Vaginal Discharge

General Consideration

Discharge per Vg

Color - White, Creamy, Yellow, Greenish

Physiological Discharge

slight discharge

• Due to Ovarian function ( mid cycle )
• Normally seen in the vulva and vagina
• Secretion from bartholins, sebaceous, sweat & apocrine glands
• Vaginal mucosa
• Cx secretion
• Fallopian tube sec

Amount

• Comfortably moist
• No enough to stain the under clothing
• Premenstrually increase amount.
• During preg.
• Sexual excitement – bartholin’s gland sec

Leucorrhoea

(Running of white substance)

More than normal amt.

• Mainly Cx component
• Fresh color— creamy
• Dries color – brownish
• Micros- mucus, epith debris, organisms, leucocytes

• Stain clothes

• Vulva soreness

• Never cause – pruritus, and offensive odour

• fear of cancer and STD

Causes of leucorrhoea

non pathological

When the normal vg secretion increases

Physiologically ↑in puberty, preg, at ovulation, premenstrually

• Active or passive congestion of the pelvic organs esp. Cx.
• Prolong ill health
• Anxiety states
• Neurosis
• Sedentary occupation ( prolong sitting )
• Standing for long period in hot atmosp.

↑ Glandular elements in the Cx

OCP ( oral contraceptive pills)

Due to develop. of ectopy on the Cx

Regular douching (misconception of genital hygene)

Discourage Regular Douching

• Regular douching does not improve genital Hygene

• Washing away naturally protective lactobacilli

• Altering the Vg pH, invite infection

Inflammatory Discharge

Infection

• Mucopurulent or frankly purulent
• Cream to yellow color
• Offensive esp. coliform bacilli
• Microscopically – pus cells
• Lesions – vulvovaginitis, cervicitis,
• endometritis

VD

Reproductive Tract Inf. (RTI)

STI infection.

Chlamydia, Gonococcus, Trichomonas

Non STD

Bacterial Vaginosis,

Candida ( Vg yeast inf. Candidiasis or Moniliasis) fungus

Vuvovaginitis

Gonococcus

Trichomonous vaginalis

Candida albican

Bacterial vaginosis

Cervicitis

Goococcal

Chlamydial

Anaerobic

Secondary infection in puerperium

Bacteria Vaginosis ( BV )

• Alteration of normal Vg Bacteria flora

↓

Loss of acid producing lactobacilli

↓

Overgrowth of predominantly anaerobic

bacteria

Dx of BV

1. Fishy Vg odour noticed following intercourse with Vg discharge
2. Grey colour, coated the Vg wall
3. pH 4.5 to 5.7
4. Microscopically ↑ No. of clue cells
5. Vg secretion + KOH →fishy ,amine like odour (Whiff test)

Treatment of BV

for anaerobic ( not for lactobacilli)

Metronidazol

• 400 mg PO tds X 7 days or
• Single oral dose 2 gm stat

Cure rate 75- 84 %

2% clindamycin cream HS X 7 days

(vaginally )

OR

Orally clindamycin 300mg BD x 7 days

Trichomonial Vaginalis

• STD
• Flagellated parasite anaerobic
• Often accompany BV

Clinical features

• Profuse purulent discharge
• Green color
• Vulva pruritus
• Vg erythema
• Strawberry Cx
• Saline drop + discharge drop – motile org
• Mertonidazol – tinidazol -95% effective
• Partner should be treated

Vulvovaginal candidiasis (moniliasis)- yeast inf.

• Candida albican
• Curdy white
• adherent discharge
• Erythematous Vg

Common in---

• Pregnancy
• Diabetes
• AB users

Treatment

Topical cream clotrimazol or nystatin

Oral antifungal- fluconazol 150 mg single dose

Investigation

History,

Clinical examination

Any Vg discharge that is frankly purulent and contain pus cells should be considered to be due to specific Vg infection

Chlamydia Trachomatis

• Most common of all bacterial STIs
• Abnormal Vg Ds
• Silently destroys Fallopian tube
• If untreated, PID, Infertility, ectopic

Rx:

Doxycyclin 500mg po bd for 7 days

OR

Azithromycin 1gm po stat