Purulent Vaginal Discharge

CLINICAL DIAGNOSTIC MANUAL

Purulent vaginal discharge is a thick, yellowish or greenish secretion that may be accompanied by an unpleasant odour.

This alteration can be a sign of infection, inflammation, or the presence of foreign bodies in the female genital tract. Identifying the underlying cause is crucial to providing appropriate treatment and preventing complications.

Condition	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Excess Secretion	Increased quantity of vaginal discharge without changes in colour or odour	History of increased secretions, no other signs of infection	Physical examination and culture of vaginal secretions
Vaginal Candidiasis	Intense itching, thick white clumpy vaginal discharge, vulvar erythema	History of itching and characteristic discharge	Wet mount microscopy, culture of secretions
Bacterial Vaginosis	Greyish vaginal discharge, fishy odour, mild itching	History of characteristic discharge and odour	Whiff test (amine test), microscopy revealing clue cells
Cervical Erosions	Vaginal discharge, postcoital bleeding, mild pelvic pain	History of postcoital bleeding, physical examination revealing erosions	Colposcopy, cervical biopsy
Endocervicitis	Purulent vaginal discharge, pelvic pain, postcoital bleeding	History of infection symptoms, physical examination	Cervical secretion culture, STI testing
Cervical Carcinoma	Purulent vaginal discharge, abnormal bleeding, pelvic pain	History of abnormal bleeding and persistent purulent discharge	Abnormal cervical cytology, cervical biopsy
Foreign Body	Foul-smelling vaginal discharge, pain, possible bleeding	History of object insertion, physical examination	Transvaginal ultrasound, direct inspection
Endometrial Polyp	Vaginal discharge, intermenstrual bleeding, mild pelvic pain	History of abnormal bleeding, physical examination	Transvaginal ultrasound, hysteroscopy
Trichomonas Infection	Green-yellow vaginal discharge, itching, dysuria	History of typical symptoms	Wet mount microscopy, trichomonas culture
Gonococcal Cervicitis	Purulent vaginal discharge, dysuria, pelvic pain	History of unprotected sexual contact, infection symptoms	Cervical secretion culture, STI testing
Chlamydial Cervicitis	Purulent vaginal discharge, dysuria, pelvic pain	History of unprotected sexual contact, infection symptoms	STI testing (NAAT for chlamydia), cervical secretion culture