Vaginal Discharge Flashcards
bacterial vaginosis discharge
thin, grey-white, offensive and fishy odour
candidiasis discharge
think, white, non-offensive
chlamydia and M. genitalium discharge
minimal discharge or purulent (cervicitis)
gonorrhoea discharge
cervicitis
trichomoniasis discharge
offensive green and yellow, scanty to profuse and frothy (vaginitis)
causes of intermenstrual or postcoital bleeding
chlamydia, M. genitalium, gonorhheoa, cervical ectropion or polyps, malignancy, vaginitis.
presence can suggest cervicitis or PID
causes of itch
candidiasis, trichomoniasis, vulvovaginal dermatitis
superficial dyspareunia
candidiasis, dermatiitiis, lichen planus, lichen sclerosis
deep dypareunia
chlamydia, gonorrhoea, M. genitalium, trichomoiasis
presence can suggest PID
lower abdominal pain
chlamydia, gonorrhoea, M. genitalium, trichomoniasis
presence can suggest upper genital tract infection
dysuria
chlamydia, trichomoniasis, candidiasis, herpes and dermatitis can present with external dysuria, fissuring
can also suggest gonorrhoea
associated factors in candidiasis
spontaneous, recent antibiotics, pregnancy, immunosuppression
associated factors in chlamydia
age <30, new partner or more than one partner in the last 12 months preceding, known contact
associated factors of gonorrhoea
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
associated factors in M. genitalium
age <30, new partner or more than one partner in the last 12 months preceding, known contact
examination for vaginal discharge
infection of external genitalia, speculum examination of cervix and vagina, and bimanual palpation
characteristics of discharge
colour, consistency, distribution, volume and odour
high vaginal swab or self collected vaginal swab
microscopy, culture and gram stain for bacterial vaginosis and candidiasis
pH test
pH > 4.5 indiciative of bacterial vaginosis
whiff test
odour during examination indicates a positive whiff test
NAAT test
nucleic acid amplification test
N. gonorrhoeae, C. trachomatis
cervical screening
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
what is bacterial vaginosis
polymicrobial syndrome cause by reduction of the hydrogen peroxide producing lactobacillus species in the vagina
amsel criteria for bacterial vaginosis
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
ddx for bacterial vaginosis
candidal vulvovaginitis
the presence of retained foreign body
irrittion eg. from over-washing
dermatoses
atrophic vaginits
trichomonas vagnalis
treatment options for bacterial vaginosis
metronidazole orally or cream
OR
clindamycin orally or as cream
antibiotic oral course of antibiotcs
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
contact tracing for bacterial vaginosis
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
symptoms of candidal vulvovaginitis
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
candidal vulvovahinnitis is associated with
broad-spectrum antibiotic use
third trimester of pregnancy
diabetes mellitus
