ODOBGYNDECODED

← All presentations

Vaginal discharge / cervicitis

Bleeding in pregnancyAbdominal pain in pregnancyReduced fetal movementsHeadache + high BP in pregnancy/postpartumFever in pregnancy/postpartumDyspnoea in pregnancyVaginal discharge / cervicitisAcute pelvic pain (non-pregnant)Postmenopausal bleedingInfertility evaluation
Immediate red flags:
  • Pelvic pain+fever (PID)
  • Pregnancy + bleeding
  • Post-surgical fistula leak (continuous urine)
Urgent workup:
  • Speculum + pH/microscopy where available
  • NAAT chlamydia/gonorrhoea
  • BV/trich testing

Structured differential — act in priority order

PriorityConditionKey featuresAction
COMMON
Bacterial vaginosis
Fishy thin discharge pH>4.5
Metronidazole course →
COMMON
Candidiasis
Itchy curdy discharge
Topical azoles (pregnancy-safe)
COMMON
Trichomoniasis
Frothy strawberry cervix
Nitroimidazole + partners
CANNOT MISS
Chlamydia/gonorrhoea cervicitis
Mucopurulent/friction bleeding
CDC regimens + partner therapy →
CONSIDER
Fistula (continuous leak)
Post-obstetric surgery history
Urogynae referral →

First moves

  1. Treat PID presumptively at low threshold