Dawaa Reference

acute

Vaginal Discharge

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clotrimazole monograph, Dosing: Adult and Dosing: Pediatric, vulvovaginal candidiasis (chapter PDF pp400-401, printed pp390-391) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Fluconazole monograph (chapter PDF p50) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Metronidazole monograph (chapter PDF p307) · Hildebrand JP, Carlson K, Kansagor AT. Vaginitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: January 19, 2025. Bookshelf ID: NBK470302, PMID: 29262024.

Verified against4 documents
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clotrimazole monograph, Dosing: Adult and Dosing: Pediatric, vulvovaginal candidiasis (chapter PDF pp400-401, printed pp390-391)
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Fluconazole monograph (chapter PDF p50)
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Metronidazole monograph (chapter PDF p307)
  • Hildebrand JP, Carlson K, Kansagor AT. Vaginitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: January 19, 2025. Bookshelf ID: NBK470302, PMID: 29262024.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (10)

  • Normal discharge shifts in look, thickness and amount across the menstrual cycle
  • Normally it runs clear to white, watery through slightly thick, with only a mild smell
  • Around ovulation it turns heavier, clearer and stretchy
  • Itch, burning or irritation is never normal, nor is a marked shift in colour, thickness or odour [itching]
  • Women come with abnormal discharge, itch, irritation, odour, painful voiding or painful sex [itching]
  • Ask about earlier episodes, and about lubricants, shaving and douching
  • Take a sexual history with past infections, ask about new allergen contact and any self-treatment tried
  • Review the past record for immune suppression
  • Up to 70% with trichomonas feel nothing; when discharge shows it is yellow-green and frothy, pH >4.5
  • Mixed vaginitis is nonspecific: altered discharge colour, thickness and odour, genital itch, burning [itching]

Signs — what you find (7)

  • Examine vulva and neighbouring skin for redness, dermatoses, ulcers, fissures and swelling [redness]
  • Record how the discharge looks, but its appearance alone settles nothing
  • Sample pH from the middle of the side wall, since cervical mucus, semen and blood raise it falsely
  • Normal vaginal pH lies in the range 3.8 to 4.5, keeping the acidity that resists infection
  • The cervix can carry a punctate strawberry look
  • Atrophic vaginitis: dryness, painful sex, thin pale mucosa with rugae lost, petechiae, sometimes pus [atrophy · pallor · petechiae · pus]
  • Desquamative inflammatory vaginitis shows inflammation, discharge and shedding

Tests (12)

  • In-clinic work-up is pH, a KOH whiff test, and microscopy in saline and in 10% KOH
  • A molecular assay is the most accurate, though microscopy alone reveals white cells and parabasal cells
  • Reference tests are NAAT for trichomonas, multi-organism PCR for bacterial vaginosis, PCR or fungal culture for thrush
  • Sampling several sites, chiefly the lower third and anterior fornix, picks up more
  • Avoid touching the cervix when sampling, as its mucus shows up as leukocytes lined in rows
  • Read the slide inside 10 min, because cooling stills the trichomonads
  • Clue cells at >20% of squamous epithelial cells mean Gardnerella overgrowth
  • A >3% white cell count suggests thrush, atrophy, or trichomonas, chlamydia, gonorrhoea or herpes
  • KOH drives off amines as a fishy smell, and that release is the whiff test
  • In desquamative vaginitis: parabasal cells, many inflammatory cells, lactobacilli scarce, pH >4.5, amine test negative
  • Culturing Gardnerella is pointless, since it is normal flora in half of women
  • Point-of-care tests for trichomonas and Gardnerella are sold commercially

If not this — what else fits (11)

  • Chlamydia or gonorrhoea, giving discharge, irritation and discomfort alike
  • Genital herpes, with pain, itch and blisters
  • Human papillomavirus, causing warts and altered discharge
  • Urinary tract infection, with burning, urgency and frequency
  • Pelvic inflammatory disease, with low abdominal pain, fever and odd discharge
  • Lichen sclerosus or lichen planus altering the vulvar skin with itch
  • Eczema or psoriasis of the genital skin
  • Vulvodynia, long-lasting pain around the vulva
  • Allergy to soaps, detergents or hygiene products
  • A retained tampon or another foreign object
  • Desquamative inflammatory vaginitis, purulent and hard to separate from other inflammatory forms

SourceStatPearls "Vaginitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

CLOTRIMAZOLE

1st line

Formvaginal

Adult dose and duration

One 500 mg clotrimazole vaginal tablet inserted as a single dose, preferably at bedtime - Single dose

Paediatric dose

Intravaginal clotrimazole is listed only for children 12 years and older and adolescents, and only as vaginal cream: 1% cream, one applicatorful at bedtime for 7 nights (some patients need 14), or 2% cream, one applicatorful at bedtime for 3 nights. The 500 mg single-dose vaginal tablet is not listed for this age group. Not used in prepubertal girls.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clotrimazole monograph, Dosing: Adult and Dosing: Pediatric, vulvovaginal candidiasis (chapter PDF pp400-401, printed pp390-391)

Why

Candidiasis is the most common cause of vaginal discharge in general practice; a single-dose vaginal tablet is a simple, effective first-line option directly matching the formulary's vulvovaginal candidiasis indication.

