Abnormal vaginal discharge.

Speculum examination to inspect vaginal walls, cervix, and characteristics of discharge. Although not mandatory, vaginal pH can be checked by using a swab to collect discharge from the lateral vaginal wall and rubbing on to narrow range pH paper. This can help discriminate between bacterial vaginosis, trichomoniasis, and candidiasis. Take endocervical swabs if there is risk of sexually transmitted infection and send off for nucleic acid amplification testing. High vaginal swabs are of limited diagnostic value except in pregnancy, post-instrumentation, failed treatment, recurrent symptoms, or to confirm candidiasis. This can also be an opportunity to carry out cervical screening.