Vaginal Discharge Flashcards
(53 cards)
Give 4 common causes of vaginal discharge
Physiological
Bacterial vaginosis
Trichomonas vaginalis
Candida
What is physiological vaginal discharge?
Clear/ white, mucoid.
No odour or itching.
Related to cycle (↑mid cycle + premenstrual)
A/w oestrogen (puberty, pregnancy, COCP) or sexual excitement
“Leucohorroea”
What is bacterial vaginosis? Describe the discharge.
Elevated vaginal pH (>4.5) with Clue cells
White-grey watery offensive discharge but NO itching
Non-STI but increased risk with more sexual partners.
Unclear triggers
What is the cause of bacterial vaginosis?
Overgrowth of anaerobic bacteria, esp Gardnerella or Bacteroides, replacing usually dominant vaginal lactobacilli
Describe the epidemiology of BV
Most common cause of abnormal discharge in childbearing age.
Much more prevalent in black populations (~50% vs ~10% white)
What criteria is used to diagnose BV?
Amsel criteria for Dx (3/4):
- white-grey homogeneous discharge
- pH >5.5
- fishy smell when KOH added
- Clue cells on microscopy wet mount
What are Clue cells?
Squamous epithelial cells with bacteria adherent on their walls
What should be advised in BV?
Avoid vaginal douching, use of shower gel, + use of antiseptic agents or shampoo in the bath
What investigations should be performed for bacterial vaginosis?
Examination + Ix can be omitted if clear dx + empirical Tx started
High vaginal swab + gram stain (ddx, recurrence)
Vaginal pH
What is the management for bacterial vaginosis?
Metronidazole 400mg BD 5-7d
or single oral dose 2g
or
PV Clindamycin/ metronidazole
What is the management of BV in pregnancy?
Metronidazole 400mg BD 5-7d
What complications are associated with bacterial vaginosis?
BV can (rarely) cause problems in pregnancy:
Miscarriage
Preterm labour
LBW
Describe the discharge and symptoms in candidiasis
White curd-like discharge “cottage cheese”
Vulval itching++
Soreness
No odour.
May have excoriations + erythema +/- satellite lesions
What is the epidemiology of candidiasis?
Non-sexually transmitted.
75% lifetime risk
Very common in pregnancy
Unlikely in post-menopausal patients unless diabetic, immunosuppressed, or have recently had Abx.
What is the oral management for candidiasis?
Itraconazole 200mg PO BD for 1 day
or
Fluconazole 150mg PO stat
What is the local management of candidiasis? For which patients is this the only option?
Clotrimazole pessary/ cream
Topical for 12-15y
Intravaginal Pregnant women
What should be prescribed if vulval symptoms are present in candidiasis?
Topical imidazole
What treatment can be bought OTC for candidiasis?
Intravaginal clotrimazole (Canesten)
Topical clotrimazole
Oral fluconazole
What advice should be given in candidiasis?
Return if not resolved in 7-14d
Don’t over-clean, use soaps/ feminine hygiene products, douche, wear tight fitting underwear
When is candidiasis considered to be recurrent? How is this managed?
> ,4x per year
Induction: Fluconazole every 3/7 x 3
Maintenance: Fluconazole weekly 6/12
Give 7 risk factors for candidiasis
Pregnancy
OCPs
Diabetes
Immunosuppression
Recent Abx use
Steroids
Excessive washing
What are 6 signs and symptoms of Trichomonas vaginalis?
Green/grey frothy fishy-smelling discharge
Itching
Soreness
Dysuria
Dyspareunia/ bleeding after SI
2% also have ‘strawberry cervix’ (petechiae)
What causes TV?
Sexually transmitted flagellated protozoan
some evidence it may enhance HIV transmission
What investigations are performed for TV?
Refer to GUM
Microscopy of wet mount: motile trophozoites
High vaginal swab + NAAT
STI screen
