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Sexual Health + Obs & Gynae > Vaginal discharge > Flashcards

Vaginal discharge Flashcards

1
Q

What are infective causes for vaginal discharge?

A

Bacterial vaginosis
Candida
Trichomonas
Chlamydia
Gonorrhea

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2
Q

What is bacterial vaginosis? What specific organisms are involved?

A

Overgrowth of anaerobic bacteria such as:
- Gardnerella vaginalis (most common)
- Prevotella species
- Mycoplasma hominis
- Mobiluncus species

This is due to pH disturbance, creating more alkaline environment for the anaerobic bacteria to multiply.

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3
Q

How does bacterial vaginosis present? Diagnosis?

A

Clinical diagnosis

Vaginal discharge:
- fishy odour
- thin
- grey/white homogenous

No vulva itching or soreness.
No urinary symptoms.
No abdominal pain.
No systemic symptoms.
No abnormal bleeding.

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3
Q

Risk factors for bacterial vaginosis?

A

Being sexually active
Douching
Genital hygiene
Menstruation
Copper coil

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4
Q

Management of bacterial vaginosis?

A

Oral Metronidazole 400mg BD for 5-7 days (preferred)

or

Metronidazole 1 applicatorful OD for 5 days, administer via vaginal gel route at night time (allows drug to work better as pt won’t be going to the toilet frequently)

Avoid:
- vaginal douching
- bubble baths
- water-based lubricants
- harsh soaps

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5
Q

What is candida?

A

Referred to as ‘thrush’.

Overgrowth of Candida yeasts in mucosa of female genital tract.
- Candida Albicans (more common)
- Candida Glabrata

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6
Q

Risk factors for candida?

A

Recent abx use
Scented soaps/washes
Immunosuppression
Uncontrolled diabetes
Pregnancy

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7
Q

How does candida present? Diagnosis?

A

Clinical diagnosis

Vaginal discharge:
- non-offensive (no smell)
- white
- cottage cheese like

Vulva or vaginal itching and soreness.
Dysuria
Dyspareunia (superficial)

No abdominal pain.
No systemic symptoms.
No abnormal bleeding.

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8
Q

Management of candida?

A

Fluconazole (oral) or Clotrimazole (intravaginal pessary)

Vulva itching or soreness →Clotrimazole cream

Avoid:
- vaginal douching
- bubble baths
- irritant soap
- tight fit clothing
- cotton underwear

Check for diabetes if recurrent thrush.

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9
Q

What is trichomoniasis?

A

A sexually transmitted infection (STI) caused by Trichomonas Vaginalis flagellated protozoan.

Lives in the urethra of men.
Lives in the urethra and vagina of women.

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10
Q

What can trichomoniasis lead to?

A

In women:
- Cervicitis
- Vaginitis
- Urethritis

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11
Q

How does trichomoniasis present? Diagnosis?

A

Women: high vaginal swab (posterior fornix of the vagina)
Men: urethral swab

Vaginal discharge:
- offensive (has smell)
- yellow/green
- frothy

+/- Vulva or vaginal itching and soreness.
+/- Dysuria
+/- Lower abdominal pain.

Strawberry cervix on speculum

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12
Q

What is chlamydia (uncomplicated)? Which sites does it infect?

A

A sexually transmitted infection (STI) caused by Chlamydia Trachomatis, which is a Gram-negative bacteria.

It is the infection of the urogenital tract targets:
- urethra (men)
- cervix and/or urethra (women)

It can also infect conjunctiva, rectum, and naspharynx.

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12
Q

Management of trichomoniasis?

A

Refer pt to genitourinary medicine (GUM) or sexual health clinic.

Metronidazole BD for 7 days

Offer full STI screen

Contact tracing

Sexual abstinence

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13
Q

Risk factors for chlamydia?

A

Under age 25
Two or more sexual partners in a year
Lack of barrier protection
New sexual partners

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14
Q

Who is the National Chlamydia Screening Programme for?

A

If partner has been suspected or proven chlamydia infection.

Under age 25 years should be offered annually screening or more frequently if partner changes.

Treated with chlamydia in last 3 months.

Two or more sexual partners in 12-month period.

Pts attending GUM clinics.

Women seeking termination of pregnancy (TOP)

15
Q

How does chlamydia present?

A

70% women are asymptomatic.