Cautions
  • Reassess if symptoms do not improve within 3 days, last more than 7 days, or the discharge is recurrent and not responding to standard treatment.
  • Vaginal use only: no tampons, douches, spermicides, other vaginal products, or intercourse during treatment.
  • Avoid with vaginal progesterone — vaginal antifungals may reduce its effect (interaction risk X).
  • A longer course may be needed in complicated infection: recurrent or severe, non-albicans Candida, or an immunocompromised patient.
  • Labelled for vaginal candidiasis — establish the cause of the discharge first; this does not treat bacterial vaginosis or trichomonas.
  • Vaginal cream/tablet can weaken latex condoms and diaphragms.
  • If discharge is accompanied by fever and pelvic pain, consider pelvic inflammatory disease rather than simple candidiasis.
  • Postmenopausal or blood-stained discharge needs referral to exclude malignancy before treating as infective.
Egyptian brands
Egyptian brandManufacturerIndicative price
CANDISTAN 200 MG 3 VAG.TABS.ARAB DRUG COMPANY (ADCO)8.50 EGP
CANDISTAN 100 MG 6 VAG.TABS.ARAB DRUG COMPANY (ADCO)9.00 EGP
LOCASTEN 1 500 MG 1 VAG. TAB.ALEXANDRIA10.25 EGP
KREMA-ROSA 100MG 6 VAG.TABS.EIPICO10.50 EGP
LOCASTEN 100 MG 6 VAG. TABS.ALEXANDRIA10.50 EGP
LOCASTEN 2% VAGINAL CREAM 20 GMALEXANDRIA29.00 EGP
CANDISTAN 2% VAGINAL CREAM 20 GMARAB DRUG COMPANY (ADCO)40.00 EGP
CANESTEN 3 2% VAGINAL CREAM 20 GMMEMPHIS > BAYER HEALTHCARE51.00 EGP
2

METRONIDAZOLE

2nd line

Formoral.solid

Adult dose and duration

500 mg orally twice daily x 7 days

Paediatric dose

Paediatric dosing is specialist-set and is not reproduced here.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Metronidazole monograph (chapter PDF p307)

Why

First choice when the discharge is frothy, malodorous, or otherwise suggests trichomoniasis rather than candidiasis; directly matches the formulary's named trichomoniasis indication.

Cautions
  • Treat the sex partner simultaneously - trichomoniasis is sexually transmitted.
  • This formulary excerpt gives a trichomoniasis-specific line; it does not give a separate bacterial vaginosis line, though metronidazole is also commonly used for BV in practice.
  • Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.
  • Avoid alcohol during treatment and for 3 days after discontinuation.
  • Contraindicated in pregnant patients (first trimester) with trichomoniasis.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRICHOGYL 250 MG 20 TAB.EL NASR4.35 EGP (0.22/unit)
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
FLAGICURE 250MG 20 TAB.KAHIRA7.00 EGP (0.35/unit)
METRONIDAZOLE-MUP 250 MG 20 F.C. TABS.MUP11.00 EGP (0.55/unit)
METROZOLE 250MG 20 TAB.MEMPHIS20.00 EGP (1.00/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP
3

FLUCONAZOLE

3rd line

Formoral.solid

Adult dose and duration

150 mg orally as a single dose (may repeat every 72 hours if the infection is complicated) - Single dose, or repeated every 72 hours for complicated infection

Paediatric dose

Paediatric dosing is specialist-set and is not reproduced here.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Fluconazole monograph (chapter PDF p50)

Why

Oral alternative to topical clotrimazole for candidal discharge when the patient prefers an oral option or has recurrent/complicated infection.

Cautions
  • Avoid in pregnancy, particularly high-dose or repeated use (teratogenicity risk).
  • Fluconazole has drug interactions via CYP3A4/2C9 - use caution with warfarin, statins, and other interacting drugs.
  • Hepatotoxicity and QT prolongation can occur - use caution with other QT-prolonging drugs or hepatic impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMRIFLUCAN 50 MG 7 CAPS.AMRIYA24.00 EGP (3.43/unit)
NAVILUCA 50 MG 21 CAPS.INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN78.75 EGP (3.75/unit)
JENFUNGA 150 MG 1 CAPS.EGPI > JENIKO MEDICINE PHARMACEUTICALS4.50 EGP (4.50/unit)
FLUCORAL 150 MG 2 CAPS.SEDICO30.00 EGP (15.00/unit)
ACTRIAZOLE 200 MG 2 CAPS.EGPI > RIGHT CARE PHARMA51.50 EGP (25.75/unit)
NAVILUCA 150 MG 6 CAPS.INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN207.00 EGP (34.50/unit)
FUNGICLEAR 200 MG 4 CAPS.EGPI > HEROPHARM148.00 EGP (37.00/unit)
DIFLUCAN 150 MG 1 CAPS.PFIZER111.00 EGP (111.00/unit)
DIFLUNAZOLE 25MG/5ML SYRUP 70ML? strength differs? different route - not oral solidCID28.80 EGP
FLUCAZONIL 25MG/5ML SYRUP 70 ML? strength differs? different route - not oral solidEL NILE.28.80 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.