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49 Cards in this Set
- Front
- Back
DDx vaginal discharge |
normal discharge vaginitis infective or chemical STIs UTIs |
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2 most common causes of dishcarge |
physiological and infective |
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Physiological discharge |
milky white or clear mucoid no odur no puritis egg white during ovulation normal discharge usually shows on underclothing by the end of the day and clear white it oxidises to yellow, borwn on contact with air and is increased by sexual stimulation |
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Normal vaginal flora |
Lactobacilli that produce lactic acid from glucose in epithieal cells that make the pH <4.7 - stap, deptheroids, strep
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Mx of physiological discharge |
reassurance and explanation • wear cotton underwear (not synthetic) |
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Commonest cause of infective vaginitis |
1. bacterial vaginosis (bacterial vaginitis, garderella vaginalis, haemophilus vaginalis) 40-50% of cases 2. 20-30% Candida albicans 3. Trichomonas vaginalis 20% |
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Serious disorders not to be missed |
cancer of the |
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Watery pink or blood stained discharge |
benign or malignant neoplasm anywhere in the gential tract |
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Probability diagnosis |
A. Normal physiological discharge |
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Q. Serious disorders not to be missed |
Neoplasia: |
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Q. Pitfalls (often missed) |
A. Chemical vaginitis (e.g. perfumes) |
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Seven masquerades checklist |
Depression |
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Psychogenic considerations |
Needs careful consideration; possible sexual |
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History of vaginal discharge |
• nature of discharge: colour, odour, quantity, relation to |
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Examination |
- Sims speculum sterile wabs (slides and cover slips) inspect vulva, introitus, urethra, vagina, cervix looking for dicharge, polyps, warts, prolapse, fistulas DDx vaginal and cervical discharge wipe the cervix clean with a cotton ball and observe the cervix, a mucopurlent discharge appearing from endometrium is a clue of Chlamydia and gonorrhoea ph test wet film |
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Pitfalls on physical Exam |
• The patient may have had a bath or a ‘good wash’ |
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Investigating discharge |
• pH test with paper of range 4 to 6 |
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A full STI work-up |
• First-pass urine and ThinPrep samples—for Chlamydia |
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Preparing a wet film |
To make a wet fi lm preparation2 (see Fig. 98.1), place |
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Cells on wet film |
Lactobacilli |
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Vaginal Discharge in children |
Most newborn girls have some mucoid white vaginal |
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Most common gynaecological disorder of childhood |
vulvovaginitis (non-specific bacterial infections) |
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Vaginal discharge in the elderly causes |
infective vaginitis, atrophic vaginitis, foreign bodies, poor hygiene and neoplasia. |
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Atrophic vaginitis |
In the absence of oestrogen stimulation the vaginal and |
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Treating atrophic vaginitis |
local oestrogen cream or tablet (e.g. Vagifem). The tablet is preferred as it is less messy |
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Vaginal candidiasis |
common |
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Clincal features of vaginal candidiasis |
• Intense vaginal and vulval pruritus |
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FActors predisposing to vaginal candidiasis |
Endogenous |
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Treating Vaginal Candidiasis |
For the fi rst attack of candidiasis it is appropriate -Nystatin reserved for recurrent cases or if there is local reaction to imidazoles - CREAM preferred (tablet and cream can be combined in severe infection) - gentian violet (-0.5% aqueous solution) is useful for rapid relief if available |
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Sx's in a male |
A male sexual partner does not usually require |
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Recalcitrant cases (proven by microscopy and if |
Recalcitrant cases (proven by microscopy and if |
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Recommended intial regimen for candiadiasis |
clotrimazole 500 mg vaginal tablet as a single dose or |
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Candida (Torulopsis) glabrata |
A signifi cant number of cases of recurrent vulvovaginal |
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Advice to patients with vaginal candidiasis |
• Bathe the genital area gently two or three times a day for symptomatic relief. In preparing for the antifungal preparation, use 1–3% acetic acid or sodium bicarbonate solution (1 tablespoon to 1 litre of water). Thoroughly cleanse the vagina, including recesses • Avoid wearing pantyhose, tight jeans or tight |
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Trichomonas vaginalis |
fl agellated protozoan, which is thought to originate |
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Clinical features of trichomonas vaginalis |
• Profuse, thin discharge (grey to yellow–green in colour) |
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Trichomonas vaginalis treatment |
oral metronidazole 2 g as a single dose (preferable) or 400 mg bd for 5 days (if relapse) or
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Bacterial vaginosis |
clinical entity of mixed aetiology |
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Bacterial vaginosis Clinical features |
• A grey, watery, profuse discharge (see Fig. 98.5) |
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Bacterial vaginosis Treatment |
metronidazole 400 mg (o) bd for 5 days or 2 g stat |
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Group B Streptococcus vaginosis |
Group B Streptococcus (Streptococcus agalactiae) is |
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Group B Streptococcus vaginosis pregnant women treatment |
It is a |
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Group B Streptococcus vaginosis non-pregnant women treatment |
In the non-pregnant woman give amoxycillin |
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Retained vaginal tampon |
A retained tampon, which may be impacted and cannot |
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Methods of removal |
Using good vision the tampon is seized with a pair of sponge-holding forceps and quickly immersed under water without releasing the forceps. A bowl of water (an old plastic ice-cream container is suitable) is kept as close to the introitus as possible. This results in minimal malodour. The tampon and water are immediately fl ushed down the toilet if the toilet system can accommodate tampons. An alternative method is to grasp the tampon with a gloved hand and quickly peel the glove over the tampon for disposal. |
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Tampon toxic shock syndrome: |
This rare, dramatic condition is caused by the production |
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Tampon toxic shock syndrome: Managment |
Active treatment depends on the severity of the illness. |
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Tampon toxic shock syndrome: Prevention |
• Good general hygiene with care in handling and |
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When to refer discharge |
• Evidence of sexual abuse in children to an experienced |