Vaginal Discharge

Question 1

bacterial vaginosis discharge

Answer 1

thin, grey-white, offensive and fishy odour

Question 2

candidiasis discharge

Answer 2

think, white, non-offensive

Question 3

chlamydia and M. genitalium discharge

Answer 3

minimal discharge or purulent (cervicitis)

Question 4

gonorrhoea discharge

Answer 4

cervicitis

Question 5

trichomoniasis discharge

Answer 5

offensive green and yellow, scanty to profuse and frothy (vaginitis)

Question 6

causes of intermenstrual or postcoital bleeding

Answer 6

chlamydia, M. genitalium, gonorhheoa, cervical ectropion or polyps, malignancy, vaginitis.
presence can suggest cervicitis or PID

Question 7

causes of itch

Answer 7

candidiasis, trichomoniasis, vulvovaginal dermatitis

Question 8

superficial dyspareunia

Answer 8

candidiasis, dermatiitiis, lichen planus, lichen sclerosis

Question 9

deep dypareunia

Answer 9

chlamydia, gonorrhoea, M. genitalium, trichomoiasis
presence can suggest PID

Question 10

lower abdominal pain

Answer 10

chlamydia, gonorrhoea, M. genitalium, trichomoniasis
presence can suggest upper genital tract infection

Question 11

dysuria

Answer 11

chlamydia, trichomoniasis, candidiasis, herpes and dermatitis can present with external dysuria, fissuring
can also suggest gonorrhoea

Question 12

associated factors in candidiasis

Answer 12

spontaneous, recent antibiotics, pregnancy, immunosuppression

Question 13

associated factors in chlamydia

Answer 13

age <30, new partner or more than one partner in the last 12 months preceding, known contact

Question 14

associated factors of gonorrhoea

Answer 14

age <30, new partner or more than one partner in the last 12 months preceding, known contact
co-infection with other pathogen, high-risk population

Question 15

associated factors in M. genitalium

Answer 15

age <30, new partner or more than one partner in the last 12 months preceding, known contact

Question 16

examination for vaginal discharge

Answer 16

infection of external genitalia, speculum examination of cervix and vagina, and bimanual palpation

Question 17

characteristics of discharge

Answer 17

colour, consistency, distribution, volume and odour

Question 18

high vaginal swab or self collected vaginal swab

Answer 18

microscopy, culture and gram stain for bacterial vaginosis and candidiasis

Question 19

pH test

Answer 19

pH > 4.5 indiciative of bacterial vaginosis

Question 20

whiff test

Answer 20

odour during examination indicates a positive whiff test

Question 21

NAAT test

Answer 21

nucleic acid amplification test
N. gonorrhoeae, C. trachomatis

Question 22

cervical screening

Answer 22

perform if overdue
HPV testing only is indicated for vaginal discharge
a co-test (HPV + cytology) should be ordered for abdominal bleeding, or suspicious findings on examination of the cervix

Question 23

what is bacterial vaginosis

Answer 23

polymicrobial syndrome cause by reduction of the hydrogen peroxide producing lactobacillus species in the vagina

Question 24

amsel criteria for bacterial vaginosis

Answer 24

thin, white homogenous discharge
vaginal fluid pH more than 4.5
clu cells (epithelial cells covered with small curved coccobacilli and mixed flora) visualised on wet preparation of. vaginnal swab or gram-stained smear
fishy odour when adding alkali to discharge

Question 25

ddx for bacterial vaginosis

Answer 25

candidal vulvovaginitis
the presence of retained foreign body
irrittion eg. from over-washing
dermatoses
atrophic vaginits
trichomonas vagnalis

Question 26

treatment options for bacterial vaginosis

Answer 26

metronidazole orally or cream
OR
clindamycin orally or as cream

Question 27

antibiotic oral course of antibiotcs

Answer 27

metronidazole for 7 days
clindmycn for 7 days
single dose options are available and have better adherence, however cure rate is lower and retreatment may be necessary

Question 28

contact tracing for bacterial vaginosis

Answer 28

contact tracing is not required
for patients with an ongoing female partner you should assess the female sexual partner for symptoms
treatment of ongoing male partners is not recommended

Question 29

symptoms of candidal vulvovaginitis

Answer 29

genital or vulval itch or discomfort
sometimes with pain, and often with a red rash on the vulva
it is often accompanied by white curd-like vaginal discharge
superficial dyspareunia, external dysuria, excoriation, fissuring, erythema and swelling my also be present

Question 30

candidal vulvovahinnitis is associated with

Answer 30

broad-spectrum antibiotic use
third trimester of pregnancy
diabetes mellitus