1)      Elderly (pelvic exam and speculum exam of cervix indicated, unhealthy cervix requires referral)

2)      High risk of STI - < 25 hrs, change in the sexual partner last year, more than 1 sexual partner

3)      Upper reproductive tract infections – as suggested by pain, dyspareunia, bleeding,

4)      Treatment failure

5)      Postnatal discharge

6)      Post-miscarriage or post-abortion discharge

7)      Within 3 weeks of IUCD insertion

8)      Change in color, odor, consistency, or quantity – signifies a pathological discharge

9)      Prepubertal child with vaginal discharge – sexual abuse

10)    Unexplained persistent vaginal discharge – gyn referral for further  evaluation indicated