Vanderbilt University School of Medicine
VC3 – Vanderbilt Core Clinical Curriculum

 

Abnormal Vaginal Discharge

 

Abnormal vaginal discharge is a common symptom that may result from a variety of causes, including gastrointestinal, urinary, gynecological, as well as emotional conditions.

 

 

************************************************************************************************************************

Prerequisites

************************************************************************************************************************

 

Describe and discuss:

  • anatomy of the pelvis and genito-urinary system
  • pathogenesis and pathophysiology of diseases and conditions that contribute to abnormal vaginal discharge
  • pharmacology of drugs used to treat abnormal vaginal discharge
  • epidemiology of abnormal vaginal discharge

Demonstrate:

  • ability to take a medical history, including a sexual history, and perform a physical exam
  • ability to perform a pelvic exam with collection of necessary specimens
  • basic communication skills

 

************************************************************************************************************************

Apply Medical Knowledge in the Clinical Encounter

************************************************************************************************************************

 

1.    Describe the clinical features that help to differentiate one etiology from another:

  • gastrointestinal
  • urinary
  • emotional
  • gynecological

 

2.    Describe the signs and symptoms that suggest gynecological etiology.

 

3.    Describe the signs and symptoms associated with abnormal vaginal discharge due to other disease and conditions:

  • gastrointestinal
  • urinary
  • emotional

 

4.    Describe the risk factors associated with acquisition of abnormal vaginal discharge.

 

5.    Describe how lab studies would help in the evaluation of abnormal vaginal discharge, including their indications, limitations, and cost.

 

6.    Describe how imaging studies would or would not help in the evaluation of abnormal vaginal discharge, including their indications, limitations, and cost.

 

************************************************************************************************************************

Diagnose

************************************************************************************************************************

1.    Obtain, document and present an age-appropriate medical history that differentiates among etiologies of disease.

2.    Perform a physical exam, including a pelvic exam, to establish the diagnosis and severity of disease.

3.    Generate a differential diagnosis recognizing specific history and physical exam findings that distinguish causes of abnormal vaginal discharge (GI, urinary and emotional as well as gynecological conditions).

4.    Recommend when to order imaging and laboratory tests, both prior to and after initiating treatment, based on the differential diagnosis. Justify ordering them and include consideration of test cost and performance characteristics as well as patient preferences.

5.    Define the indications for and interpret (with consultation) the significance of the results of appropriate clinical tests.

6.    Perform relevant basic clinical diagnostic procedures.

7.    Record, present, research, critique, and manage clinical information.

 

************************************************************************************************************************

Develop a Management Plan

************************************************************************************************************************

 

1.    Describe and discuss indications, mechanism of action, side effects, adverse reactions, and significant interactions of medications that could be prescribed for patients with abnormal vaginal discharge.

 

2.    Describe and discuss the indications, benefits and disadvantages of the interventional therapy.

 

3.    Describe and compare the cost-effectiveness of:

  • various agents within each class of medications
  • interventional strategies

 

4.    Select an approach to treatment for the patient with abnormal vaginal discharge based on the diagnosis, evidence about treatment options, patient characteristics, and patient preferences.

 

5.    Formulate a prognosis for the patient with abnormal vaginal discharge based on the diagnosis, treatment plan, and patient's characteristics.

 

6.    Communicate the diagnosis, treatment plan, and prognosis of the disease to patients and their families in a caring and compassionate manner, reflecting an understanding of the emotional impact of a diagnosis related to abnormal vaginal discharge and its potential effect on lifestyle (partner status, sexual functioning, etc.).

 

7.    Provide education for the patient about the treatment plan.

 

8.    Provide counseling to patients when indicated about issues related to prevention.

 

9.    Refer for psychological support if indicated.

 

10. Access and utilize appropriate information systems to ascertain information about health system and community resources.

 

11. Plan for follow-up.

 

************************************************************************************************************************

Differential Diagnosis

************************************************************************************************************************

  • Bacterial vaginosis
  • Candida
  • GC and chlamydia
  • physiologic