vaginal discharge
- 1. By Dr.Hafsa Asim VAGINAL DISCHARGE
- 2. • Vaginal discharge is the most common presenting complaint of females attending obs department. • Excessive vaginal discharge may be physiological or Pathological.
- 3. DEFINITION Abnormal vaginal discharge (AVD) is defined as any one of the three presentations, • 1. Excessive vaginal discharge not associated with menstruation; pre, mid and post period. • 2. Offensive or malodorous discharge • 3. Yellowish or mucopurulent discharge
- 4. PREVALANCE It has been estimated that approximately 1/3 rd of female patients may complain of abnormal vaginal discharge. It can occur in females of all ages,from neonatal to the post menopausal period and it is quite common during pregnancy. Many clinics have reported that 70% of pregnant women manifest Abnormal vaginal discharge due to lower genital tract infection.
- 5. NORMAL DISCHARGE • Floccular in consistency • Whitish and non malodourous • Normal pH is acidic ranging from 3.5 to 4.5 due to Lactobacilli which convert glycogen to lactic acid • Secondary fermentation of endocervical mucus by vaginal flora also contribute to low pH.
- 6. Normal Flora : i. Lactobacilli : • Found in 96% of women ii. Concentrations 105 to 108 / ml. iii. Protective effect by interfering with adherence to epithilial cells iv. Facultative organisms : • Diphtheroids – streptococci – E.coli – ureapalasma urealyticum – mycoplasma hominis i. Anaerobic organisms : • Peptostreptococci – bacteroid - fusobacterium
- 7. CAUSES FOR VAGINAL DISCHARGE • PHYSIOLOGICAL : AGE-DEPENDENT : 1.NEONATE AND INFANT 2.PRE-PUBERTY 3.CHILD BEARING 4.POST MENOPAUSAL
- 8. • EXCESSIVE SECRETION : 1.PREGNANCY 2.SEXUAL AROUSAL PATHOLOGICAL : A) NON-INFECTIVE CHEMICAL IRRITATION –Antiseptics,bath additives deodorants,detergent spermicides,douches, perfumed soaps. B) FOREIGN BODIES IUCD,RETAINED MATERIALS,RETAINED TAMPONS RETAINED SHEATHS GYNAECOLOGICAL CONDITIONS ENDOCERVICAL C) INFECTIVE CAUSES CERVICITIS 1.HERPES GENITALIS 2.MUCOPURULENT CERVICITIS— a) Gonococcal b) Non gonococcal- Chlamydia positive and Chlamydia negative VAGINITIS 1.BACTERIAL VAGINOSIS 2.VAGINAL CANDIDIASIS 3.VAGINAL TRICHOMONIASIS
- 9. • CHILD BEARING AGE : Causes for increased vaginal secretion during child bearing age is as follows: 1.Mid cycle stimulation of endo cervical glands by oestrogen 2. EXOGENOUS-Semen of recent ejaculation 3. Mid cycle discharge is sufficient to keep the vagina moist and usually does not stain the under garments.It may be associated with Mittelshmerz or mid cycle unilateral pelvic discomfort.
- 10. • POST MENOPAUSAL PERIOD There is atropy of vaginal epithelium due to diminished estrogen secretion Thin,serous discharge,occasionally blood stained and associated with itching and burning. Small areas of granulation and ulceration along with slight vaginal bleeding may develop .Most common cause of Abnormal Vaginal discharge is Atropic vulvovaginitis.
- 11. EXAMINATION
- 12. HISTORY: Source of discharge must be determined. Perineal discharge could originate from vagina, cervix, urinary tract and rectum Ascertain the following attributes of the discharge: quantity, duration, colour, consistency and odour. Symptoms include : itching or burning . External Dysuria, Dyspareunia Obtain history of the following: • Prior similar episodes • Sexually transmitted infection • Sexual activities • Birth control method • Last menstrual period • Douching practice • Antibiotic use • General medical history • Systemic symptoms such as lower abdominal pain, fever, chills, nausea, and vomiting
- 13. PHYSICAL EXAMINATION Appearance of discharge. Erythema and edema of vaginal mucosa pH levels Diagnostic Tools: pH : Nitrazine paper ,Wet prep: microscopic examination of discharge ( clue cells of BV) KOH prep: dissolves cellular debris leaving pseudohyphae of candida. Whiff test: Fishy odor of BV Culture
- 14. Bacterial Vaginosis Medication: Oral: metronidazole 500mg bid for 7 days, or clindamycine 300mg bid for 7 days. 2. Vaginal: metronidazole gel 0.75% bid for 5 days, or clindamycine cream 2% for 7 days. NO TREATMENT OF SEXUAL PARTNER IS NEEDED
- 15. • Candida medication Clotrimazole 1% cream 5g intravaginally for 7-14 days OR 2% for 3 days OR Miconazole 2% for 7 days OR 4% for 3 days OR Tioconazole 6.5% single application OR Butoconazole 2% single application OR Terconazole 0.4% for 7 days OR 0.8% for 3 days ORAL AGENT: Fluconazole 150mg orally single dose
- 16. • Trichomonas Vaginitis Medication Metronidazole 2g orally single dose OR Tinidazole 2g orally single dose Alternative regimen Metronidazole 500mg orally twice a day for 7 days