Gynae Infections

Question 1

Outline the causes of vaginal discharge

Answer 1

COMMON causes of vaginal discharge:

• Physiological
• Candida
• Trichomonas vaginalis
• Bacterial vaginosis

 

Less common causes of vaginal discharge

• Gonorrhoea
• Chlamydia- can cause vaginal discharge although rarely a presenting symptom
• Ectropion
• Foreign body
• Cervical cancer

Question 2

Questions to ask when doing a history for infections/ vaginal discharge

Answer 2

• Discharge – smell, consistency, colour, amount
• Itch
• Blood
• FLAWS – infection, immunosuppression, cancer
• Pain
• Pregnant
• Urinary symptoms – frequency, urgency, pain
• Sexual history – partners (inc. change), barrier, STIs

Question 3

Investigations for gynae infections

Answer 3

Investigations: Always do speculum before bimanual (lubrication in bimanual ruins speculum swabs)

1. pH:

Lateral wall of vagina (avoid cervix) -> normal pH 3-5-4.5 (due to lactobacilli in vagina)

Sensitive, not specific

• Low pH = candida
• Normal pH = physiological, candida
• Raised pH = contamination (blood, semen, lubrication), BV, TV

2. Swabs – 1st endocervical; 2nd high vaginal…

Double swabs:

• Endocervical swab -> (‘2-in-1’ NAAT testing) gonorrhoea, chlamydia
• High vaginal – charcoal swab -> (fungal and bacterial) BV, TV, candida, GBS

Triple swabs:

• Swab 1 (endocervical) -> chlamydia
• Swab 2 (endocervical – charcoal swab) -> gonorrhoea
• Swab 3 (high vaginal – charcoal swab) -> fungal and bacterial (BV, TV, candida, GBS)
• NAAT (nucleic acid amplification tests) – gonorrhoea + chlamydia (endocervical/VVS)
• MC&S – gonorrhoea, candida, TV, BV -> gonorrhoea under microscope = gram -ve diplococci

3. Bloods:
   * HIV, syphilis

Question 4

Differentiate between the discharge in different infections

Answer 4

Question 5

Outline the differential diagnosis of vaginal discharge

Answer 5

Question 6

Investigations for STIs

Answer 6