Vaginal Discharge Flashcards
(39 cards)
1
Q
VAGINAL DISCHARGE
physiological causes
A
- Oestrogen related -puberty, pregnancy, COCP
- Cycle related – maximal midcycle and premenstrual
- Sexual excitement and intercourse
2
Q
VAGINAL DISCHARGE
pathological causes
A
Infection – non STI (BV, candida) / sexually transmitted (TV, chalmydia, gonorrhea)
3
Q
VAGINAL DISCHARGE
history
A
- Characteristics – onset, duration, odour, colour
- Associated symptoms – itching, burning, dysuria, superficial dyspareunia
- Relationship of discharge to menstrual cycle
- Precipitating factors – pregnancy contraceptive pill, sexual excitement
- Sexual history – risk factors for STI
- Medical history -diabetes immunocopromised
- Non infectious causes (foreign body, ectopy, malignancy, dermatological conditions)
- Hygiene practices – douches, bath products, talcum powder
- Allergies
4
Q
VAGINAL DISCHARGE
examination
A
- External genital inspection for vulvitis, obvious discharge, ulcers, other lesiosn
- Speculum – appearance of vagina, cervic, foreign bodies, amount, coour, consistency
- Bimanual examination – masses, adrenal tenderness, cervical motion tenderness
5
Q
VAGINAL DISCHARGE
investigations
A
Endocervical or vulvovaginal swabs for gonorrhoea and chlamydia
6
Q
VAGINAL DISCHARGE physiological 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- clear/white
- mucoid
- none
- none
- reassure
7
Q
VAGINAL DISCHARGE candida infection 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- white
- curd-like
- none
- itching
- antifungal
8
Q
VAGINAL DISCHARGE Trichomonal infection 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- green/grey
- frothy
- offensive
- itching
- metronidazole
9
Q
VAGINAL DISCHARGE gonococcal infection 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- greenish
- watery
- none
- none
- antibiotics
10
Q
VAGINAL DISCHARGE bacterial vaginosis 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- white/grey
- watery
- offensive
- none
- metronidazole
11
Q
VAGINAL DISCHARGE malignancy 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- bloody
- watery
- offensive
- none
- according to disease
12
Q
VAGINAL DISCHARGE foreign body 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- grey or bloody
- purulent
- offensive
- none
- remove object
13
Q
VAGINAL DISCHARGE atrophic vaginitis 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- clear/blood stained
- watery
- none
- none
- topical oestrogen
14
Q
VAGINAL DISCHARGE cervical ectropion 1. colour 2. consistency 3. odour 4. vulval itching 5. treatment
A
- clear
- watery
- none
- none
- cryotherapy
15
Q
JOCK ITCH (TINEA CRURIS) what is it causative organisms contagious? risk factors
A
- Superficial fungal infection or groin
- Trichophyton rubran, Epidermophyton floccosum
- Contagious – transmitted by fomites eg contaminated towels of hotel bedroom sheets
- Risk factors – tight fitting/wet clothing
- More common in men
- Recent visit to tropical climate, tight clothing, shared clothing, sports, coexisting diabetes, obesity
- Symmetric erythematous rash in groin
16
Q
CANDIDIASIS
THRUSH
A
- Yeast like fungus – candida albicans
- 75% women experience at least one episode
- 10-20% asymptomaic chronic carriers (40% in pregnancy)
- Predisposing factors: immunosuppression, antibiotics, pregnancy, diabetes mellitus, anaemia
- Symptoms – vulval itchng, soreness, thick, curd like, white vaginal discharge, dysuria, superficial dyspareunia
- Diagnosis: appearance of erythema, vulval fissuring, typical white plaques adherent to vaginal wall, culture from HVS or LVS, microscopic detection of spores and pseudohypae onwet slides
- Treatment: only treat if symptomatic, clotrimazole 500mg psseary +/- topical clotrimazole cream OR flyconazole 150mg (single dose)
- Prevention – wear cotton underwear, avoid chemical irritants eg soap and bath salts
- In pregnancy is common – topical imidazoles aren’t systemically absorbed so are safe
17
Q
MOLLUSCUM CONTAGIOSUM
A
- Benign viral infection
* Poxviridae family
18
Q
GENITAL HERPES/HERPES SIMPLEX
what is it
A
- DNA virus – herpes simplex (orolabial/genital) and type 2 (genital only)
- 3rd most common STI in England
19
Q
GENITAL HERPES/HERPES SIMPLEX
symptoms
A
primary infection – most severe and results in..
