26 - Vaginal Discharge

Question 1

Vaginal discharge benefits:

Answer 1

1– maintain the vagina ph
2– lubricant for sex
3– protective for infections

Question 2

CCC of Normal vagina discharge:

Answer 2

4 ml per day
White to transparent
Thick to thin in consistency
Odorless

Question 3

Components of vagina discharge:

Answer 3

Desquamated epithelial cells
Mucus
Bacteria
Transudate
Protein, amino acid, enzymes and polysaccharide

Question 4

Vaginitis VS vaginosis:

Answer 4

— High Number of leukocytes and associated with Candida and trichomonas Infections

— Few leukocytes and associated with bacterial infection

Question 5

Vagina investigation:

Answer 5

Nitrazine paper for ph
Wet preparation (Microscopic examination of the discharge)
Potassium hydroxide preparation (cellular debris)
Whiff test (for the odor)
Culture

Question 6

Infective causes of vaginal discharge is either; Non sexually transmitted infections VS sexually transmitted infections:

Answer 6

— Bacterial vaginosis and Candida vaginitis

— N gonorrhea, syphilis, HPV, HIV, chlamydia trachomatis, trichomonas vaginitis

Question 7

Non infectious causes of vaginal discharge:

Answer 7

— foreign bodies, dermatitis and fistula or polyps

—Physiological Like menstrual cycle pregnancy and sexual excitement

Question 8

Bacterial vaginosis causes:

Answer 8

Oral sex
Douching
Sexy during menses
Intrauterine devices
New or multiple sexual partners
And mostly or involve women without Previous sexual experiences

Question 9

Bacterial vaginosis diagnosis:

Answer 9

Amsel criteria: 3 out of 4 confirms the diagnosis:
Homogenous and gray discharge adhering to the vagina walls
Fishy odor with the whiff test
Ph >4.5
Clue cells on wet preparation

Question 10

Bacterial vaginosis management:

Answer 10

— topical or oral preparation: Clindamycin or metronidazole

Question 11

Most common causative agent of Candidal vaginitis:

Answer 11

Candida albicans/tropicalis/glabrata

Question 12

Risk factors for Candida vaginitis:

Answer 12

DM
Chronic usage of antibiotics (by decreasing the lactobacilli concentration)
Contraceptives

Question 13

Clinical pictures of Candida vaginitis:

Answer 13

Itchy and burning vagina or vulva + dyspareunia

Question 14

Candida vaginitis discharge and in physical examination:

Answer 14

—Whitish with thin or curd consistency aka cottage cheese like discharge

— erythema and satellite’s lesions

Note: Candida tropicalis/glabrata are associate with white-gray and thin discharge

Question 15

Candida Vaginitis investigations:

Answer 15

1– Ph is normal

2– On wet examination: hyphae or psudohyphae with budding yeast

Question 16

Candida vaginitis management:

Answer 16

1– Topical:
Butaconazole, Clotimazole, Miconazole

2– oral agents:
Fluconazole (For uncomplicated vaginal Candida) or ketoconazole (For Chronic and recurrent Candida)
And both may cause hepatotoxicity