Case Management

Vaginal Discharge Syndrome (VDS)

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Symptoms:

Abnormal vaginal discharge/dysuria or vulval itching/burning.

Diagnosis:

Vaginal candidiasis/ or bacterial vaginosis…?

Treatment:

If no male urethritis syndrome (MUS), the patient is above 35 years and discharge is not confirmed:

  1. Tabs Metronidazole 2mg STAT
  2. Clotrimazole pessary 200mg inserted intravaginal NOCTE x 3/7

or

Clotrimazole pessary 500mg inserted intravaginal NOCTE.

or

Clotrimazole pessary 100mg inserted intravaginal NOCTE 6/7

***If no satisfactory response

Metronidazole 400mg tabs BD x 1/52

*** If no male urethritis syndrome (MUS), the patient is above 35 yrs, and discharge is confirmed. NO lower abdominal pain (LAP) or NO pain on moving the cervix.

  1. Tabs Norfloxacin 800mg STAT
  2. Caps Doxycycline 100mg BD x 1/52

*Alternative treatment A

  1. Inj. spectinomycin 2gm STAT
  2. Caps Doxycycline 100mg BD x 1/52

*Alternative treatment B

  1. Inj. Ceftriaxone 250mg STAT
  2. Tabs Azithromycin 1gm STAT
  3. Tabs Metronidazole 2gm STAT

*** In case of vulval oedema, curd-like discharge, erythema and excoriations treat for candidiasis:

  1. Clotrimazole pessary 200mg inserted intravaginal NOCTE x 3/7
  2. Clotrimazole cream is applied thinly on the vulva BD and continues for 3 days after symptoms disappear (maximum of 2 wk)

or

  1. Caps Fluconazole 200mg STAT

*For the partner;

  1. Caps Fluconazole 200mg STAT plus
  2. Clotrimazole cream BD

*if no improvement add;

Tabs Metronidazole 400mg BD x 1/52