• prodrome (tingling/itching)
• flu like illness +/- inguinal lymphadenopathy
• vulvitis and pain (urinary retention)
• small charactereistic vesicles on vulva – can be atypical with fissues, erosions, erythema of skin
recurrent attacks
• result from reactivation of latent virus in sacral ganglia
• shorter and less severe
• triggered by – stress, sexual intercourse, menstruation
20
Q
GENITAL HERPES/HERPES SIMPLEX
- complications
- diagnosis
A
- meningitis, sacral radiculopathy, transverse myelitis, disseminated infection
- appearance of typical rash, PCR testing of vesicular fluid (gold standard), culture of vesicular fluid
21
Q
GENITAL HERPES/HERPES SIMPLEX
treatment
A
- no cure
- symptomatic relief with simple analgesia, saline bathing, topical anaesthetic
- oral acyclovir not beneficial
- condoms/abstinence whilst prodromal/symptomatic to reduce transmission
- suppressive antiviral treatment if >6 recurrences/year
22
Q
SYPHILIS
- causative organisms
- prevalence
A
- treponema pallidum – spirochaete
2. rare, increasing prevelance
23
Q
SYPHILIS
primary syphilis
A
- 10-90 days postinfection
* Painless, genital ulcer, inguinal lymphadenopathy
24
Q
SYPHILIS
secondary syphilis
A
- Occurs within 2yrs of infection
- Generalised polymorphic rash affecting palms and soles
- Generalised lymphadenopathy
- Genital condyloma lata
- Anterior uveitis
25
SYPHILIS
| tertiary syphilis
* Presents in upto 40% infected for at least 2yrs but may take 40+yrs to develop
* Neurosyphilis – tabes dorsalis and dementia
* Cardiovascular syphilis – commonly affecting aortic root
* Gummata – inflammatory plaques or nodules
26
SYPHILIS
| diagnosis
* Specific treponemal enzyme immunoassay for screening (IgG +IgM)
* Primary lesion smear may show spirochaetes on dark field microscopy
* Quantitative cardioipin tests ie rapid plasma regain useful in assessing need for and response to treatment
27
SYPHILIS
| treatment
* Depends on penicillin allergy
* Benzathine benzylpenicillin 2.4MU single dose IM
* Doxycycline 100mg bd PO 14 days
* Erythromycin 500mg qds PO 14 days
* Longer treatment in tertirary syphilis
* Contract trace
28
GONORRHEA
| organism, prevelance, symptoms, complications
* Neisseria gonorrhoea – intracellular gram -ve diplococcus
* 4th most common STI in UK
* 33% strains are resistant to ciprofloxacin, 70% to tetracyclines
* Usually asymptomatic
* Can present with vaginal discharge, low abdo pain, IMB, PCB
* Diagnosis: endocervical or vulvovaginal swab with NAAT
* If diagnosed with NAAT, culture for sensitivity testing taken before antibiotic treatment
* Complications: PID, Bartholins or skenes abscess, disseminated gonorrhoea can cause fever, pustular rash, migratory polyarthralgia, septic arthritis / tubal infertility / ectopic pregnancy
29
GONORRHEA
| treatment
* Ceftriaxone 500mg IM stat plus azithromycin 1g PO stat
* Spectinomycin 2mg IM plus azithromycin 1g PO stat (if penicillin allergy)
* Contact tracing
30
CHLAMYDIA
* Chlamydia trachomatis – obligate intracellular parasite
* Commonest bacterial STI in UK
* Cause of tubal infertility
* Symptoms: dysuria, vaginal discharge, irregular bleeding, 70% asymptomatic
* Complications: PID, perihepatitis (fitz-high-curtis syndrome), reiters syndrome (arthritis, urethritis, conjunctivitis), tubal infertility, risk of ectopic pregnancy
* Diagnosis – vulvovaginal or endocervical swab – NAAT
* Treatment – azithromycin 1g single dose OR doxycycline 100mg bd 7 days. Contact tracing and treat partners
* Screening – national chlamydia screening programme
* Implications in pregnancy – association with preterm rupture of membranes and premature delivery. Risks to baby are; neonatal conjunctivitis, neonatal pneumonia. Treat pregnant women with erythromycin 500mg bd for 10-14 days
31
HPV clinical features
* DNA virus
* Subtypes 6 and 11 cause genital warts
* ¼ presenting wih warts have concurrent sti
* Commonest viral STI
* Subtypes 16 and 18 associated with CIN and cervical neoplasia
* Asymptomatic
* Painless lumps in genitoanal area
32
HPV investigations
* Usually identified by clinical appearance
| * Non wart HPV diagnosed by characteristic appearance on cervical cytology or colposcopy
33
HPV management
* Cryotherapy
* Trichloroacetic acid
* Electrosurgery/scissors excision/curettage/laser
* Podophyllotoxin cream 4-6 weeks
* Imiquimod cream – upto 16 weeks
* Routine vaccination – 16,18, 6, 11
34
TRICHOMONIASIS
| clinical features
* Trichomonal vaginalis – flagellated protozoan
* Found in vaginal, urethrl and para-urethral glands
* Cervix may have strawberry appearance from puncture haemorrhages
* Asymptoatic in 10-50%
* May present with frothy, greenish, offensive smelling vaginal discharge, vulval itching and soreness, dysuria
* May enhance HIV transmission
35
TRICHOMONIASIS
| investigations
* Observation of organism by wet smear or acridine orange stained slide from posterior vaginal fornix
* Culture media
* NAATS
36
TRICHOMONIASIS
| management
* Metronidazole 2g oral single dose
* Metronidazole 400-500mg bd 5-7 days
* Contact tracing
37
BACTERIAL VAGINOSIS
| clinical features
* Due to overgrowth of mixed anaerobes including Gardnerella and mycoplasma hominis
* Commonest cause of abnormal vaginal discharge in women of childbearing age
* Not sexually transmitted
* 12% women experience BV at some point in lives
* May be asymptomatic
* Profuse, whitish grey, offensive smelling vaginal discharge, fishy smell
38
BACTERIAL VAGINOSIS
| investions
```
Amsel criteria – 3 out of 4 needed for diagnosis
• Homogenous grey-white discharge
• Vaginal pH >5.5
• Fishy smell
• ‘clue cells’ on microscopy
```
39
BACTERIAL VAGINOSIS
| management
* May resolve spontaneuously
* High recurrence rate
* Metronidazole 400mg oral bd 5 days
* Metronidazole 2g single dose
* Clindamycin 2% cream vaginally at night for 7 days
* Lifestyle – avoid vaginal douching/overwashing which can destroy natural vaginal flora
