Vaginal discharge

Question 1

Mcc of vaginal discharge

Answer 1

Physiological
Clear mucoid/milky white
Lactobacilli.. lactic acid … acidi pH (4.7)
Can turn yellow or brown (normal)

Question 2

Candida albicans associated discharge features, mx

Answer 2

1. Colour: White
2. Consistency: Thick, COTTAGE CHEESE
3. Odour: none
4. pH: <4.5
5. A/w: itching

Requires estrogination of mucosa
Preg, OCP, steroid, HIV, DM, antibiotics

Vag Swab - Microscopy, culture candida species
Rx-
1. Azole creams
or
2. Nystatin pessary when azole not tolerated
or
3. Fluconazole oral every 3 days for 2-3doses
Avoid in preg, check LFT, Sr K Many drug interactions

Question 3

Chronic candidiasis

Answer 3

> 4episodes/yr
Low vaginal swab

Rx:
Flucon/itraconazole OD 2wks-6months
Review after 3 months

Question 4

Candida glabrata

Answer 4

Boric acid intravaginally x2wks

Question 5

Trichomonas vaginalis features

Answer 5

1. Colour: yellow-green
2. Consistency: mucopurulent, profuse, bubbly
3. Odour: fishy
4. pH: 5-6
5. A/w: vulvitis, soreness

*sTRawberry cervix … green (leaves) vag discharge

Sexually transmitted:
Treat sexual partner
No sex for 1 wk

Swab

Rx:
1. Metronidazole orally
or
2. Tinidazole

Question 6

Bacterial vaginosis features

Answer 6

Normal vag bact replaced by
Gardinella vaginalis

Common in female-female sex partners
(treat both even if one partner +)

1. Colour: white/grey
2. Consistency: profuse, bubbly, watery
3. Odour: fishy - whiff test
4. pH: 5-6
5. A/w: irritation uncommon

CLUE CELLS in wet field microscopy

Rx:
Metronidazole orally/vag gel
or
Clindamycin - preg

Question 7

Mx of suspected bacterial vaginosis during IUCD insertion

Answer 7

1. DO NOT have to terminate procedure
2. Start antibiotics

No need for screening for bacterial vaginosis in
1. low risk pregnancies
2. before surgical termination of pregnancy
3. insertion of an IUD in asymptomatic people

Question 8

IUCD user with first attack of bacterial vaginosis, mx?

Answer 8

Metronidazole
No need to remove IUCD

Remove if recurrence+

Question 9

Bacterial vaginosis rx during breast feeding

Answer 9

Intra vaginal rx better

Metronidazole changes taste of breast milk
Do not use in high doses

Question 10

Investigations in vaginal discharge

Answer 10

1. M&Culture
   High>low vaginal swab for
   Bact vaginosis
   candida
   STIs
2. pH test - acidic in normal/candida
3. Amine/WHIFF test - bact vaginosis
   discharge+KOH … fishy smell
4. Wet film microscopy -
   candida
   bact vaginosis: CLUE CELLS

Question 11

Vaginal discharge in childern

Answer 11

Normal upto 3 months of age
Should be absent till puberty
If present - Vulvovaginitis

If profuse- INTROITAL SWAB (vag opening)
Strep
Haemophillus
Gardinella

FB- rectal exam
Cannot be candida as it needs estrogen in mucousa

Question 12

Atrophic vaginitis

Answer 12

Dry vag … thin dry red
Dyspareunia
yellow, no odour discharge

Rx: Estrogen cream/pessary
Zinc/castrol oil lotion

USG - r/o endometrial CA in bleeding cases

Question 13

Tampon Toxic shock syndrome

Answer 13

Staph - forgotten tampon
Within 5 days of period
1. Sudden onset fever
2. Vomit, diarrhoea
3. Skin rash, muscle aches
4. Hypotention.. confusion, stupor, death

Mx:
●CS- vag, cervix, perenium, nasopharynx
●Flucloxacin or Vancomycin IV
●Tampon removed, cleaned with povidine iodine x2days