Vaginal discharge Flashcards
Green For more info, see sexual health
What are the physiological causes of vaginal discharge?
Normal discharge - serous, not unusual quantity
Pregnancy Arousal in sex Puberty COCP Around ovulation Ectropion can increase discharge
What are abnormal causes of discharge?
Aberrant discharge - inc volume, mucinous, occurring at unexpected intervals
Typically infection -Thrush (candida) -Trichomoniasis (TV) -BV -Chlamydia -Gonorrhoea Also consider psychosexual components Rare causes can include foreign body and malignancy
What should be included in the history?
Colour
Odour
Timing
Irritation
Bleeding (IMB, PCB)
Pelvic pain, intercourse, dyspareunia (s and d)
Bloody discharge? (may suggest cervicitis or less commonly malignancy)
What should be looked for on examination?
Pelvis -Masses/tenderness Cervix -Eversion/ectropion Vulva -Dermatoses -Redness -Fissures -Ulcers
What Ix would be indicated?
HVS for candida
Endocervical swab for NAATS (gonorrhoea, chlamydia, TV)
Cervical smear
How would ectropion/eversion present?
No itching Clear discharge Normal pH No redness Normal odour Treat with cryotherapy if problematic
How would bacterial vaginosis (BV) present?
No itching Grey/white discharge Raised pH No redness Fishy odour Treat with antibiotics (metronidazole 2g PO once or clindamycin vaginal cream 2% per night for 7d; if pregnant 400mg metronidazole 12hr PO for 5d)
How would candidiasis present?
Itching Cottage cheese discharge Normal pH Redness Normal odour Treat with antifungals (clotrimazole 500mg pessary + cream for vulva; alternatively use fluconazole 150mg PO once)
How would trichomoniasis (TV) present?
Itching Grey/green discharge Raised pH Redness Odour Treat with abx (metronidazole 2g PO stat or 400mg/12hr for 5d e.g. if pregnant; treat partner too)
How would malignancy present?
No itching Red/brown discharge Variable pH No redness Odour Perform biopsy
How would atrophic vaginal discharge present?
No itching Clear Raised pH Redness No odour Treat with oestrogen
Where might vaginal discharge in children have its origin?
Infection from faecal flora, associated with alkalinity from lack of vaginal oestrogen (prepubertal atrophic vaginitis)
What are the likely causative agents in children?
Staph and strep - pus
Threadworms - pruritic
Always exclude sexual abuse
Gentle rectal exam may exclude foreign body
What investigations would be performed in children with vaginal discharge?
Vulval +/- vaginal swab (difficult to tell if result normal flora)
MSU (look for glycosuria)
Examine under anaesthesia +/- USS/Xray if prolonged/bloody discharge
How should vaginal discharge in children be managed?
Discuss hygiene
If abx indicated, use erythromycin
Oestrogen cream may be tried (<1cm strip)
