Differential diagnosis |
Laboratory data |
Signs and symptoms |
Treatment |
Menses |
CBC count, urine hCG |
Cyclic bleeding every 21–35 d |
Iron therapy if indicated |
Dysfunctional uterine bleeding |
CBC count, urine hCG, endometrial biopsy if >35 yr, duration >6 mo |
Noncyclic bleeding; may have associated dysmenorrhea, fatigue, or dizziness |
Hormonal therapy if patient is hemodynamically stable; if hemodynamically unstable, transfuse as needed, IV estrogen or high-dose oral contraceptive pills |
Infection: gonorrhea/chlamydia cervicitis |
Cervical culture, wet prep |
Purulent vaginal discharge, possible spotting |
Ceftriaxone, 125 mg IM × 1; azithromycin, 1 g PO × 1 |
Trichomonas vaginitis |
Wet prep |
Yellow-green frothy vaginal discharge, possible spotting |
Metronidazole, 500 mg PO BID × 7 days or 2 g PO × 1 (if pregnant, defer treatment to second trimester) |
Sexual trauma |
Rape kit |
Vaginal bleeding and/or discharge |
Emergency contraception, prophylactic treatment for sexually transmitted diseases; if laceration, pack vagina, possible surgical repair |
Malignancy |
Endometrial biopsy, Pap smear, cervical biopsy |
Postmenopausal bleeding, postcoital bleeding, intermenstrual bleeding |
Refer to gynecologic oncologist |
BID, twice daily; CBC, complete blood cell; hCG, human chorionic gonadotropin; IM, intramuscular; IV, intravenous; PO, oral. |