A spontaneous complaint of abnormal2 vaginal discharge is most commonly due to a vaginal infection. Rarely, it may be the result of muco-purulent STI-related cervicitis. T. vaginalis, C.
albicans and bacterial vaginosis are the commonest causes of vaginal infection and N. gonorrhoeae and C. trachomatis cause cervical infection. The clinical detection of cervical infection is difficult because a large proportion of women with gonococcal or chlamydia. cervical infection is asymptomatic. The symptom of abnormal vaginal discharge is highly indicative of vaginal infection, but poorly predictive for cervical infection. Thus, all women presenting with vaginal discharge should receive treatment for trichomoniasis and bacterial vaginosis.
2 Abnormal in terms of quantity, colour or odour.
Among women presenting with discharge, one can attempt to identify those with an increased likelihood of being infected with N. gonorrhoeae and/or C. trachomatis. Microscopy adds little to the diagnosis of cervical infection and is not recommended. To identify women at greater risk of cervical infection, an assessment of a woman's risk status is useful, especially when risk factors are adapted to the local situation.
Knowledge of the prevalence of gonococcal and/or chlamydia in women presenting with vaginal discharge is important for the decision to treat for cervical infection. The higher the prevalence, the stronger the justification for treatment. Risk assessment positive women have a higher likelihood of cervical infection than those who are risk negative. Women with vaginal discharge and a positive risk assessment could therefore, be offered treatment for gonococcal and chlamydia cervicitis.
Where resources permit, one could consider the use of laboratory tests to screen women with vaginal discharge. Such screening could be applied to all women with discharge or selectively to those with discharge and a positive risk assessment.
In some countries, syndromic management algorithms have been used as a screening tool to detect cervical infection among women not presenting with a genital complaint (e.g. in family planning settings). While this may assist in detecting some women with cervical infections, it is likely that there will be substantial over-diagnosis.