Vaginal Discharge

Question 1

What are the signs and symptoms of bacterial vaginosis?

Answer 1

Milky, thin, white/grey discharge; fishy or unpleasant odour (worse after sex/periods), rare to have itch or irritation, no dyspareunia. Can be asymptomatic

Question 2

When should you treat bacterial vaginosis?

Answer 2

If symptomatic or having instrumentation

Question 3

What causes bacterial vaginosis?

Answer 3

Imbalance of vaginal flora resulting in low levels of lactobacilli - this results in a rise in pH and production amines

Question 4

Is bacterial vaginosis a STI?

Answer 4

No

Question 5

How do you diagnose bacterial vaginosis?

Answer 5

HVS

Question 6

What are the diagnostic criteria for bacterial vaginosis?

Answer 6

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

Question 7

What is the treatment for bacterial vaginosis?

Answer 7

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).

Question 8

Do males need treating for bacterial vaginosis?

Answer 8

No

Question 9

What organism causes Trichomoniasis?

Answer 9

The protozoan Trichomonas vaginalis

Question 10

What are the symptoms of Trichomoniasis?

Answer 10

Profuse frothy discharge; exam may be normal. Strawberry cervix.

Question 11

Do sexual contacts of person testing positive for trichomoniasis need testing and treating?

Answer 11

Yes

Question 12

What are complications associated with Trichomoniasis?

Answer 12

Associated with low BWT, premature ROM, and preterm delivery; can sometimes cause prostatitis in males

Question 13

What is the treatment for Trichomoniasis?

Answer 13

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.

Question 14

What tests are recommended for Trichomoniasis?

Answer 14

NAAT is the gold standard (vaginal swab for females, FVU for males)

Question 15

What symptoms are associated with candidiasis?

Answer 15

White thick cottage cheese like discharge; no offensive odour, common to have itch or irritation, sometimes have dyspareunia

Question 16

When should you treat Candidiasis?

Answer 16

If symptomatic

Question 17

What is the treatment for Candidiasis?

Answer 17

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.

Question 18

Do specific diets or probiotics help with recurrences of Candidiasis?

Answer 18

No

Question 19

How do you treat recurrent thrush?

Answer 19

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.

Question 20

Do male contacts need treating if partner tests positive for thrush?

Answer 20

Male contacts don’t need treating unless symptomatic

Question 21

What defines recurrent thrush?

Answer 21

4+ symptomatic episodes in 12 months confirmed by culture or microscopy on at least 2 occasions.

Question 22

What are the symptoms of Desquamating inflammatory vaginitis?

Answer 22

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

Question 23

What are the clinical signs of Desquamating inflammatory vaginitis?

Answer 23

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.

Question 24

What is the treatment for Desquamating inflammatory vaginitis?

Answer 24

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.