Vaginal Discharge

Question 1

What are causes of vaginal discharge?

Answer 1

Physiological
Candida
Trichomonas vaginalis
Bacterial vaginosis

Gonorrhoea
Chlamydia
Extropion
Foreign body
Cervical cancer

Question 2

Describe candida discharge

Answer 2

Cottage cheese discharge, thick white
Vulvitis
Itch

Question 3

Describe trichomonas vaginalis discharge

Answer 3

Offensive, green/yellow, frothy discharge
Vulvovaginitis
Strawberry cervix

Question 4

Describe bacterial vaginosis

Answer 4

Offensive, thin, white/grey, fishy discharge

Question 5

Management for trichomonas vaingalis?

Answer 5

Oral metronidazole

Question 6

Amsel’s crittera for bacterial vaginosis?

Answer 6

Thick, white homogenous discharge
Clue cells on microscopy: stippled vaginal epithelial cells
Vaginal pH < 4.5
Positive whiff test (addition of KOH results in fishy odour)

3/4 for diagnosis

Question 7

What is management for bacterial vaginosis?

Answer 7

Oral metronidazole

Question 8

What is management for gonorrhoea?

Answer 8

IM ceftriaxone + 1g oral azithromycin stat

Azithromycin acts synergistically and useful for eradicating co-existant Chlamydia

Question 9

What are risks of bacterial vaginosis in pregnancy?

Answer 9

Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage