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A Painful Discharge

Wendy is a forty-five year old woman who is in a stable married relationship. She presented to the doctor complaining of an increasingly sore discharge from her vagina that began about five days before. Wendy takes the oral contraceptive and skips the sugar pills, so her last period was about four months previously. She has no medical conditions of note and takes no other medications. She has treated herself for thrush by taking oral fluconazole but this has not helped.

The GP examined Wendy and felt that this discharge was not typical of anything he had seen before. There was a large amount of inflammation, it was very painful to perform a speculum examination and the discharge was profuse and yellowy. There was no abdominal tenderness. He took swabs for both microscopy and PCR testing and let Wendy get dressed before he discussed things further. He asked Wendy if she and her husband were monogamous; Wendy again said yes. The GP explained he was not sure what the cause of the discharge was but that the swabs would be back within three working days and Wendy should not be sexually active until the diagnosis was made.

On her return three days later the GP informed Wendy that she had been infected with gonorrhoea, but that she did not have chlamydia. He then asked Wendy if her husband travelled, especially to South-east Asia. Wendy affirmed this; he travelled a number of times a year there for business and had returned four weeks ago. The GP treated Wendy with ceftriaxone 1g stat as per laboratory sensitivities and went on to discuss further sexually transmitted disease screening. Because of the “window period” for several of these diseases, Wendy had a very unpleasant wait, but later found out she was HIV, hepatitis B and syphilis negative.

It is imperative to familiarise oneself with the window period, i.e. the timescales at which sexually transmitted diseases can be earliest detected after infection. It is quite inappropriate, and even dangerous, to reassure someone that their sexually transmitted disease screen is “negative” when they have had unprotected sex the weekend before, without explanation of the need for repeat testing later on.


Australian STI Management Guidelines for Use in Primary Care