Vaginal discharge and bacterial vaginosis

Nicky Perkins talks about vaginal discharge. Nicky is a specialist in sexual health medicine practicing at the Auckland Sexual Health Service and privately at Omnicare Women’s Health Clinic.

Nicky is actively involved in teaching and research. In addition to general sexual health medicine, she is interested in chronic genital and sexual pain, vulvovaginal disease and genital dermatology.

Nicky practices from a whole person perspective and has completed post-graduate training in MindBody Medicine.

Topics

What do we need to consider and offer women in terms of examination/ testing?
When should we be offering full sexual health testing? What does this look like? Does it always include HIV, Hep C, syphilis?
What is the role of self-testing?
If a patient has bacterial vaginosis, what are the clues to diagnosis? When do we offer treatment, and what treatment do we offer?
What vaginal discharge requires urgent treatment and referral to a sexual health team?
Who with a vaginal discharge needs partner notification and how do we do this?

Take home messages

Management of vaginal discharge requires a good history – consider using a questionnaire to help determine risk of STI.
Full sexual health testing including serology should be offered more then we currently do.
Self-swabbing is only appropriate with asymptomatic women.
Bacterial vaginosis is common and not all positive gram stains require treatment, although all who are symptomatic require treatment.
Recurrent bacterial vaginosis often requires a specialist referral.