Discharge

Question 0

Infective causes of discharge

Answer 0

Yeast/fungal- Candida albicans
Bacterial- garderella, bacteroides, mycoplasma hominis, Neisseria Gonorrhoea, chlamydia.
Parasites- threadworms
Protozoa- amoeba, trichomonas vaginalis (strawberry cervix)

Question 1

Physiological Causes for changes in discharge

Answer 1

Menstrual cycle, emotional stressors, nutritional status, pregnancy, meds, sexual arousal

Question 2

Non infective causes of discharge

Answer 2

Atrophic change- prepubertal, post menopausal
Foreign body- tampon
Chemical irritation
Excretions- urine from vesicovaginal fistula, or faeces from rectovaginal fistula.
Seroanguinous discharge(blood and serous fluid)- ca of vagina, cervix, endometrium. Necrotic Polyp

Question 3

What can the history suggest.

Answer 3

Candidiasis- pregnancy, DM, recent antibiotic Rx, obesity, COC use, immunosuppression, dyspareunia, itchy vulval irritation, curd like/cheesy discharge, erythema and oedema of vulvovagonal area.
Trichomoniasis- yellow/green, offensive, frothy discharge.
Bacterial vaginosis- fishy odour (amine), homogenous vaginal discharge, clue cells, raised pH (greater than 4.5)

Question 4

What are the principals of the syndromic approach

Answer 4

Syndrome should have one or more causes (organisms)
Drugs should cover common organisms
Treat with combination of drugs
Organisms must be sensitive to drugs

Question 5

Advantages of syndromic approach

Answer 5

No lab tests needed thus reducing costs, and loss of follow up
Simple to use
Used in all levels of health care
Promotes standardization 
Control of STDs limits spread of HIV.

Question 6

Disadv of syndromic approach

Answer 6

Many STIs are asymptomatic
Vaginal discharge is not always infective
Overuse of drugs- costs, side effects, resistance
Prescription may predispose to domestic violence.