Vaginal Discharge Flashcards
What are the signs and symptoms of bacterial vaginosis?
Milky, thin, white/grey discharge; fishy or unpleasant odour (worse after sex/periods), rare to have itch or irritation, no dyspareunia. Can be asymptomatic
When should you treat bacterial vaginosis?
If symptomatic or having instrumentation
What causes bacterial vaginosis?
Imbalance of vaginal flora resulting in low levels of lactobacilli - this results in a rise in pH and production amines
Is bacterial vaginosis a STI?
No
How do you diagnose bacterial vaginosis?
HVS
What are the diagnostic criteria for bacterial vaginosis?
Amsel criteria:
3+ of homogenous thin, white discharge that smoothly coats the vaginal walls; clue cells on microscopy; pH of vaginal fluid > 4.5 or fishy odour of vaginal discharge before or after adding KOH OR gram stain with low lactobacilli
What is the treatment for bacterial vaginosis?
Treat if symptomatic with Metronidazole 400mg PO BD for 7/7 or Metronidazole 2g stat (higher risk of relapse) or ornidazole if not pregnant (avoid alcohol for 48-72hrs after this).
Do males need treating for bacterial vaginosis?
No
What organism causes Trichomoniasis?
The protozoan Trichomonas vaginalis
What are the symptoms of Trichomoniasis?
Profuse frothy discharge; exam may be normal. Strawberry cervix.
Do sexual contacts of person testing positive for trichomoniasis need testing and treating?
Yes
What are complications associated with Trichomoniasis?
Associated with low BWT, premature ROM, and preterm delivery; can sometimes cause prostatitis in males
What is the treatment for Trichomoniasis?
Metronidazole 2g PO stat OR ornidazole 1.5g PO stat (not in pregnancy) OR metronidazole 400mg PO BD for 7/7 (preferred in pregnancy). Abstain 1 week from start of Rx until 1 week after sexual contacts have been treated. Abstain from alcohol for duration of treatment and for >24 hrs after completion of treatment.
What tests are recommended for Trichomoniasis?
NAAT is the gold standard (vaginal swab for females, FVU for males)
What symptoms are associated with candidiasis?
White thick cottage cheese like discharge; no offensive odour, common to have itch or irritation, sometimes have dyspareunia
When should you treat Candidiasis?
If symptomatic
What is the treatment for Candidiasis?
Intravaginal and oral azoles same efficacy.
Clotrimazole 2% PV nocte for 3/7 or fluconazole 150mg PO stat (avoid in pregnancy). Clotrimaxole 1% BD for 5-7/7 for penile.
Do specific diets or probiotics help with recurrences of Candidiasis?
No
How do you treat recurrent thrush?
Fluconazole 150mg for 3 doses 3 days apart then 150mg weekly for 6 months (funded if vocationally registered GP/specialist). If breakthrough sx while on rx, re swab.
Do male contacts need treating if partner tests positive for thrush?
Male contacts don’t need treating unless symptomatic
What defines recurrent thrush?
4+ symptomatic episodes in 12 months confirmed by culture or microscopy on at least 2 occasions.
What are the symptoms of Desquamating inflammatory vaginitis?
Persistent or intermittent, blood-stained or yellow, profuse or sticky vaginal discharge
Painful intercourse (dyspareunia)
Itch (pruritus vulvae) and/or burning (vulvodynia)
Post coital bleeding
Dryness
Malodour
Dysuria
What are the clinical signs of Desquamating inflammatory vaginitis?
The vagina and the vaginal vestibule appear inflamed. Clinical signs include:
Redness
Swelling
Atrophic epithelium
Yellow secretions
Purpura (bleeding under the skin)
Contact bleeding
A greyish film.
What is the treatment for Desquamating inflammatory vaginitis?
Not always effective.
Clindamycin 2% vaginal cream AND
Hydrocortisone 1% cream or 10% foam for at least 2 weeks and potentially twice weekly long term
General care should include gentle cleansing of the external genitalia with water and non-soap cleansers. Vaginal moisturisers may be helpful for dryness.
