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40 Cards in this Set
- Front
- Back
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Name some infectious causes of vaginal discharge? |
Bacterial Vaginosis Candidiasis Trichomoniasis Atrophic vaginitis with secondary bacterial infection Foreign body with secondary bacterial infection |
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Name some non-infectious causes of vaginal discharge? |
Chemical Allergic Traumatic Atrophic vaginitis Foreign Body |
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How do we classify vaginal discharge? |
Diffuse: - Physiological, infectious, atrophic, irritants and allergens Localized: - foreign body, fistula, neoplasm |
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What history would you take in a patient with discharge? |
Type: - offensive, associated itching or dispareunia, associated with menstrual cycle Reproductive stage of the patient Sexually active? Partner symptoms? Personal habits Medication use |
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How would you examine a patient with discharge? |
Temperature, pulse, lymph nodes, peritonism, abdominal tenderness Gynaecological exam: - vulva: rash, ulcers, atrophy - vaginal speculum to determine origin - cervix: signs of inflammation, smear - adnexae: masses, tenderness |
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What side room investigations are done for a patient with discharge? |
pH Whiff test Wet smear microscopy: - 10% KOH - saline |
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What laboratory tests are done for a patient with discharge? |
Cervical smear Endocervical smear for gonorrhoea and chlamydia RPR HIV |
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How does physiological discharge present? |
fluctuates with menstrual cycle clear or white Whiff test negative Not irritating or itching Epithelial cells with Lactobacilli on smear |
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What are the causes of physiological discharge? |
Endocervical mucus, exfoliated epithelial cells and vaginal transudate Amount increases due to oestrogen Lactobacilli |
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How do we manage endocervical discharge? |
Reassure NB - do not treat |
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What are the functions of Lactobacilli? |
Produces hydrogen peroxide and lactic acid Maintains low pH Keep the vagina clean Protects against vaginal infections |
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How does atrophic vaginitis present? |
Postmenopausal Genital atrophy Wet smear - epithelial and pus cells - no Lactibacilli |
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What causes atrophic vaginitis? |
Decreased oestrogen leads to decreased glycogen which reduces Lactobacilli This leads to secondary bacterial invasion |
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How do we manage atrophic vaginitis? |
Cervical smear Consider endometrial biopsy Local or systemic oestrogen therapy NO antibiotics |
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What organisms can cause infectious bacterial vaginitis? |
Trichomonas vaginalis Candida Bacerial vaginoses |
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Which organisms cause endocervitis? |
Neisseria gonorrhoea Chlamydia trachomatis |
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How does trichomonas vaginalis present? |
Malodorous discharge Pain, dyspareunia, dysuria and frequency Profuse grey-white to yellow-green discharge, can contain bubbles pH >5 red vagina and cervix, oedomatous |
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How is trichomonas vaginalis diagnosed? |
Wet smear mount -organism visualised |
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How is trichomonas vaginalis treated? |
Metronidazole 2g stat per os - avoid alcohol - treat partner as well Counsel about risks of other STDs RPR and HIV Condom use |
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How does gonorrhoea present? |
purulent discharge intermenstrual or post coital bleeding yellow/white discharge from male partner |
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How is gonorrhoea diagnosed? |
Wet smear - Inclusions |
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How is gonorrhoea managed? |
First line treatment: - cefixime 400 mg single oral dose or - ceftriaxone 250 mg single IMI dose Mild/non-threatening penicillin allergy: - cefixime or ceftriaxone Serious penicillin allergy: - Azithromycin 2g single oral dose (1st choice) - Gentamycin 240 mg single IMI dose (2nd choice) Add doxycycline or azithromycin to cover for chlamydia |
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How does Candida present? |
White discharge Thin to thick cheesy apearance Vulvar pruritis Vulvar and vaginal redness pH <5 |
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How is Candida diagnosed? |
Wet mount - KOH preparation |
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How is Candida treated? |
Anti-fungal preparations: - Clotrimazole, miconazole or econazole pv - Fluconazole orally Avoid irritants Rule out immunosupression when recurrent |
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What causes bacterial vaginosis |
Complex change in the vaginal flora - concentration of Lactobacilli decreases - increase in concentration of other organisms, especially gram negative rods The mechanism by which the imbalance occurs and the role of sexual activity unclear |
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What organisms are commonly found in bacterial vaginosis? |
Gardnerella vaginalis, Prevotella species,Porphyromonas species, Bacteroidesspecies, Peptostreptococcus species,Mycoplasma hominis, Ureaplasmaurealyticum, and Mobiluncus species
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How does bacterial vaginosis present? |
75% asymptomatic - only symptomatic when mixed viginitis present Thin malodorous discharge White to grey Positive Whiff test pH >5 Usually no vaginal or vulvar redness |
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What are the Amsel Criteria? |
Fishy discharge pH >4.5 Clue cells on wet mount Positive amine test |
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How is bacterial vaginosis diagnosed? |
Amsel criteria (not all are always met) Gram stain = gold standard Cytology not reliable No place for culture Presence of clue cells on wet mount = most reliable predictor (>90%) |
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How is bacterial vaginosis treated? |
Metronidazole orally x 7 days or topical x5days Klindamycin cream x 7 days – weakenscondoms
No difference if partner is treated |
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What is the role of Bacterial vaginosis in pregnancy |
Associated with adverse pregnancy outcome: - PPROM - Prematurity - Postpartum endometriosis Treat symptomatic as well asasymptomatic pregnant patients Metronidazole 400mg tds for 7 days |
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What is the role of Gardnerella in Bacterial Vaginosis? |
Gardnerella vaginalis culture positive inmost women with symptomatic infection
– detected in 50 to 60 % of healthyasymptomatic women – Presence of GV alone is not diagnostic ofBV |
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How does a patient with foreign body causing discharge present? |
Watery and profuse Malodorous Foreign body visible on examination History not always reliable |
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How is foreign body causing discharge managed? |
Removal Antibiotics not necessary |
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How does irritants or allergen causing discharge present? |
History of use of possible irritants
– Soaps, lubricants, spermicides, perfumedtoilet paper, other feminine hygienicproducts Discharge not very prominent Vulva and vagina inflamed and red Whiff test negative Wet smear normal |
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How is irritant and allergen causing discharge treated? |
Identify and avoid culprit
1% hydrocortisone cream bd for 7days |
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How does neoplasia causing discharge present? |
Discharge can be post-coital
Poor response to other therapies Watery, malodorous, can be bloody orany other color |
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How is neoplasia causing discharge treated? |
Smear if cervix normal Biopsy if suspicious lesions Treat cause |
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What is the role of fistulas in discharge? |
Causes– Obstetric trauma, malignancy, surgery,irradiation
Incontinence of stool or urine Usually identified at examination Refer for management |
