Vaginal Discharge BY SAQER ABBADI Objectives Know the
Vaginal Discharge BY: SAQER ABBADI
Objectives: Know the Defensive mechanism in vagina Normal vaginal discharge and vaginal discharge in concerns Know the Non STD infective causes of vaginal discharge Clinical approach
Approach for any vaginal discharge: 1 -History 2 -Examination(Visual inspection of the perineum, vulva. . etc) 3 - Vaginal PH (3. 5 -4. 5), using p. H-dependent Nitrazine paper 4 - Micrpscopic examination : Normal Saline and KOH
Bacterial Vaginosis: It is not a true infection but rather an alteration in concentrations of normal vaginal bacteria. lactobacilli ----- Anaerobes Postmenopausal Because of Low estrogen The most common patient complaint is a fishy odor “whiff ” test is elicited when KOH is placed on the discharge, releasing a fishy odor. Wet Mount. Microscopic examination reveals “clue cells” *GOOGLE Metronidazole is safe to use during pregnancy, including the first trimester GYN Triad Bacterial Vaginosis • Vaginal discharge p. H >4. 5 • Fishy odor • “Clue” cells
Trichomonas Vaginitis -STD (flagellated pear-shaped protozoan that can reside asymptomatically in male seminal fluid. - vaginal discharge associated with itching, burning, and pain with intercourse. Speculum Examination. frothy and green “strawberry” appearance Wet Mount, actively motile “trichomonads” on a saline preparation. WBCs are seen. GOOGLE oral metronidazole for both the patient and her sexual partner. Vaginal metronidazole gel has a 50% failure rate. GYN Triad Trichomonas Vaginitis • Vaginal discharge >4. 5 • Itching and burning • “Strawberry” cervix
Candida (Yeast) Vaginitis The most common organism is Candida albicans. It is not transmitted sexually. Risk Factors. These include diabetes mellitus, systemic antibiotics, pregnancy, obesity, and decreased immunity. Symptoms. The most common patient complaint is itching, burning, and pain with intercourse. Candida vaginitis is seen in non-sexually active patients as well. Vaginal discharge is typically curdy and white Pseudohyphae on a KOH prep. WBCs are frequently seen on wet mount GOOGLE. e oral dose of fluconazole or vaginal “azole” creams GYN Triad Yeast Vaginitis • Vaginal discharge p. H
Physiologic Discharge Thin, watery cervical mucus discharge seen with estrogen dominance with prolonged anovulation The most common patient complaint is increased watery vaginal discharge. There is no burning or itching. Speculum Exam. The columnar epithelium of the endocervical canal extends over a wide area of the ectocervix, producing abundant mucus discharge (BOARD) Wet Mount. Microscopic examination reveals an absence of WBCs, “clue cells, ” trichomonads, or pseudohyphae. Management. The treatment of choice is steroid contraception with progestins,
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