Abnormal vaginal discharge Flashcards
what is vaginal discharge
is fluid/mucus that keeps the vagina moist, clean, lubricated and acts as a defense mechanism-normal.
what characterizes abnormal vaginal discharge
by a change in colour, consistency, volume or odor, and may be associated with symptoms such as itch, soreness, dysuria, pelvic pain, intermenstrual bleeding or postcoital bleeding.
what is the most prevalent microbiological cause of abnormal vaginal discharge
bacterial vaginosis
what are infectious causes of abnormal vaginal discharge (6)
Vaginal:
1. bacterial vaginosis
2. candida albicans
3. trichomonas vaginosis
Cervical:
1. Neisseria gonorrhea
2. Chlamydia Trachomatis
3. Herpes Simplex Virus
what are non infectious causes of abnormal vaginal discharge (4)
- physiological changes
- atrophic vaginitis ( menopausal changes- the inflammation of the vagina as a result of tissue thinning due to low estrogen levels.)
- postpartum (RPOC- Can result in the inflammation of the endometrium, increasing the risk of infection. An infected uterus may produce purulent(pus-filled),foul-smelling vaginal discharge.) - Mechanical/chemical irritation
- Foreign Bodies
- IUCD
- douching
- hygiene products
- contact dermatitis. - Malignancy and structural abnormalities:
- endometrial and cervical cancer
- polyps
- fistulas. - Systemic:
- diabetes mellitus ( High sugar levels creates an environment that supports the overgrowth of Candida. It can also affect vaginal pH making it more alkaline vaginal environment reducing the number of beneficial bacteria (Lactobacillus) allowing yeast to grow.)
- psoriasis ( there is inflamed and broken skin which may become a site for secondary bacteria or fungal infections which could cause discharge if the infection spreads to the vaginal area.)
- dermatitis
what are risk factors for AVD (5)
- Douching
- Multiple sexual partners
- Poor hygiene practices
- Systemic conditions
- Antibiotic/Oral contraceptive use
what things should you ask in a history for AVD
- Age, LNMP, period cycle(regularity and timing of cycle)- provide essential information that helps differentiate between physiological variations and potential pathological causes of AVD.
- Hormone status(Pre- or postmenopausal) - Postmenopausal women are less likely to have yeast and more likely to have noninfectious cause. Postmenopausal women with atrophic vaginal mucosa may develop a watery, irritating, sometimes malodorous discharge secondary to local irritation, especially from intercourse.
- Birth control methods and Pregnancy - predispose to yeast infections( Estrogen levels increase glycogen levels in the vaginal cells, producing rich source of nutrients for the yeast to thrive)
- Duration (acute, chronic ,frequently recurrent)- bacterial vaginosis and yeast are often recurrent in some women,
-Discharges that patients claim “never go away” are likely to be bacterial vaginosis - Pruritus, dysuria(external or internal),Dyspareunia- internal dysuria is suggestive of diseases such as a UTI, Gonorrhea and Chlamydia…..External dysuria suggests vulvovaginal irritation with secondary burn from urine.
- Colour and consistency, odour
- Systemic symptoms e.g. Fever, abdominal pain
- Sexual history: number of partners, new partners, partner symptoms, Hx of STIs.
- Hygiene practices, recent medications (systemic or otherwise).
what things do you look for on physical exam for AVD (3)
- Systemic signs of illness:
- fever
- nutritional status ( can be a sign of malignancy
- stigmata of systemic disease
- abdominal pain. - Vaginal examination:
- discharge
- herpetic vesicles
- contact dermatitis
- bimanual palpation may reveal cervical motion tenderness. - Speculum: visualisation of cervix:
- strawberry cervix
- collection of a sample
- friability or easy bleeding
- erythema of the vaginal walls/cervix.
