TemplateVaginal dischargeTap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.Try a Repertoire Linevaginal dischargevaginal symptoms: bacterial vaginosis, clue cells, wet mountvaginitis: yeast infection, clotrimazoleabnormal discharge: trich, sexual history, abstain, eptteen vaginal discharge: cervicitisvaginal discharge: pidvaginal discharge: retained tamponPractice wording only: leave out patient details. Nothing typed here is saved or sent. Practice a case insteadConfidential interviewChoose anyConfidential time with the adolescent, with the limits of confidentiality reviewedDefaultHistoryChoose anyDischarge, irritation, odor, urinary symptoms, and products used reviewedDefaultSexual historyChoose anySexual history and infection risk reviewedAssessmentChoose oneDischarge consistent with normal physiologic dischargeDefaultVulvar irritation from soaps or products, without infectionBacterial vaginosisVulvovaginal candidiasisRecurrent vulvovaginal candidiasis, with 3 or more episodes in the past yearTrichomoniasisCervicitisPelvic inflammatory disease with cervical motion tenderness; treated as an outpatientRetained tampon or foreign body removedFindingsChoose anyclue cells with pH above 4.5yeast on KOHtrichomonas detectedTestingChoose anyvaginal swab for bacterial vaginosis, yeast, and trichomonaswet mount, KOH, and pH in clinictrichomonas NAATurine pregnancy testInfection testingChoose anygonorrhea and chlamydia NAATHIV and syphilis testingTreatmentChoose oneNo treatment neededDefaultStarted Metronidazole for bacterial vaginosisStarted Metronidazole vaginal gel for bacterial vaginosisStarted Clindamycin vaginal cream for bacterial vaginosisPrescribed Fluconazole for vulvovaginal candidiasisPrescribed weekly Fluconazole for recurrent vulvovaginal candidiasisRecommended clotrimazole vaginal cream for vulvovaginal candidiasisStarted Metronidazole for trichomoniasisTreated presumptively with Doxycycline for cervicitisTreated presumptively with Rocephin given in clinic and Doxycycline for cervicitis given gonorrhea riskTreated with Rocephin given in clinic, Doxycycline, and Metronidazole for pelvic inflammatory diseasePartner treatmentChoose anyPartner treatment for trichomoniasis discussedExpedited partner therapyChoose anyExpedited partner therapy providedRetestingChoose anyRetest for trichomonas in about 3 monthsProductsChoose anyRecommended avoiding douching and scented productsCounselingChoose anyCounseled to avoid sex until treatment is complete and partners are treatedEncouraged condoms with every encounter for infection preventionFollow-upChoose oneas neededDefaultafter the resultsin 2-3 daysin 3 monthsCounseling paragraphChoose oneParagraphSome clear or white discharge is normal in teens and changes through the cycle; it does not need treatment. Recommended supportive care with an emphasis on cotton underwear and avoiding douching and scented products. Return precautions given including itching or burning, a strong odor, green or gray discharge, pelvic pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.DefaultIrritation from soaps, wipes, or scented products is common and improves when the products are stopped. Recommended supportive care with an emphasis on plain water for washing, cotton underwear, and a barrier ointment for comfort. Return precautions given including discharge with a strong odor, sores or blisters, pelvic pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.Bacterial vaginosis is an imbalance of normal vaginal bacteria rather than a sexually transmitted infection, and partners do not need treatment. Recommended supportive care with an emphasis on finishing the medicine and avoiding douching and scented products. Return precautions given including symptoms that continue after treatment, pelvic pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.Yeast infections are common, are not sexually transmitted, and usually clear with treatment. Recommended supportive care with an emphasis on loose cotton underwear and avoiding scented products. Return precautions given including symptoms that continue after treatment, symptoms that keep coming back, pelvic pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.Trichomoniasis is a sexually transmitted infection, so partners need treatment and retesting in about 3 months is recommended. Recommended supportive care with an emphasis on finishing the medicine and avoiding sex until partners are treated. Return precautions given including symptoms that continue after treatment, pelvic pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.Cervicitis is usually caused by an infection, so it is treated today while the test results are pending, and partners may need treatment too. Recommended supportive care with an emphasis on finishing the medicine and avoiding sex until treatment is complete. Return precautions given including pelvic pain, fever, vomiting, pain during sex, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.Pelvic inflammatory disease is an infection of the uterus and tubes, and finishing the full treatment protects future fertility; a recheck in 2-3 days makes sure it is improving. Recommended supportive care with motrin as needed with an emphasis on finishing every dose and avoiding sex until treatment is complete. Return precautions given including worsening pelvic pain, fever, vomiting or not keeping the medicine down, fainting, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.The discharge came from a retained tampon, and it should clear now that it has been removed. Recommended supportive care with an emphasis on changing tampons regularly. Return precautions given including fever, a rash, vomiting, dizziness, discharge that does not clear, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.What the sources coverConfidential timePhysiologic, irritant, BV, VVC, recurrent VVC, trichomoniasis, cervicitis, PID, retained tamponFindings (clue cells and pH, yeast on KOH, trichomonas)"Targeted testing""Treatment based on findings"Trichomoniasis partner treatment, EPT and retestProducts, abstinence, condomsReturn precautions in the templateitching or burninga strong odorgreen or gray dischargepelvic painfeverSourcesPediatric Care Online: Vaginal DischargeRed Book 2024-2027: Pinworm InfectionRed Book 2024-2027: Group A Streptococcal Infections