Abnormal Vaginal Discharge(AVD) Flashcards
What is vaginal discharge and which hormone is it under the influence of?
Vaginal discharge is fluid/mucus that keeps the vagina moist, clean, lubricated and acts as a defense mechanism-normal.
Estrogen
How are the causes of abnormal vaginal discharge grouped?
Infectious or Non infectious
What are the infectious causes of vaginal discharge?
Vaginal :Bacterial Vaginosis, Candida Albicans and Trichomonas Vaginosis
Cervical: Neisseria gonorrhea, Chlamydia Trachomatis ,Herpes Simplex Virus
What are the non-infectious causes of vaginal discharge? And explain them.
-Physiological changes: atrophic vaginitis (menopausal changes), postpartum (e.g. RPOC).
-Mechanical/chemical irritation: —Foreign Bodies, IUCD, douching, hygiene products, contact dermatitis.
-Malignancy and structural abnormalities: endometrial and cervical cancer, polyps, fistulas.
-Systemic: diabetes mellitus, psoriasis, dermatitis
What is the approach taken for a patient with AVD?
-A good gynecological history, physical exam and laboratory diagnosis
What are the Risk Factors of AVD?
Douching
Multiple sexual partners
Poor hygiene practices
Systemic conditions
Antibiotic/Oral contraceptive use
What are some of the important his history taking points to pay attention to in a patient with AVD? And explain why?
Age, LNMP, period cycle(regularity and timing of cycle)
Hormone status(Pre- or postmenopausal)
Birth control methods.
Pregnancy
Duration (acute, chronic ,frequently recurrent)
Pruritus, dysuria(external or internal),Dyspareunia
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 kind of physical exam in a patient who presents with AVD?
Systemic signs of illness: fever, nutritional status, stigmata of systemic disease, abdominal pain.
Vaginal examination: discharge, herpetic vesicles, contact dermatitis, bimanual palpation may reveal cervical motion tenderness.
Speculum: visualization of cervix: strawberry cervix, collection of a sample, friability or easy bleeding, erythema of the vaginal walls/cervix.
What is the most infectious cause of AVD?
Bacterial Vaginosis
What is the causative agent of BV? And how?
Gardnerella Vaginalis
Occurs when there an alteration of normal vaginal flora resulting in leading to overgrowth of organisms
What are the risk factors of BV?
Douching, Antibiotic use and low estrogen levels
What are the general symtoms of BV?
Increased discharge-gray and milky
Fishy odor
How do you diagnose BV?
Diagnosis is confirmed if 3/4 of the Amsel criteria is met.
-pH of > 4.5
-Clue cells
-Grey/white discharge that adheres to vaginal walls
-A positive whiff/amine test
Describe the Amine /Whiff test?
1-2 drops of potassium hydroxide is added to a sample of infected vaginal discharge and emit a characteristic amine odor
Treatment for BV?
Metronidazole.
Which fungus causes Vulvoaginal Candidiasis?
Candida Albicans
Presentation of Candida Albicans?
Presents with discharge, vaginal burning sensation, strong pruritus, dysuria, dyspareunia.
What is seen on the physical exam in the case of VVC?
Thick, white curd like discharge (cottage cheese),Erythematous vagina and labia.
What investigations are done in VVC and what is seen?
-A vaginal wet mount with potassium hydroxide(Pseudohyphae seen)
-pH-remains with the normal range
What treatment is used in VVC?
-topical antifungals, cotrimazole pessaries , fluconazole
-Use topical azoles and not oral azoles in pregnant women
Risk factors of VVC?
-Pregnancy
-Systemic illness(DM)
-Use of antibiotics
What causes trichomoniasis?
Trichomonas Vaginalis
How does trichomoniasis present/symptoms?
Foul- smelling discharge(frothy),vulvovaginal pruritus, burning sensation, dyspareunia and dysuria
What are the signs of Trichomoniasis?
yellow-green purulent discharge, endocervix that easily bleeds(erythematous mucosa that easily bleeds), strawberry cervix
What investigations are done in Trchomoniasis?
-Saline vaginal wet mount(Motile trophozoites with multiple flagella)
-pH (>4.5), culture.
If the wet mount is inconclusive do a culture
What is the treatment for Tricho?
Treatment: of both partners, with metronidazole. Consider empiric treatment of other STIs.
Women + their partners with TV should be told to abstain from sexual intercourse until treatment is completed and symptoms have resolved, as it is sexually transmissible.
What is the cause of gonorrhea?
Neisseria gonorrhoea
What are the signs and symptoms of Gonorrhea?
Presents with thin, purulent, malodorous AVD, intermenstrual bleeding, dysuria, dyspareunia.
Signs: mucopurulent discharge(yellow-green, possibly blood tinged) friable cervix, vaginal bleeding, signs of PID.
What investigations are done for gonorrhea? And when is it done?
NAAT, blood cultures for disseminated disease NAAT-Nucleic acid Amplification test- is A vaginal swab of the affected site is taken
In the case that NAAT is unavailable or for antibiotic sensitivity testing in the case of (treatement failure, complicated infections aucg PID or DGI.
What treatment id offered in gonorrhea?
Ceftriaxone + azithromycin/Doxycycline
Which serovars of chlamydia trachomatis causes Chlamydia?
Serovars D-K
What are the signs and symptoms of Chlamydia?
Presents with white/yellow, mucopurulent discharge, AVB, dysuria, dyspareunia, postcoital bleeding
Signs: discharge, cervical friability, adnexal tenderness(PID)
What are the investigations done in Chlamydia?
nucleic acid amplification test, serology, cytology and culture.
Treatment of chlamydia?
Doxycycline, azithromycin.
What is the cause of genital herpes?
HSV-1 and HSV-2
How does genital herpes present?
-Presentation depends on the designation of the infection i.e. primary or recurrent.
-Skin lesions may be present in both(Prodromal symptoms of redness, swelling , tingling, pain pruritus)
-Primary Infection : white thick and/or foul-smelling vaginal discharge
-May have lesions at different stages of resolution e.g. vesicles/ulcers, inflamed vaginal mucosa, cervical involvement, vaginal discharge (thick, white, cloudy and may have a pungent smell).
What investigations are done in Genital herpes?
Serological test, PCR and viral culture
Treatment for Genital Herpes?
Antiviral such as Acylovir
What are the complications of AVD?
any woman:
PID
Ectopic pregnancy
Tuboovarian abscess
In pregnant women:
Premature rupture of membranes
Low birth weight
Vertical transmission of infection
Post partum endometritis
Chorioamnionitis
Post caesarean wound infection
Miscarriages
