When should I consider referring a patient with vaginal discharge for specialist assessment?

Consider referring a patient with vaginal discharge for specialist assessment if:

• The vaginal discharge is unexplained in women aged 55 and over, especially if it is a first presentation or associated with thrombocytosis or haematuria; in this case, consider a direct access ultrasound scan to assess for endometrial cancer and refer accordingly if indicated.
• There is an unexplained and palpable vaginal mass in or at the entrance to the vagina, which warrants a suspected cancer pathway referral.
• The vaginal discharge in a pregnant woman is accompanied by symptoms such as itching, soreness, an unpleasant smell, or pain on passing urine, suggesting infection that requires investigation and possible referral.
• A sexually transmitted infection is suspected as the cause of vaginal discharge, prompting appropriate investigations and possible specialist referral.

In other cases, if symptoms persist, worsen, or are associated with other concerning features, consider specialist assessment based on clinical judgment.

References: NICE NG12,NICE NG201