🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Vaginal discharge

Specialties > Sexual health

Background knowledge 🧠

Definition

  • Vaginal discharge refers to fluid secreted from the vagina.
  • It can be physiological or pathological.
  • Normal discharge varies in amount, consistency, and color during the menstrual cycle.
  • Pathological discharge is often associated with infections or other conditions.

Epidemiology

  • Common reason for gynecological consultations.
  • Affects women of all ages.
  • Higher incidence in sexually active women.
  • Increased risk with certain risk factors such as multiple sexual partners.

Aetiology and pathophysiology

  • Infectious causes: bacterial vaginosis, candidiasis, trichomoniasis.
  • Non-infectious causes: foreign bodies, atrophic vaginitis, allergic reactions.
  • Pathophysiology involves disruption of normal vaginal flora and pH.
  • Overgrowth of pathogens leads to symptoms.
  • Hormonal changes can also affect vaginal discharge.

Types

  • Physiological discharge: normal, varies during menstrual cycle.
  • Bacterial vaginosis (alteration in balance of mucosal bacteria): thin, grey, fishy-smelling discharge; causative pathogen: Gardnerella vaginalis.
  • Candidiasis (Candida albicans – a yeast): thick, white, curd-like discharge; causative pathogen: Candida albicans.
  • Trichomoniasis (Trichomonas vaginalis- a flagellated protozoa): frothy, yellow-green, foul-smelling discharge; causative pathogen: Trichomonas vaginalis.
  • Atrophic vaginitis: scanty, watery discharge, often post-menopausal; associated with decreased estrogen levels.

Clinical Features 🌡️

Symptoms

  • Change in color, consistency, or amount of discharge.
  • Itching or irritation in the vaginal area.
  • Odor, particularly a fishy smell in bacterial vaginosis.
  • Dysuria or discomfort during urination.
  • Dyspareunia (pain during intercourse).
  • Lower abdominal pain, less common.

Signs

  • Abnormal discharge on pelvic examination.
  • Erythema or swelling of the vulva and vagina.
  • Clue cells on microscopy in bacterial vaginosis.
  • Hyphae or pseudohyphae on microscopy in candidiasis.
  • Motile trichomonads on wet mount in trichomoniasis.
  • pH testing: elevated pH in bacterial vaginosis and trichomoniasis.

Investigations 🧪

Tests

  • Microscopy of vaginal swab: clue cells, hyphae, motile trichomonads.
  • Gram stain for bacterial vaginosis diagnosis.
  • Culture for Candida species.
  • Nucleic acid amplification tests (NAATs) for STIs.
  • pH testing: normal (3.8-4.5), elevated in infections.
  • Amine test (whiff test) for bacterial vaginosis.

Management 🥼

Management

  • Bacterial vaginosis: metronidazole or clindamycin.
  • Candidiasis: topical or oral antifungals (clotrimazole, fluconazole).
  • Trichomoniasis: metronidazole or tinidazole.
  • Remove any foreign bodies if present.
  • Advise on proper genital hygiene and avoiding irritants.
  • Partner notification and treatment if STI is confirmed.

Complications

  • Pelvic inflammatory disease (PID).
  • Infertility if infections ascend to the upper genital tract.
  • Adverse pregnancy outcomes (preterm birth, low birth weight).
  • Recurrent infections.
  • Psychological impact and sexual dysfunction.

Prognosis

  • Generally good with appropriate treatment.
  • High recurrence rate, especially for bacterial vaginosis and candidiasis.
  • Prompt treatment of infections prevents complications.
  • Long-term prognosis depends on underlying cause and adherence to treatment.

Key points

  • Distinguish between physiological and pathological discharge.
  • Identify and treat the underlying cause of pathological discharge.
  • Educate patients on proper genital hygiene.
  • Ensure partner notification and treatment if STI is confirmed.
  • Regular follow-up may be necessary for recurrent cases.

No comments yet 😉

Leave a Reply

Sexual health