# Vaginal Discharge - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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. ## Treatment metadata - Clotrimazole — vaginal - Metronidazole — oral.solid - Fluconazole — oral.solid ## Complete treatment card ```text VAGINAL DISCHARGE 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. Review status: REVIEWED against 2 sources listed above (2026-08) 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 Source StatPearls "Vaginitis" - disease-level clinical article Status traced to the source above 1. CLOTRIMAZOLE [1st line] Adult One 500 mg clotrimazole vaginal tablet inserted as a single dose, preferably at bedtime - Single dose Peds 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. 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. Caution 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. Egypt CANDISTAN 200 MG 3 VAG.TABS. ARAB DRUG COM... 8.50 EGP CANDISTAN 100 MG 6 VAG.TABS. ARAB DRUG COM... 9.00 EGP LOCASTEN 1 500 MG 1 VAG. TAB. ALEXANDRIA 10.25 EGP KREMA-ROSA 100MG 6 VAG.TABS. EIPICO 10.50 EGP LOCASTEN 100 MG 6 VAG. TABS. ALEXANDRIA 10.50 EGP LOCASTEN 2% VAGINAL CREAM 20 GM ALEXANDRIA 29.00 EGP CANDISTAN 2% VAGINAL CREAM 20 GM ARAB DRUG COM... 40.00 EGP CANESTEN 3 2% VAGINAL CREAM 20 GM MEMPHIS > BAYER HEALTHCARE 51.00 EGP 2. METRONIDAZOLE [2nd line] Adult 500 mg orally twice daily x 7 days Peds Paediatric dosing is specialist-set and is not reproduced here. 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. Caution 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. Egypt TRICHOGYL 250 MG 20 TAB. EL NASR 4.35 EGP (0.22/unit) DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) FLAGICURE 250MG 20 TAB. KAHIRA 7.00 EGP (0.35/unit) METRONIDAZOLE-MUP 250 MG 20 F.C. TABS. MUP 11.00 EGP (0.55/unit) METROZOLE 250MG 20 TAB. MEMPHIS 20.00 EGP (1.00/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid 3. FLUCONAZOLE [3rd line] Adult 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 Peds Paediatric dosing is specialist-set and is not reproduced here. 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. Caution 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. Egypt AMRIFLUCAN 50 MG 7 CAPS. AMRIYA 24.00 EGP (3.43/unit) NAVILUCA 50 MG 21 CAPS. INTERNATIONAL... 78.75 EGP (3.75/unit) JENFUNGA 150 MG 1 CAPS. EGPI > JENIKO... 4.50 EGP (4.50/unit) FLUCORAL 150 MG 2 CAPS. SEDICO 30.00 EGP (15.00/unit) ACTRIAZOLE 200 MG 2 CAPS. EGPI > RIGHT ... 51.50 EGP (25.75/unit) NAVILUCA 150 MG 6 CAPS. INTERNATIONAL... 207.00 EGP (34.50/unit) FUNGICLEAR 200 MG 4 CAPS. EGPI > HEROPHARM 148.00 EGP (37.00/unit) DIFLUCAN 150 MG 1 CAPS. PFIZER 111.00 EGP (111.00/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)