Vaginal discharge resident survival guide

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Vaginal discharge Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Non-sexually transmitted infection
Sexually transmitted infection
Non-infective causes
Physiological:
Non-physiological:

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Vaginal discharge.

 
 
 
 
 
 
Patient with history of Vaginal discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history :

❑ Age of menarche

❑ Last menstrual period

❑Is the menstrual flow normal? How many pads she has to use in a day?

❑ Is there any foul smell or colour change?

❑ How many days does the menstrual period stay?

Contraceptive history for example oral contraceptives, intrauterine device

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about general health :

❑ Ask about medical and drug history including recent antibiotic use and type of contraceptive use

❑ Assess for the possibility of a foreign body in situ

❑ Ask if there was any surgery or instrumentation to the genital region recently

❑ Is there any other health conditions like Diabetes Mellitus?

❑ Is there any history of fever, lower abdominal pain?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about colour, appearance of the discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the discharge white or cream coloured, resembling "cottage cheese"?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check if they have the following complains :

Pruritus

Vaginal Burning, usually with increased vaginal discharge

❑ Vague but inoffensive odour

Dysuria, dyspareunia in patients with intense scratching and itching that led to skin excoriations

❑ Presence of vulval erythema, fissures

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask if the following factors are present
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Associated factors:

Glycosuria

Diabetes Mellitus

Obesity

Pregnancy

❑ Recent use of steroids/ antibiotics/ immunosuppressive agents

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examination of direct vaginal secretions or scrapping from vaginal wall via direct microscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
When a drop of 10% Potassium Hydroxide is added, typical myecelis or pseudo hyphae is seen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Candidiasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the discharge greenish?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check if they have the following complains :

Purulent, frothy discharge

❑ Foul smelling discharge with vulval soreness and irritation, if severe vulval oedema

❑ Punctate hemorrhagic area or strawberry cervix is path gnomic

Lower abdominal pain anddyspareunia may be seen in patients with long standing infection

❑ Male partners are usually asymptomatic except having penile pruritus after coitus

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Associated factors:

❑Multiple sexual partners

❑Increased level sexual activity

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wet mount test: a drop of vaginal secretion is mixed with saline and examined under microscope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trichomonads are recognised by their twitching motility
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vaginal pH > 5 helps to distinguish between trichomoniasis and candidiasis which has pH of less than 4.5
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trichomoniasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the discharge thin, homogenous, bubbly?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
Herpes Simplex
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check if they have the following complains :

❑ Malodorous, fishy discharge

❑ No itching or discomfort

❑No inflammation of vulva

 
 
 
 
 
 
 
While it does not produce vaginal discharge itself, it causes cervicitis and vaginitis that are associated with severe leukorrhea
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Associated factors:

❑ Vary in intensity during menstrual cycle, worse at mid-cycle and especially after intercourse

❑ Partner and children of the patient may complain of odour that may need the use of frequent douches or perfumed bath

 
 
 
 
 
 
 
Diagnosis :

❑ Diagnosis is made from history and appearance of typical, multiple, painful vesicles

Culture is done to confirm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Whiff test: When a drop of 10% potassium hydroxide is added to a drop of vaginal secretion fishy amine odour is released
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vaginal pH > 5 with presence of clue cells are diagnostic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bacterial vaginosis (Gardnerella vaginosis)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mucopurulent discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Neisseria gonorrhoea
 
Chlamydia trachomatis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check if they have the following complains :

Mucopurulent cervicitis and urethritis

Dysuria, urethral irritation

❑Infection of peri-urethral glands and Bartholin's duct

❑ As infection progresses, patient may experience abdominal pain.

 
Check if they have the following complains :

❑ Watery, thinner discharge with dysuria and lower abdominal discomfort

❑ Cervical friability and oedema with ectopy of cervix

❑ Infection of peri-urethral glands and Bartholin's duct

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnosis :

❑ Culture of endo-cervical specimen shows gram negative diplococci, Neisseria gonorrhoea

 
Diagnosis :

❑First void urine and vaginal swabs are the recommended specimens for NAAT( Nucleic Acid Amplification Test) for diagnosis of Chlamydia trachomatis.[6]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of Vaginal discharge.


Organisms Recommended Drugs Alternative drugs
Candidiasis Clotrimazole/Miconazole

100 mg vaginally QHS for 7 days
Or
200 mg vaginally QHS for 3 days

Or

Clotrimazole 500 mg tab vaginally single dose


Nystatin 1,00,000 unit tab vaginally QHS for 2 weeks
Trichomoniasis Metronidazole

2gm orally single dose
Or
250 mg TID orally for 7 days

Clotrimazole 2 X 100 mg vaginal tabs QHS for 7days
Bacterial Vaginosis Metronidazole

500 mg orally bid X 7 days

Ampicillin/Amoxicillin
or
500 mg tab QUD for 7 days
or

Doxycycline 100 mg bid for 7 days

Neisseria gonorrhoea Amoxicillin orally 3gm single dose
or
Ampicillin orally 3.5 gm single dose
or
Procaine PCN G 4.8 million IM single dose


PLUS


Probenecid 1 gm orally single dose


AND


Tetracycline 500 mg orally QID for 7 days
or
Doxycycline 100 mg orally BID for 7 days
or
Ceftriaxone 250 mg IM single dose

Erythromycin 500mg orally QID for 7 days
or
Tetracycline 500 mg orally QID for 7 days
or
Doxycycline 100 mg orally BID for 7 days
or
Spectinomycin 2 gm IM single dose
Chlamydia trachomatis Tetracycline 500 ng orally QID for 7 days
or
Doxycycline 100 mg orally BID for 7 days
Erythromycin base 500 mg orally QID for 7 days
or
Erythromycin ethylsuccinate 800 mg orally QID for 7 days
or
Sulfamethoxazole 1gm orally BID for 10 days


Herpes Simplex


Acyclovir


Patient should be referred to a gynaecologist if following are present. [7]

Dos

Don'ts

  • Patient should be advised to avoid tight-fitting synthetic clothing.[7]
  • Patient should be told to avoid local irritants such as perfumed products and soap gels, and vaginal douching.
  • There is no clear and consistent evidence across currently published studies regarding the role of probiotics for vaginal health.[7]

References

  1. Cettl L, Dvorak J, Felkel H, Feuereisl R (1979). "Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement". Int J Biomed Comput. 10 (1): 67–74. doi:10.1016/0020-7101(79)90042-4. PMID http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 Check |pmid= value (help).
  2. 2.0 2.1 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/j.ogrm.2016.08.002 Check |pmid= value (help).
  3. Wathne B, Holst E, Hovelius B, Mårdh PA (1994). "Vaginal discharge--comparison of clinical, laboratory and microbiological findings". Acta Obstet Gynecol Scand. 73 (10): 802–8. doi:10.3109/00016349409072509. PMID https://pubmed.ncbi.nlm.nih.gov/7817733 Check |pmid= value (help).
  4. Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://pubmed.ncbi.nlm.nih.gov/18048541 Check |pmid= value (help).
  5. Hainer BL, Gibson MV (2011). "Vaginitis". Am Fam Physician. 83 (7): 807–15. PMID 21524046.
  6. Meyer T (August 2016). "Diagnostic Procedures to Detect Chlamydia trachomatis Infections". Microorganisms. 4 (3). doi:10.3390/microorganisms4030025. PMC 5039585. PMID 27681919.
  7. 7.0 7.1 7.2 7.3 7.4 Sim, M; Logan, S; Goh, LH (2020). "Vaginal discharge: evaluation and management in primary care". Singapore Medical Journal: 297–301. doi:10.11622/smedj.2020088. ISSN 0037-5675.


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