Week 2 - DDx Vaginal Discharge Flashcards
When during the cycle is the highest peak for volume of discharge?
day before ovulation/ at ovulation
What does d/c look like at ovulation?
day before & day after ovulation: wet & slippery
What days does a woman produce dry/tacky/thick cervical mucus? (aka not fertile)
2 days before flow& 2 days after flow
what does cloudy d/c signify?
semi-fertile
stretchy
days surrounding ovulation, before & after wet & slippery
what d/c is thick white, curd-like, pruritic, excoriations, sour odour
candida
what d/c is m/c gardnerella vaginalis w/elevated pH (>4.5, fishy odour)
bacterial vaginosis
what d/c thrives in alkaline environment? profuse grey green , frothy, malodourous
trichomonas vaginali
what are Amsel criteria for BV dx?
thin, white, yellow homogenous d/c
clue cells on microscopy
pH >4.5 (slightly alkaline; vagina normal pH = 3.8-4.2)
what is normal pH of vagina?
slightly acidic
3.8-4.2
release of fishy odour on adding alkali (KOH)
BV treatment options?
- herbal suppositories (one 5d/wk for 2 wks)
- Vag-Pak suppositories (one 2d/wk for same 2wks as herbal suppository)
- vaginal lactobacillus suppository (daily for 6 d)
- oral lactobacillus (one daily 2-6mos to restore normal vaginal ecology)
- if recurrence, add boric acid suppository (one daily x2wks)
whats in an herbal suppository?
myrrh echinacea ulmus fulva hydrastis althea geranium achillea
whats in a vag-pak suppository?
mag sulfate glycerin complex hydrastis tincture thuja oil tea tree oil bitter orange oil vitamin A 100,000 IU ferric sulfate ferrous sulfate
what dose of boric acid suppository?
600 mg
one daily x 2 wks
trichomoniasis is associated with increased risk of transmission of which infection?
HIV
trichomoniasis may cause woman to deliver infant with which negative outcome?
low birth weight
premature
