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  7. Vaginal Discharge Management (317)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Vaginal Discharge Management (317)

Please report any inaccuracies or issues with this guideline using our online form

Recurrent symptoms, symptoms of PID, postpartum or post abortion, post gynaecological instrumentation or pregnant

Offer face to face appointment in an appropriate clinic, i.e TOPAR/ GU Complex / Urgent Care or in the case of post partum infection refer back to Obstetric services.

Investigations

  • Examination and pH
  • Microscopy (*dry slide for Gram staining and **wet prep)
  • Endocervical GC culture (if plates available)
  • High Vaginal Swab (⁂HVS) if recurrent or persistent
  • Vulvovaginal CT/GC NAAT

Management of results (please refer to appropriate guidelines)

  • Trichomonas Vaginalis (TV) seen – TV
  • pH >4.5 +/- Clue cells and abnormal flora – BV
  • pH <4.5 +/- Yeast cells – Candida
  • Gram Negative Diplococci (GNDC) seen – GC
  • High AV score: discuss with senior

*Dry slide (vaginal and cervix) for Gram stain.
**Wet prep taken from the vaginal posterior fornix. Connect a HVS is taken using a charcoal swab for wet prep.
⁂ HVS – taken from lateral vaginal wall. Stored at 4°C for maximum 48 hours.

Microscopy venue: Sandyford Central.
CONNECT: If microscopy requested please leave the registration form of client with the Connect nurse to follow up client with result.

Aerobic Vaginitis (AV)

Defined as “Disruption of the lactobacillary (LB) flora, accompanied by signs of inflammation and the presence of predominantly aerobic microflora composed of enteric commensals or pathogens.”

Vaginal Flora Grade – Modified Hay-Ison Score

Grade

Description

0

No flora

I

Normal vaginal flora (LB alone)

II

Mixed

III

Abnormal

IV

Gram positive cocci only

AV Donder’s Score

This is calculated from a WET film. Not all people who can read slides are trained to do this assessment please confirm on the day. It is based on the following criteria, each given a score from 0-2.

  1. Lactobacillary (LB) flora
  2. Number of leucocytes
  3. Proportion of toxic leucocytes
  4. Background flora
  5. Proportion of parabasal cells (epithelial damage)

Severity

  • Mild 1-4
  • Moderate 5-6
  • Severe 7-10
  • Scores above 5-6 (moderate) or 7 or higher (severe) require clinician to consider AV as well as other causes for an inflammatory vaginitis, including TV and Group A streptococcus.
  • Always take a HVS culture swab (self-taken is fine) if moderate or high AV score.
  • No clear evidence base for treatment. Discuss with senior clinician. Consider using clindamycin vaginal cream (covers aerobic organisms) instead of metronidazole

Advice on vaginal health

Advice should be given to the client that some factors may affect normal vaginal health causing a disruption to the normal flora and pH.

Some causes of irritation include:

  • Antibiotics
  • Some types of clothing (tightly fitted/synthetic material)
  • Over-washing/bathing douching or the use of shower gels or antiseptic agents, bath oils
  • Avoid using feminine hygiene sprays, perfumes or wipes
  • Avoid using daily pads or fragranced sanitary products
  • Avoid use of flavoured/coloured condoms or lubricant
  • Avoid using fabric conditioner and biological washing powder

Advise to wash with water or a soap substitute. Offer and prescribe soap substitutes such as aqueous cream or emulsifying ointments.

Consider providing a Sandyford genital skin information leaflet via SMS

Editorial Information

Last reviewed: 04/03/2024

Next review date: 31/03/2025

Author(s): Kay McAllister.

Version: 5

Approved By: Gynaecology Clinical Governance Group

Document Id: 317

References

BASHH CEG UK National Guideline on the Management of Bacterial Vaginosis 2012  [accessed Mar 2022]
Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy. BJOG 2011. DOI: 10.1111/j,1471-0528.2011.03020.x. [accessed Mar 2022]
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 Nov;29(13):1258-1272. doi: 10.1177/0956462418785451. Epub 2018 Jul 27. PMID: 30049258