DR Medhat MRCP

Vaginal discharge :
- Vaginal discharge is a common presenting symptom and is not always pathological
• Common causes
• Physiological.
• Candida.
• Trichomonas vaginalis.
• Bacterial vaginosis.
Candida
Condition
Trichomonas vaginalis
Bacterial vaginosis
Key features
الجبن القريش `Cottage cheese` discharge
Vulvitis.
Itching
Offensive , yellow/green,frothy discharge
Vulvovaginitis
Strawberry cervix
سؤال discharge. Offensive , thin , white/grey fishy
• Less common causes
Cervical infections such as Chlamydia and Gonorrhoea (rare presenting symptoms)
Ectropion.
Foreign body.
Cervical cancer.
Bacterial vaginosis (BV) :
- Overgrowth of anaerobic organism ,Gardnerella vaginalis lactic acid
production by lactobacilli vaginal alkalosis ( pH).
- It`s not STD but it`s found exclusively in sexually active woman.
• Diagnosis ( Amsel`s criteria) : 3 of the following 4
1) Thin,white, homogenous discharge.
2) Clue cells on microscopy.
3) Vaginal pH > 4.5.
4) +ve Whiff test ( adding KOH fishy odour).
• Bacterial vaginosis in pregnancy :
It risk of preterm labour ,late miscarrage ,
low birth weight & chorioamnionitis.
TTT : Metronidazole (can be used throughout the pregnancy
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Features :
Thin ,white/grey offensive fishy
discharge
Asymptomatic in 50% .
Management :
Oral metronidazole x 5-7 days.
70-80 % initial cure rate
Relapse rate > 50% within 3 m.