Abnormal vaginal discharge (bacterial vaginosis, candidiasis, trichomoniasis), including in pregnancy
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Abnormal discharge (outside pregnancy)
Vaginal sample (self-collection possible)
- Vaginal sample: direct examination (flora, yeasts, Trichomonas) and cultureif neededSevere or recurrent symptoms, failure of probabilistic treatment, Trichomonas seen on a cervical smear, partner with trichomoniasis [1]. The IUSTI even advises sampling every symptomatic woman when possible [1].
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR)if neededSexually active woman aged 15 to 25 years, or risk factor for STI: at least two partners in the year, recent change of partner, STI in the patient or her partner, history of STI, sex work, after rape [2].
- Multiplex NAAT (PCR) for Chlamydia, gonococcus and Mycoplasma genitalium (instead of the previous one if cervicitis)if neededAcute cervicitis on speculum examination (inflamed cervix, mucopurulent discharge, contact bleeding): the NABM reserves Mycoplasma genitalium for this indication [3]. See the page "Urethritis or cervicitis".
- Trichomonas vaginalis nucleic acid amplification test (not in the French laboratory fee schedule)if neededSuspected trichomoniasis (malodorous discharge, pH > 4.5, partner affected) with a negative direct examination: nucleic acid amplification is the most sensitive test [1], but it is not listed in the NABM; direct examination of the vaginal sample already looks for Trichomonas [3].
Laboratory tests
Do not order
- Vaginal sample in a woman without symptoms to look for vaginosis, candidiasis or aerobic vaginitis: pointless [1].
- Testing for urogenital mycoplasmas (Mycoplasma hominis, Ureaplasma) in a symptomatic or asymptomatic woman: not recommended, they are commensals and not STI agents [4,11]; NABM 105 no longer includes a culture code for urogenital mycoplasmas [3], whose removal HAS had relayed [12].
- Testing for Mycoplasma genitalium without cervicitis or symptoms: not recommended [4]; the NABM excludes it from screening [3].
- "Standard" vaginal culture to make a diagnosis: group B streptococcus, E. coli or staphylococcus on culture does not indicate vaginitis [1], and vaginosis is diagnosed on Gram stain, not on culture [1].
- Chlamydia serology: always pointless, except in upper genital tract infection when no sample is possible [2].
- Follow-up sample after treatment of vaginosis, candidiasis or trichomoniasis in a woman who has become asymptomatic [1].
Recurrent candidiasis or bacterial vaginosis
Vaginal sample (during an episode, before treatment)
- Vaginal sample: direct examination and culture with identification of the yeast species
Laboratory tests
- Fasting plasma glucose (recurrent candidiasis)if neededRecurrent candidiasis (at least 4 episodes per year): exclude diabetes [1].
- HIV serology (recurrent candidiasis with a risk factor)if neededRecurrent candidiasis: exclude underlying immunosuppression [1].
- FBCif needednon-French guidelineBASHH (UK, 2019) considers this test in recurrent candidiasis, especially if there are other warning signs (grade 2C), while noting that the link between iron deficiency and recurrence remains uncertain [13]. IUSTI does not mention it [1].
- Serum ferritinif needednon-French guidelineBASHH (UK, 2019) considers this test in recurrent candidiasis, especially if there are other warning signs (grade 2C), while noting that the link between iron deficiency and recurrence remains uncertain [13]. IUSTI does not mention it [1].
Do not order
- Tests of an asymptomatic male partner in recurrent candidiasis or vaginosis: neither screening nor treatment [1].
During pregnancy
Vaginal sample
- Vaginal sample: direct examination and cultureif neededAbnormal discharge or symptoms during pregnancy [1]; history of spontaneous preterm delivery or 2nd-trimester miscarriage (looking for vaginosis, to be treated even without symptoms) according to the IUSTI [1]; the CNGOF reserves this screening for a history of preterm delivery with maternofetal bacterial infection [14].
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) (under 25 years, in the 1st trimester)if neededRoutine Chlamydia screening in the 1st trimester in pregnant women under 25 years [2].
One month after treatment of vaginosis
- Repeat vaginal sampleif neededVaginosis treated during pregnancy to reduce the risk of preterm delivery: check at one month, and treat again if it has recurred [1].
Do not order
Sources (17)
- Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS. 2018;29(13):1258-72.
- Haute Autorité de santé, Conseil national du sida et des hépatites virales, ANRS-MIE. Traitement curatif des personnes infectées par Chlamydia trachomatis. Recommandation de bonne pratique, avril 2025.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : dispositions générales des examens microbiologiques, actes 5202 (prélèvement génital féminin), 5304 et 5305 (amplification génique Chlamydia, gonocoque, Mycoplasma genitalium), 1307 (sérologie Chlamydia), 0252 (identification d'une levure autre que C. albicans).
- Haute Autorité de santé, Conseil national du sida et des hépatites virales, ANRS-MIE. Traitement curatif des personnes infectées par Mycoplasma genitalium. Recommandation de bonne pratique, avril 2025.
- Sherrard J, Pitt R, Hobbs KR, et al. British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021. Int J STD AIDS. 2022;33(8):740-750.
- ASHM. Australian STI Management Guidelines for Use in Primary Care : pages Trichomoniasis, Vaginal discharge, Bacterial vaginosis et Candidiasis (consultées le 30/10/2026).
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021 (Centers for Disease Control and Prevention). MMWR Recomm Rep. 2021;70(4):1-187.
- Geer K, Klega A. Vaginitis: Diagnosis and Treatment. Am Fam Physician. 2025;112(5):504-512.
- British Association for Sexual Health and HIV (BASHH), Bacterial Special Interest Group. Position statement on the inappropriate use of multiplex testing platforms, and suboptimal antibiotic treatment regimens for bacterial sexually transmitted infections.
- US Preventive Services Task Force, Davidson KW, et al. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(10):949-956.
- Horner P, Donders G, Cusini M, Gomberg M, Jensen JS, Unemo M. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? A position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatol Venereol. 2018;32(11):1845-51.
- Haute Autorité de santé. Diagnostic biologique des mycoplasmes urogénitaux dans les infections génitales basses. Rapport d'évaluation technologique, juillet 2022, actualisé en avril 2025.
- Saxon C, Edwards A, Rautemaa-Richardson R, et al. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS. 2020;31(12):1124-1144.
- Sentilhes L, Sénat MV, Ancel PY, et al. Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2017;210:217-24.
- US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;323(13):1286-92.
- Bretelle F, Loubière S, Desbriere R, et al. Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial. JAMA Pediatr. 2023;177(9):894-902.
- National Institute for Health and Care Excellence. Antenatal care. NICE guideline NG201, 19 août 2021 (recommandations 1.4.10 à 1.4.14 et justification).