From the Guidelines
Yes, someone with grey, thin, smelly vaginal discharge should get a full pelvic exam. These symptoms strongly suggest bacterial vaginosis (BV), a common vaginal infection caused by an imbalance in the normal bacteria in the vagina. A healthcare provider needs to examine the vagina, collect samples of the discharge, and possibly perform tests like a pH test and microscopic examination to confirm the diagnosis. The standard treatment for BV is typically metronidazole (500 mg orally twice daily for 7 days), metronidazole gel (0.75%, one applicator intravaginally once daily for 5 days), or clindamycin cream (2%, one applicator intravaginally at bedtime for 7 days) 1. Without proper diagnosis and treatment, BV can increase the risk of getting sexually transmitted infections and cause complications during pregnancy. The grey color and fishy odor are particularly characteristic of BV, which occurs when harmful bacteria overgrow and outnumber the beneficial lactobacilli that normally keep the vaginal environment healthy and acidic.
Some key points to consider:
- BV is a clinical syndrome resulting from replacement of the normal H2O2-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria, G. vaginalis, and Mycoplasma hominis 1.
- The Amsel criteria are used to diagnose BV, which include a homogeneous, white, noninflammatory discharge that smoothly coats the vaginal walls, the presence of clue cells on microscopic examination, a pH of vaginal fluid >4.5, and a fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test) 1.
- Treatment of BV is important to prevent complications, such as increased risk of sexually transmitted infections and pregnancy complications 1.
- A full pelvic exam is necessary to confirm the diagnosis and rule out other conditions that may cause similar symptoms 1.
It's worth noting that while some studies suggest that routine screening pelvic examinations may not be necessary for asymptomatic women 1, the presence of symptoms such as grey, thin, smelly vaginal discharge warrants a full pelvic exam to confirm the diagnosis and provide appropriate treatment.
From the Research
Patient Presentation
The patient presents with grey, thin, malodorous vaginal discharge, which is a common symptom of various vaginal infections, including bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis 2, 3, 4.
Diagnosis and Examination
A pelvic exam is recommended for any woman presenting with vaginal discharge to confirm the diagnosis and rule out an upper tract infection, such as pelvic inflammatory disease (PID) 2. The exam may include visual inspection, speculum examination, bimanual examination, single digit examination, and/or rectovaginal examination, depending on the indication for examination 5.
Indications for Pelvic Examination
According to the guidelines, any woman with gynaecologic complaints, including vaginal discharge, should undergo appropriate components of the pelvic examination to identify benign or malignant disease 5. The examination is necessary to rule out conditions such as PID, which can lead to serious long-term sequelae, including increased risk for ectopic pregnancy, infertility, and chronic pelvic pain 2.
Key Points
- A pelvic exam is necessary for women presenting with vaginal discharge to confirm diagnosis and rule out upper tract infections 2, 5.
- The exam may include various components, depending on the indication for examination 5.
- Vaginal discharge can be a symptom of various infections, including BV, vulvovaginal candidiasis, and trichomoniasis 2, 3, 4.
- PID can lead to serious long-term sequelae, making prompt diagnosis and treatment essential 2.