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Leukorrhea
Increased vaginal discharge Physiologic/Pathologic
pH < 4.5
Atrophic vaginitis
Postmenopause Decreased estrogen
Vaginal wall thining Decreased acidic environment
Yellow/Green/Bloody Pruritic/Painful Dysuria Dyspareunia/Postcoital bleeding Vaginal wall thining, colpitis macularis, patchy ulceration, adhesive vaginitis
Atrophic vaginitis
PAP smear, Gram stain, culture +- Cervical biopsy, Fractional curettage Treatment:
Antibiotics estrogen (local/systemic)
Candidiasis
Yeast cells/Pseudohyphae Inflammation and curd-like discharge Predisposing factors
Diabetes Obesity Pregnancy Antibiotics Contraceptives Low immunity Premenstrual period
Candidiasis
KOH preparation, Gram stain (positive) Subourauds/Nicersons media culture Treatment:
Uncomplicated
Clotrimazole V.P. (100) Vg suppo OD 6days Clotrimazole V.P. (200) Vg suppo OD 3days Itraconazole (400) PO stat Fluconazole (150) PO stat
Complicated
Clotrimazole V.P. (100) Vg suppo OD 14 days then Clotrimazole V.P. (500) Vg suppo weekly for 6 months Repeat Fluconazole 3 days after then weekly for 6 months
Partner?
Bacterial vaginosis
Decreased amount of Lactobacilli Increased amount of anaerobes Low immunity, fatigue, frequent sexual intercourse, vaginal douche Mostly asymptomatic Increased (foul-smelling) discharge
Bacterial vaginosis
Amsel criteria (3/4)
Gray-white discharge pH > 4.5 Clue cells Whiff test
Treatment:
Metronidazole (500) 1 tab PO bid pc 7 days Clindamycin (300) 1 tab PO bid pc 7 days
Trichomonas vaginitis
Anaerobic flagellated protozoa Mainly sexually transmitted Yellowish green/white discharge Itchy Dysuria, dyspareunia Vaginal mucosa inflammation colpitis macularis, strawberry cervix
Trichomonas vaginitis
Wet smear, Gram stain to rule out gonococcal infection Treatment
Metronidazole (500) 1 tab PO bid pc 7 days Clotrimazole V.P. (100) Vg suppo OD 6days
Mucopurulent cervicitis
Mucopurulent discharge Dysuria Vulval inflammation N. gonorrhoeae, C. trachomatis, HSV Gram stain intracellular gram negative diplococci
Mucopurulent cervicitis
Dual therapy Gonococcal infection
Ceftriaxone 125 mg IM stat
Chlamydial infection
Doxycycline (100) 1 tab PO bid pc 7 days Azithromycin (1g) 1 tab PO stat
Foreign Bodies
Children Adultscontraceptive devices, pessary, swabs, tampons Purulent vaginal discharge; foul-smelling, bloody Speculum; may use nasal or aural speculum Removal then antiseptics
Neoplasm
Benign/Malignant Leukorrhea purulent, foul-smelling, bloody if infected/malignant
Fecal discharge
Recto-vaginal fistula
Summary
Physiologic Pathologic
Vaginitis in infancy and childhood Senile vaginitis (Atropic vaginitis) Candidiasis Bacterial vaginosis Trichomonas vaginitis Mucopurulent cervicitis Foreign bodies Neoplasm Urinary and fecal discharge
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