Purulent discharge
Post coital bleeding
Dysuria
Deep dyspareunia
Pelvic pain or tenderness

Cervical tenderness
Cervix inflamed
Contact bleeding

16
Q

Diagnosis of chlamydia?

A

Nucleic acid amplification tests (NAATs)
Women: vulvo-vaginal swab or endocervical swab
Men: first-void urine sample

17
Q

Management of chlamydia?

A

Refer pt to genitourinary medicine (GUM) or sexual health clinic.

Doxycycline BD for 7 days
or
Azithromycin 1g single dose, then take 500mg OD for 2 days.

Offer full STI screen

Contact tracing

Sexual abstinence

Chlamydia screening

18
Q

What is gonorrhoea?

A

A sexually transmitted infection caused by gram negative bacteria called Neisseria gonorrhoea.

Uncomplicated gonorrhoea infection can affect mucosal membrane urethra, endocervix, rectum, pharynx, and conjunctiva.

19
Q

Risk factors of gonorrhoea?

A

Young age 15-24 years
New sexual contact
More than one partner in the year
Lack of barrier protection
Previous STI

20
Q

How does gonorrhoea present?

A

50% women are asymptomatic.

Altered vaginal discharge
Lower abdominal pain
Intermenstrual bleeding (rare)
Dysuria
Deep dyspareunia

+/- purulent discharge frm cervix

21
Q

Diagnosis of gonorrhoea?

A

Nucleic acid amplification tests (NAATs)
Women: vulvo-vaginal swab
Men: first-void urine sample

22
Q

Management of gonorrhoea?

A

Refer pt to genitourinary medicine (GUM) or sexual health clinic.

Ceftriaxone 1g IM single dose
or
Ciprofloxacin 500mg oral single dose

Offer full STI screen

Contact tracing

Sexual abstinence

Test of cure recommended 1 week post tx

23
Q

What is pelvic inflammatory disease (PID)?

A

Inflammation or infection of the organs of the pelvis (or upper genital tract) -for e.g. uterus, fallopian tubes, ovaries, peritoneum.

24
Q

What commonly causes pelvic inflammatory disease (PID)?

A

STI:
- Chlamydia Trachomatis
- Neisseria Gonorrhoeae
- Mycoplasma Genitalium

Other infections include:
- Gardnerella vaginalis
- Escherichia coli
- Haemophilus influenzae

25
Q

Risk factors for pelvic inflammatory disease (PID)?

A

Not using barrier contraception
Multiple sexual partners
Younger age
Existing sexually transmitted infections
Previous pelvic inflammatory disease
Intrauterine device (e.g. copper coil)

25
Q

How does pelvic inflammatory disease (PID) present?

A

Pelvic or lower abdominal pain and tenderness
Deep dyspareunia
Abnormal vaginal bleeding (post coital bleeding, intermenstrual bleeding)
Abnormal vaginal discharge
+/- fever
+/- n+v

Febrile (fever)
Adnexal tenderness
Cervical excitation
Contact bleeding

26
Q

How is pelvic inflammatory disease (PID) diagnosed?

A

Clinical diagnosis

  • Nucleic acid amplification tests (NAATs) -endocervical swab
  • Pregnancy test
  • Urine dip

Consider bloods:
- FBC, CRP, ESR
- HIV, Hepatitis, Syphilis serology

27
Q

Management of pelvic inflammatory disease (PID)?

A

Refer pt to genitourinary medicine (GUM) or sexual health clinic.

Don’t wait for results to start tx.
1st line:
ceftriaxone 1g IM single dose, then take doxycycline 100mg oral BD PLUS metronidazole 400mg BD for 14 days

In severe cases, pts may require IV abx.

Analgesia

Contact tracing

Sexual abstinence

28
Q

What are non-infective causes for abnormal vaginal discharge?

A

Retained foreign body -tampons, condoms
Allergy/irritant -deodrant/lubricants
Physiological
Malignancy -vulva, vaginal, cervix, endometrium

29
Q

How does cervical cancer present?

A

Often asymptomatic in early stages.

Unexplained abnormal vaginal bleeding (IMB, PCB)

Unexplained persistent vaginal discharge.

Pelvic pain

Postmenopausal bleeding (PMB not on HRT)

Cervix inflamed
Contact bleeding
Ulcerating or necrotic lesion on cervix

30
Q

Management of cervical cancer?

A

Suspect cancer →refer via 2ww pathway to gynaecology

Sexual Health + Obs & Gynae (5 decks)

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