Vaginal Discharge Flashcards
How does the vagina keep itself free from pathogens?
the epithelium of the vagina contains glycogen which is broken down by enzymes and bacteria (lactobacilli) into acids - maintaining low vaginal pH creating an inhospitable environment for pathogens
What are specific questions you may ask a pt with suspected vaginal discharge?
Discharge - strong odour should be referred
Age - rare in premenarchal girls, women over 60
Pruritus -
What are symptoms of vaginal thrush?
itch (pruritus), burning, discomfort in vaginal area; vaginal discharge may be watery or thicker and may be think, curdy and cream-coloured.
Dysuria (pain on urination) can also occur
shouldnt have any odour
If the discharge is grey-white and has a fishy odour, what type of bacterial infection is it?
bacterial vaginosis
if the discharge is green-yellow and has a fishy odour, what type of bacterial infection is it?
trichomoniasis
Is vaginal itching prominent in thrush or bacterial vaginosis or trichomoniasis?
Vaginal itching is prominent only in thrush
Is the onset of thrush sudden or gradual? Which would you refer?
suffen
if gradual - refer
When to refer patients with vaginal thrush?
- Yellow/green or white vaginal discharge -may indicate bacterial vaginosis, chlamydia, gonorrhoea
- More than 2 attacks in previous 6 months
- First occurrence of symptoms
- Pregnancy or suspected pregnancy
- Previous hx of sexually transmitted disease
- pt under 16 or over 60 years
- Abnormal or irregular vaginal bleeding
- Blood stain in vaginal discharge
- Vaginal sores, ulcer, blisters
- Lower abdominal pain or dysuria
- No improvement within 7 days of tx
- diabetic pts - poorly controlled diabetes?
what tx is used for bacterial vaginosis and trichomoniasis?
Metronidazole 400mg BD for 5-7 days
what is trichomoniasis?
protozoan infection
Which pts are likely to get thrush?
Medicine-induced thrush - antibiotics, diabetes - poorly controlled diabetes - hyperglycaemia can enhance production of protein surface receptors on C.albicans organisms, pregnancy - hormonal changes, chemical mechanical irritants - can alter the vaginal pH
What tx is used for vaginal discharge?
imdazoles (clotrimazole, miconazole) - pessary and cream, fluconazole capsule
what are the side effects of imidazoles and when should you apply it? Can it be given in pregnancy? Any drug interactions?
vaginal irritation and apply at night
yes for pregnancy but pt must be referred
no drug interactions
what are the side effects of fluconazole and any drug interactions to avoid? Can it be given in pregnancy?
GI disturbances
anticoagulants, ciclosporin, rifampicin, phenytoin, tacrolimus but relate to multiple use of fluconazole
AVOID in pregnancy
how do you administer pessaries?
use at night
place the pessary into the applicator firmly
lie on your back with knees drawn towards chest and insert the applicator as deeply as is comfortable
slowly press the plunger until it stops, remove and dispose of the applicator