Vaginal discharge and epidiymitis Flashcards
(22 cards)
STI causes of vaginal discharge?
- Trichomonas vaginalis
- Herpes
- Gonorrhoea
- Chlamydia
Non STI infective causes of vaginal discharge?
- Bacterial vaginosis
* Vulvovaginal candidiasis
Non infective causes of vaginal discharge?
• Atrophic vaginitis • Irritant vaginitis • Vaginal/cervical/endometrial malignancy • Cervical ectopy • Cervical/endometrial polyp Pessary in situ? Foreign body?
What Qs should be asked for a pt presenting with vaginal discharge?
- Change to vaginal discharge colour/smell/volume
- Associated symptoms:
- Abdo pain
- Abnormal bleeding
- Fever
- Dyspareunia
- Dysuria
- Vulval pain
- Vulvovaginal soreness/itching
- Sexual history (recent partner change)
- Cervical smear history
- Gynae history (recent procedures, fistula formation?)
What are you looking for in an examination of pt w/vaginal discharge?
• Vulva: erythema, excoriation, dermatitis, fissures, ulcers, vulvitis
• Vagina: discharge, foreign body, vaginitis
• Cervix: Discharge, cervicitis, ectopy, polyp
Foreign body!?
Most common cause of vaginal discharge in women of child bearing age?
Bacterial vaginosis
Not an STI
What is BV?
Change in flora of vagina from lactobacillus (pH 3.5-4) to Gardnerella vaginalis (pH 4.5-6)
• 50% foul fishy smelling discharge
• 50% asymptomatic (screening not recommended)
Risk factors for BV
- Change of partner
- Receptive oral sex
- Unprotected sexual intercourse
- Presence of an STI
- Women who have sex with women
- Menstruation
- IUD
- Smoking
- Vaginal douching
- Black ethnicities
Diagnosis of BV?
Gram stained microscopy lack of lactobacilli
Complications of BV
- Risk for HIV acquisition
- Associated with other STIs
- Associated with post-surgery complications
- Stigma
- Late miscarriage
- Preterm birth
- PROM
- Recurrence
Treatment for BV
Treat if symptomatic/risk of ascending infection
• Metronidazole 400mg BD 5 days (only choice if pregnant)
• Intravaginal metronidazole gel
• Intravaginal clindamycin cream OD 7 days
• Soap substitute
Treatment of recurrent BV
- Intravaginal metronidazole gel (0.75%) twice weekly
* Intravaginal probiotic lactobacilli / lactic acid gel (OTC)
What is vulvovaginal candidiasis?
Thrush Candida albicans (80-92%) Non-albicans species: C. glabrata, C. tropicalis, C. krusei, C. parapsoilosis, Saccharomyces cerevisiae
Symptoms of candidiasis?
- Vulval itch
- Vaginal discharge
- Vulval soreness
- External dysuria
- Superficial dyspareunia
- 10-20% asymptomatic colonisation
Diagnosis of candidiasis?
- Spores and hyphae seen
- Culture
- Examination with fissuring, erythema, curdy discharge, oedema, satellite lesions and excoriation
Treatment of candidiasis?
• Topical imidazoles e.g. clotrimazole pessary 500mg stat +/-clotrimazole cream
• Systemic azoles e.g. fluconazole 150mg stat
• Antifungals e.g. Nystatin vaginal tablets (for non-albicans species)
• Soap substitute, cotton pants
Only local treatment in pregnancy
Risk factors for recurrent candidiasis?
- Diabetes is a risk factor (glucose risk environment)
- Immunosupression
- Hyperoestrogenaemia (HRT, COCP)
- Broad spectrum antibiotics
- Link to allergy
What is epididymitis?
Inflammation of the epididymides +/- testicular inflammation triggered by an infectious agent
• Unilateral/bilateral scrotal swelling
• Scrotal erythema
• Scrotal pain
Differential diagnosis for epididymitis?
- Torsion (if under 20yrs)
- Inguinal hernia
- Tumour (uncommon, usually not painful)
Causes of epididymitis?
- N. gonorrhoea (50% also have chlamydia)
- C. trachomatis
- E. coli (if over 35 and/or structural urinary tract abnormality
- M. tuberculosis (rare, if chronic)
Assessment of epididymitis?
- Sexual Hx
- STI screen
- MSU and urine dip
Management of epididymitis?
If under 35 assume STI while waiting for results
Doxycycline 100mg BD 14 days
Rest, analgesia, supportive underwear
Treat UTI of dipstick +ve
F/U 2 weeks, continue treatment for 1 month if not fully recovered
Partner tracing and notification
