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Vaginal Discharge

    General Consideration

    Discharge per Vg
    Color - White, Creamy, Yellow, Greenish

    Physiological Discharge

    slight discharge
    • Due to Ovarian function ( mid cycle )
    • Normally seen in the vulva and vagina
    • Secretion from bartholins, sebaceous, sweat & apocrine glands
    • Vaginal mucosa
    • Cx secretion
    • Fallopian tube sec

    Amount
    • Comfortably moist
    • No enough to stain the under clothing
    • Premenstrually increase amount.
    • During preg.
    • Sexual excitement – bartholin’s gland sec

    Leucorrhoea

    (Running of white substance)
    More than normal amt.
    • Mainly Cx component
    • Fresh color— creamy
    • Dries color – brownish
    • Micros- mucus, epith debris, organisms, leucocytes

    • Stain clothes

    • Vulva soreness

    • Never cause – pruritus, and offensive odour

    • fear of cancer and STD

    Causes of leucorrhoea

    non pathological

    When the normal vg secretion increases

    Physiologically ↑in puberty, preg, at ovulation, premenstrually

    • Active or passive congestion of the pelvic organs esp. Cx.
    • Prolong ill health
    • Anxiety states
    • Neurosis
    • Sedentary occupation ( prolong sitting )
    • Standing for long period in hot atmosp.

  • ↑ Glandular elements in the Cx
  • OCP ( oral contraceptive pills)
  • Due to develop. of ectopy on the Cx
  • Regular douching (misconception of genital hygene)

  • Discourage Regular Douching
    • Regular douching does not improve genital Hygene

    • Washing away naturally protective lactobacilli

    • Altering the Vg pH, invite infection

    Inflammatory Discharge

    Infection
    • Mucopurulent or frankly purulent
    • Cream to yellow color
    • Offensive esp. coliform bacilli
    • Microscopically – pus cells
    • Lesions – vulvovaginitis, cervicitis,
    • endometritis

    VD
    Reproductive Tract Inf. (RTI)

    STI infection.
    Chlamydia, Gonococcus, Trichomonas


    Non STD
    Bacterial Vaginosis,
    Candida ( Vg yeast inf. Candidiasis or Moniliasis) fungus

    Vuvovaginitis

    Gonococcus

    Trichomonous vaginalis

    Candida albican

    Bacterial vaginosis

    Cervicitis

    Goococcal

    Chlamydial

    Anaerobic

    Secondary infection in puerperium

    Bacteria Vaginosis ( BV )
    • Alteration of normal Vg Bacteria flora
    Loss of acid producing lactobacilli
    Overgrowth of predominantly anaerobic
    bacteria

    Dx of BV

    1. Fishy Vg odour noticed following intercourse with Vg discharge
    2. Grey colour, coated the Vg wall
    3. pH 4.5 to 5.7
    4. Microscopically ↑ No. of clue cells
    5. Vg secretion + KOH →fishy ,amine like odour (Whiff test)


    Treatment of BV

    for anaerobic ( not for lactobacilli)

    Metronidazol
    • 400 mg PO tds X 7 days or
    • Single oral dose 2 gm stat

    Cure rate 75- 84 %

    2% clindamycin cream HS X 7 days
    (vaginally )
    OR
    Orally clindamycin 300mg BD x 7 days


    Trichomonial Vaginalis
    • STD
    • Flagellated parasite anaerobic
    • Often accompany BV




    Clinical features
    • Profuse purulent discharge
    • Green color
    • Vulva pruritus
    • Vg erythema
    • Strawberry Cx
    • Saline drop + discharge drop – motile org
    • Mertonidazol – tinidazol -95% effective
    • Partner should be treated

    Vulvovaginal candidiasis (moniliasis)- yeast inf.
    • Candida albican
    • Curdy white
    • adherent discharge
    • Erythematous Vg

    Common in---
    • Pregnancy
    • Diabetes
    • AB users



    Treatment

    Topical cream clotrimazol or nystatin

    Oral antifungal- fluconazol 150 mg single dose

    Investigation

    History,
    Clinical examination

    Any Vg discharge that is frankly purulent and contain pus cells should be considered to be due to specific Vg infection

    Chlamydia Trachomatis
    • Most common of all bacterial STIs
    • Abnormal Vg Ds
    • Silently destroys Fallopian tube
    • If untreated, PID, Infertility, ectopic

    Rx:
    Doxycyclin 500mg po bd for 7 days
    OR
    Azithromycin 1gm po stat