Genital discharge Flashcards
Questions to ask regarding genital discharge
Consistency Volume Colour Blood Smell Duration Washing Abx use
Differentials for abnormal genital discharge
Chlamydia Gonorrhoea Trichomoniasis Bacterial vaginosis Mycoplasma genitalium
Cervical ectropion
Cervical neoplasm
Post menopausal vagintis
Associated female symptoms
Pelvic pain PCB IMB Itchiness Dyspareunia Rashes
Examination for female genital discharge
Inspect genitalia
Speculum
+/- Bimanual exam
When to do a bimanual exam
If there is lower abdominal pain or deep dyspareunia
Investigations for abnormal genital discharge
High vaginal swab - wet mount and garm stain for microscopy
Vulvovaginal swab - NAAT
What does a high vaginal swab detect
Trichomonas vaginalis
Gardenerella vaginalis
Candida
What does a vulvovaginal swab detect
Chlamydia trachomatis
Neisseria gonorrhoea
Candidiasis presenting complaint
Thick, white, cheese-like discharge
Itching and soreness
Candidiasis history
Antibiotic use Washing Steroid use Chemotherapy HIV Pregnancy DM Atopy
Investigations for candidiasis
high vaginal swabs - microscopy and culture
Microscopy of candida albicans
Spores
Psuedohyphae
Neutrophils
Treatment of candida albicans
Fluconazole orally stat
+ clotrimazole cream BDS for 2 weeks
Contrainidcations for fluconazole
Pregnancy and breastfeeding
Treatment for recurrent candida albicans
Fluconazole every 72 hours for 3 doses
then
Fluconazole once per week for 6 months
Advice for candidiasis
Good diabetes control
Avoid perfumed products
Do not over wash
May swap to POP
Bacterial vaginosis presenting complaint
Copious discharge
Fishy odour
White
Amsel criteria for bacterial vaginosis
- Discharge
- Clue cells on wet mount
- Raised pH
- KOH whiff test +ve
Microscopy for Gardenerella vaginalis
Gram positive cocci
Hay Ison criteria for bacterial vaginalis
Gram stain of posterior fornix
Bacterial vaginalis history
Antibiotic use Washing Steroid use Chemotherapy HIV Pregnancy
Treatment of bacterial vaginalis
Metronidazole BDS 5 days
Bacterial vaginalis
Treat even if asymptomatic
Avoid high dose metronidazole
Trichomonas vaginalis presenting complaint in females
Frothy discharge
Dysuria
Vulval soreness
Itching
Sign of trichomoniasis
Strawberry cervix
Trichomonas vaginalis presenting complaint in males
Non-specific urethritis
Complications of trichomoniasis
Pre term
Low birth weight
Enhanced HIV transmission
Investigations for trichomoniasis
High vaginal swab - wet mount, gram stain microscopy and culture
Speculum
NAAT from first void urine sample
Treatment of trichomoniasis
Metronidazole BD 5 - 7 days - first line
Metronidazole 2g PO stat - 2nd line
Associated male symptoms
Testicular pain Anal pain Swellings Lumps Dysuria Urinary symptoms
What does polymorphonuclear leucocytes indicate
Urethritis
How to treat non-specific urethritis
Doxycycline bds oral - 7 days
Non specific urethritis
Inflammation of the urethra that is not due to chlamydia or Neisseria gonorrhoea
Presenting complaint for chlamydia
Urethritis - dysuria Cervicitis - clear, thin discharge PMB IMB Lower abdominal pain
Complications of chlamydia
PID Epididymo - orchitis SARA - arthritis Tubal infertility Increased risk of ectopics
Extra-genital symptoms of chlamydia
Conjunctivitis
Pharyngitis
SARA
Proctitis
Treatment for chlamydia
Doxycycline PO BDS 7 days
Azithromycin if allergic
Contraindications of doxycycline
Pregnancy
When to retest for chlamydia
12 weeks
Neisseria gonorrhoea on microscopy
Gram negative diplococci
Presenting complaint of gonorrhoea
Purulent discharge
IMB or PCB
Complications of gonorrhoea
PID
epididymo-orchitis
Proctitis
Disseminated gonorrhoea
Rash
Joint pain
Erythema
Investigations for gonorrhoea
Vulvovaginal swab - gram stain and microscopy and culture and sensitivity
First void urine - NAAT
Treatment for gonorrhoea
Ceftriaxone IM single dose
Mycoplasma genitalium treatment
1 week doxycycline + 3 days azithromycin
