaginalis protozoan, STI; frothy yellow-green discharge, fishy odour, vulval soreness, pH >4.5; motile flagellates on fresh wet mount; treated with metronidazole 2 g single dose; simultaneous partner treatment is mandatory. Syndromic management: metronidazole covers BV + TV; add fluconazole if candida features present. Always avoid vaginal douching; screen for co-STIs in all TV-positive patients.

REFLECT

Reflect using Kolb's framework. Concrete Experience: recall a patient (real or from the hook scenario) presenting with vaginal discharge — what was your first impression of the likely diagnosis? Reflective Observation: which clinical feature was most diagnostic, and did the pH measurement or microscopy confirm or change your impression? Abstract Conceptualisation: how does the three-syndrome framework (BV/VVC/TV — pattern, pH, microscopy, treatment) function as a structured reasoning tool that prevents both under- and over-treatment? Active Experimentation: in your next STI or gynaecology clinic session, apply the Amsel criteria systematically to every discharge presentation and compare your bedside diagnosis against any microscopy results available. Document the cases in your logbook with a one-line diagnostic reasoning note for each.