Vaginal Discharge

Question 1

What causes vaginal discharge?

Answer 1

Bacterial vaginosis
Thrush
Thricomoniasis

Question 2

What conditions can be treated over the counter?

Answer 2

Thrush only - BV marketed products but not recommended

Question 3

What is normal discharge?

Answer 3

Non odorous

Question 4

What can cause vaginal pH levels to drop?

Answer 4

Changes in oestrogen levels - decreased oestrogen increased pH

Question 5

What are the symptoms of thrush?

Answer 5

Vulval itching
Vulval soreness and irritation
Cottage cheese/curd like discharge with little/no odour

Question 6

What are the symptoms of bacterial vaginosis?

Answer 6

Thin white/grey discharge with a strong fishy odour - odour is worse after sex and may worsen during menses
Itching and soreness not usually present

Question 7

What are the symptoms of trichomoniasis?

Answer 7

Profuse, frothy, greenish yellow discharge with a fishy smell
Vulval itching and soreness
Vaginal spotting
Dysuria
Lower abdominal pain

Question 8

What are the symptoms of chlamydia?

Answer 8

Purulent or mucopurulent discharge
Dysuria
Urinary frequency
Intermenstrual or post coital bleeding

Question 9

What can cause vaginal discharge?

Answer 9

1. Atrophic vaginitis - post menopausal women - refer
2. Medicine induced - corticosteroids, immunosuppressant, abx, contraceptives (affect oestrogen), HRT,
3. Diabetes - more difficult to eliminate therefore don’t treat and refer
4. Pregnancy - hormonal changes - difficult to eradicate - refer
5. Irritants - alter pH

Question 10

What specific questions would you ask the patient?

Answer 10

1. Discharge - strong odour = refer
   - fishy odour = BV/Tric
2. Age - <16 and >60 refer
3. Itch - thrush - no itch/slight = tric/BV
4. Onset - thrush is sudden, BV/tric is gradual

Question 11

When would you refer a patient?

Answer 11

1. Discharge that has a smell
2. <16 and >60
3. Diabetes
4. OTC med failure
5. Predisposed to thrush
6. Recurrent attacks

Question 12

What medicines interact with imidazoles?

Answer 12

None

Question 13

What medicines interact with fluconazole?

Answer 13

Anticoagulants
Ciclosporin
Rifampicin
Phenytoin
Tacrolimus

Question 14

What are the counselling points for topical imidazoles and fluconazole?

Answer 14

Topical
1. Apply at night
2. Damage latex and condoms - contraceptive effect is reduced

Fluconazole
1. Drug interactions however one dose unlikely
2. Can be taken any time of the day

Question 15

What general advice should you give to prevent thrush?

Answer 15

1. Avoid tight fitting clothes
2. Use non perfumed soaps - underwear and jeans
3. Do not douche

Question 16

When should symptoms resolve with treatment?

Answer 16

Within 3 days - no improvement after 7 days see GP

Question 17

What are the license restrictions?

Answer 17

1. Age
2. Pregnant or breastfeeding
3. Previous STD
4. Abnormal menstrual bleeding or lower abdominal pain
5. No symptom resolution after 7 days
6. 2 episodes in 6 months

Question 18

What is appropriate for pregnant and breastfeeding ?

Answer 18

Imidazoles = okay but refer
Fluconazole = avoid