what causes bacterial vaginosis
when there an alteration of normal vaginal flora resulting in leading to overgrowth of organisms (Gardnerella Vaginalis, Mycoplasma Hominis, Mobiluncus species)
what are risk factors of bacterial vaginosis (3)
- douching
- antibiotic use
- decreased oestrogen levels- Glycogen causes the lining of the vagina to thicken and acts as the main form of sustenance for protective bacteria called lactobacilli. When there is less estrogen present,there is less glycogen, and therefore fewer lactobacilli to maintain a healthy vaginal pH and keep “bad” bacteria at bay
what are symptoms of BV(2)
- Normally asymptomatic
- increased discharge(usually gray or milky with fishy odour)
what do you use to diagnose BV
amsel criteria
what is needed in the amsel criteria (4)
- Vaginal pH >4.5
- thin homogenous grey/white discharge that adhere to vaginal walls
- Clue cells on microscopy
- positive amine/whiff test)
**3 out 4 are needed to confirm diagnosis
what is vulvovaginal candidiasis
A fungal infection caused by yeasts from the genus Candida, with albicans being the most common.
what are risk factors for vulvovaginal candidiasis (3)
- Pregnancy
- systemic illnesses(DM)
- use of antibiotics
how does someone with vulvovaginal candidiasis present (5)
- discharge
- vaginal burning sensation
- strong pruritus *
- dysuria
- dyspareunia.
what do you see on exam for someone with vulvovaginal candidiasis (2)
- Thick, white curd like discharge (cottage cheese)
- Erythematous vagina and labia.
what investigations are done for vulvovaginal candidiasis (2)
- microscopy(Pseudohyphae seen)
- pH is within normal range(4-4.5)
what is the rx for vulvovaginal candidiasis (3)
- topical antifungals
- clotrimazole pessaries
- fluconazole
what is trichomoniasis
its a STI caused by trichomonas vaginalis and usually comes with coinfection of other STIs.
how does trichomoniasis present (5)
- Foul- smelling discharge(frothy)
- vulvovaginal pruritus
- burning sensation
- dyspareunia
- dysuria
what are signs of trichomoniasis (3)
- yellow-green purulent discharge
- endocervix that easily bleeds(erythematous mucosa that easily bleeds)
- strawberry cervix.
what investigations do you do for trichomoniasis (3)
- Saline vaginal wet mount ( motile trophozoites with multiple flagella)
- pH (>4.5) ( protozoa grow well at pH of 6
- culture.
how do you treat trichomoniasis
both partners, with metronidazole. Consider empiric treatment of other STIs.
what causes gonorrhea
Neisseria gonorrhoea.
how does gonorrhea present (4)
1, thin, purulent, malodorous AVD
2. intermenstrual bleeding
3. dysuria
4. dyspareunia.
what are signs of gonorrhea
- mucopurulent discharge(yellow-green, possibly blood tinged)
- friable cervix
- vaginal bleeding
- signs of PID.
how can you investigate gonorrhea (2)
- NAAT
- blood cultures
what is the rx of gonorrhea
Ceftriaxone + azithromycin/Doxycycline + treatment of sexual partners.
what is chlamydia
STI caused by Chlamydia trachomatis, specifically serovars D-K
how does chlamydia present (4)
- white/yellow, mucopurulent discharge
- dysuria
- dyspareunia
- postcoital bleeding
what are signs of chlamydia (3)
- discharge
- cervical friability
- adnexal tenderness(PID)
what are the investigations for chlamydia (2)
- NAAT
- culture
what is the rx for chlamydia
Doxycycline, azithromycin.
what are complications of AVD in women (3)
NB: AVD isnt the cause but the underlying pathology is
- PID
- Ectopic pregnancy
- Tuboovarian abscess
in pregnant women what are the possible complications of AVD (7)
NB: AVD isnt the cause but the underlying pathology is
1. Premature rupture of membranes
2. Low birth weight
3. Vertical transmission of infection
4. Post partum endometritis
5. Chorioamnionitis
6. Post caesarean wound infection
7. Miscarriages
