GPAtlas🧭 When to suspect – abnormal vaginal discharge in pregnancy
Increased discharge is one of the commonest complaints of pregnancy. Most of it is physiological leukorrhoea – thin, white or clear, and non-offensive – driven by oestrogen and increased cervical and vaginal secretion. The clinical task is to separate this reassuring picture from a pathological one.
Suspect a treatable cause when the discharge changes in colour (green, yellow, grey), consistency (curd-like, frothy), develops an offensive odour, or comes with itch, soreness, dysuria or dyspareunia. The common infective causes are candidiasis, bacterial vaginosis, trichomoniasis and the bacterial STIs (chlamydia, gonorrhoea).
The two clinical priorities in pregnancy are, first, to exclude an obstetric emergency hiding as “discharge” – ruptured membranes or an antepartum haemorrhage – and second, to confirm the cause with a swab rather than treat blind, because empirical treatment is less reliable and prescribing choices are constrained.
| Discharge pattern | Most likely cause |
|---|---|
| Thin, white/clear, non-offensive, no itch | Physiological leukorrhoea – normal; reassure |
| Thick, white, curd-like ± vulval itch and soreness | Candidiasis (thrush) |
| Thin, grey-white, homogeneous, fishy odour | Bacterial vaginosis (pH > 4.5) |
| Yellow-green, frothy, offensive ± vulvitis | Trichomonas vaginalis |
| Mucopurulent ± cervicitis, contact bleeding, dysuria | Chlamydia or gonorrhoea |
| Clear, watery, continuous leak or gush | Suspect ruptured membranes (PROM) – not infection |
| Blood-stained | Suspect antepartum haemorrhage – not infection |
Source: BASHH · UKHSA
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