Infective vaginal discharge Flashcards
(32 cards)
What are the non-STI causes of vaginal discharge?
Bacterial vaginosis
Candida (thrush)
What is the cause of BV?
Low levels of lactobacilli and high levels of anaerobic bacteria
What are the symptoms of BV?
Offensive fishy discharge
Increased volume of thin watery discharge
Absence of soreness, itching and irritation
How is BV diagnosed?
May be a clinical diagnosis
If clincial doubt:
- Low vaginal swab
- Gram staining of vaginal smear using Hay/Ison criteria
How is BV treated in non-pregnant and pregnant women?
Non-pregnant:
- PO 400mg metronidazole BD for 5/7
Pregnant:
- PV metronidazole OD for 5/7
What are the complications of untreated BV in pregnant and non-pregnant women?
All women: - PID - Cellulitis Pregnant women: - Late miscarriage - PPROM
What is the cause of thrush?
Candida albicans
What are the symptoms of thrush?
Vulval itch and soreness
Thick, chunky white discharge
Superficial dyspareunia
What are the risk factors for thrush?
Recent course of antibiotics Immunocompromised DM Elevated oestrogen Pregnancy
How is thrush diagnosed?
Nil investigations required
Clinical diagnosis
How is thrush managed in pregnant and non-pregnant women?
Non-pregnant:
- PO fluconazole 150mg stat
OR
- Clotrimazole pessary stat
Pregnant:
- 7/7 clotrimazole pessary
Do asymptomatic partners need to be treated in thrush?
No
What are the STI causes of vaginal discharge and how are they classified?
Vaginal causes:
- Trichomoniasis vaginalis
Endocervical causes:
- Chlamydia trachomatis
- Neisseria gonorrhoeae
What is are the cardinal symptoms of trichomoniasis vaginalis?
Frothy yellow discharge
Vulval itch
Discomfort in vagina and vulva
What is a cardinal sign of trichomoniasis vaginalis on speculum examination?
Strawberry cervix
How is trichomoniasis vaginalis diagnosed?
Posterior fornix swab with microscopy
NAAT if available
How is trichomoniasis vaginalis managed?
PO metronidazole 400mg BD for 5/7
What is the advice for sexual partners in trichomoniasis vaginalis?
Must also be treated for trichomoniasis vaginalis AND avoid sex completely for 1/52
What is the most common STI?
Chlamydia
How does chlamydia present in women?
Largely asymptomatic Increased vaginal discharge Dysuria PCB IMB Deep dyspareunia and lower abdominal pain
What signs are present on speculum in chlamydia?
Mucopurulent cervictis
May also have contact bleeding
What is the window period after infection for chlamydia to be detectable?
2/52
How is chlamydia diagnosed in women?
Vulvovaginal swab + NAAT if available
+ rectal or pharyngeal swabs if required
How is chlamydia treated in pregnant and non-pregnant women?
Non-pregnant: - Doxycycline 100mg BD for 7/7 Pregnant: - Azithromycin 1g PO stat on Day 1 Day 2 and 3 500mg PO azithromycin OD AND a test of cure
