Abnormal Vaginal Discharge

Question 1

What is the purpose of vaginal discharge?

Answer 1

Maintains the health of the female reproductive tract

Question 2

Where does vaginal discharge come from?

Answer 2

Mucus produced by the cervix

Question 3

When are estrogen levels usually high in the body?

Answer 3

• few days before ovulation
• in newborns for a week or two after birth
• few months before 1st period in girls
• during pregnancy
• in women who take drugs containing estrogen

Question 4

Describe the physiological vaginal discharge.

Answer 4

Odorless, milky white, thin and clear

Question 5

What colonizes the vaginal epithelium?

Answer 5

Lactobacilli

Question 6

What is the range of the vaginal pH?

Answer 6

Between 3.8 and 4.4

Question 7

What is abnormal (pathological) vaginal discharge?

Answer 7

Discharge that is different from the usual concerning colour, odour or consistency

Question 8

What are the associated symptoms of for AVD?

Answer 8

Vulva pruritis, dysuria, dyspareuria, LAP, soreness, swelling

Question 9

Describe vaginal discharge at different stages of the cycle.

Answer 9

Slide 5 of handout

Question 10

Give 3 behavioral risk factors for AVD.

Answer 10

Vaginal douching, smoking, new/multiple changes in sexual partners, intravaginal foreign body

Question 11

Give genetic and demographic risk factors for AVD.

Answer 11

DM, black African women, lesbian

Question 12

Give a physiological risk factor of AVD.

Answer 12

Pregnancy

Question 13

Give 5 infections causes of AVD.

Answer 13

• Candida albicans
• Trichomonas vaginalis
• Chlamydia trachomatis
• Neisseria gonorrhoea
• Human papilloma virus
• Primary syphilis

Question 14

Give 5 non-infectious causes of AVD.

Answer 14

• Retained tampon
• Chemical irritation
• Allergic responses
• Ectropion
• Endocervical polyp
• Intrauterine device

Question 15

What points would be important for history taking in AVD?

Answer 15

See slide 11 of handout

Question 16

What would you look for on physical exam in AVD?

Answer 16

See slide 12 of handout

Question 17

List 4 tests that you would carry out for AVD.

Answer 17

pH testing, Wet mount and KOH, Culture, HIV test, syphilis serology, urinalysis and urine culture

Question 18

What is the treatment for candida?

Answer 18

Clotrimazole vaginal peasant- 500 mg single dose

Miconazole 200 mg oh x 3 days

Fluconazole 150 mg po single dose

Question 18

How is bacterial vaginosis treated?

Answer 18

Metronidazole 2g orally, single dose

Question 19

Which drugs are used to treat gonococcal vaginal discharge?

Answer 19

Gentamicin 240 mg IM single dose

Doxycycline 100 mg bd x 7 days (use erythromycin 500 mg q6h x 7 days in pregnancy)

Metronidazole 2g, orally single dose

Question 20

How do you treat trichromatic vaginal discharge?

Answer 20

Metronidazole 2g po single dose