Vaginal Discharges

Question 1

Bacterial Vaginosis (Etiology)

Answer 1

Imbalance of normal vaginal flora
Decrease in Lactobacilli
Increase of Gardnerella vaginalis, Mycoplasma hominis, and other anaerobes

Question 2

Bacterial Vaginosis (Clinical Diagnosis)

Answer 2

Amsel’s criteria (at least 3):

Homogenous, thin, white discharge
Clue cells on microscopy
Ph > 4.5
(+) whiff’s test: fishy odor

Question 3

Trichomoniasis (Etiology)

Answer 3

Trichomonas vaginalis
Protozoan
4 free flagella
1 recurrent flagellum undulating membrane
Costa
Axostyle
Destroys epithelium via direct contact and cytotoxicity
Lacks mitochondria; has hydrogenosome instead(for fermentation)

Question 4

Trichomoniasis ( Symptoms)

Answer 4

Vaginal discharge: yellow green, frothy, prufuse
“Strawberry cervix” 
Pruritus
Vulvar erythema
Dyspareunia

Question 5

Trichomoniasis (Diagnosis)

Answer 5

NAAT>culture>wet mount

Wet mount should be done immediately as sensitivity decreases with time

Question 6

Bacterial Vaginosis (Gram Stain Diagnosis)

Answer 6

Mixed bacteria >=5 per oif

Lactobacillus <5 per oif

Question 7

Vulvovaginal candidiasis (Risk factors)

Answer 7

Pregnancy
Dm, obesity
Steroids, immunosupressants
Abx
Oral contraceptives
Tight-fitting underclothing

Question 8

Vulvovaginal candidiasis (Symptoms)

Answer 8

Vaginal discharge: white, curd-like
Vulvar pruritus
Vulvar erythema with scaling/excoriations
dyspareunia, external dysuria

Question 9

Vulvovaginal candidiasis (Diagnosis)

Answer 9

KOH staining- spag and meatballs

Fung culture: Sabouraud’s or Nickerson’s media