Scribd
Upload
274 views39 pages

Women's STI Clinic Guide

This document discusses common causes of vaginal discharge, including physiological discharge as well as infections like gonorrhea, chlamydia, trichomoniasis, vulvovaginal candidiasis, bacterial vaginosis, and others. For each condition, it describes clinical features, causative organisms, investigations like microscopy and cultures, treatment options, and potential complications. Differential diagnosis of vaginal discharge involves taking a history and examining the discharge's characteristics, odor, and relationship to the menstrual cycle to determine if the cause is infectious or non-infectious. Proper diagnosis and treatment are important to prevent complications like pelvic inflammatory disease and infertility.

Uploaded by

Ali Sohail
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
274 views39 pages

Women's STI Clinic Guide

This document discusses common causes of vaginal discharge, including physiological discharge as well as infections like gonorrhea, chlamydia, trichomoniasis, vulvovaginal candidiasis, bacterial vaginosis, and others. For each condition, it describes clinical features, causative organisms, investigations like microscopy and cultures, treatment options, and potential complications. Differential diagnosis of vaginal discharge involves taking a history and examining the discharge's characteristics, odor, and relationship to the menstrual cycle to determine if the cause is infectious or non-infectious. Proper diagnosis and treatment are important to prevent complications like pelvic inflammatory disease and infertility.

Uploaded by

Ali Sohail
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 39

Vaginal Discharge

Dr.Nagina
Introduction

Common presentation of women to the


STI clinic
Can be physiological or pathological
Related with some common STIs
VAGINAL DISCHARGE
Secretions produced by the
glands of vaginal wall and
cervix that drain from the
vaginal opening
Differential Diagnosis
NON-INFECTIOUS VAGINAL
DISCHARGE
INFECTIOUS VAGINAL
DISCHARGE
Physiological Vaginal Discharge
White or clear
Thick or thin
Mostly odorless/ slight odor
Normal vaginal discharge in reproductive
aged women
History of Presenting Complaint
Color
Odour
Presence of blood
Relationship to the menstrual cycle
Associated symptoms
NATURE OF THE DISCHARGE
EXAMINATION
Patient is examined in the lithotomy
position
A speculum can be inserted
GONORRHOEA
CLINICAL FEATURES:
Endocervical mucopurulent discharge
When complicated with PID
Dysuria
Lower abdominal pain
Post coital and intermenstrual bleeding.
Pathogen – Neisseria gonorrhoeae
Mainly affect endocervix
50% of females are asymptomatic
I.P. 2-7 days
Common age of onset 15 - 24
GONORRHOEA
COMPLICATIONS
Bartholin’s abscess Blisters near small
Pelvic inflammatory joints
disease Perihepatitis
Due to ascending infertility
infection Mother to child
Disseminated transmission
gonococcal infections Opthalmia neonatorum
Fever
Septic arthritis
INVESTIGATIONS
Microscopy of Gram stained endocervical smear
for Gonorrhea:
Gram negative intracellular diplococci
Rapid diagnosis
Culture for Gonorrhea
Thayer Martin medium- gray colonies
Nucleic acid amplification test (NAAT)
Vulvovaginal swab is used
TREATMENT
Cefexime 400mg stat
IM Ceftriaxone 250mg
Partner tracing and Epidemiological
treatment to the partner
Avoid sexual relationships until both
partners complete treatments
CHLAMYDIA
CLINICAL FEATURES:
Purulent, mucopurulent discharge
When complicated with PID:
 Dysuria
 Lower abdominal pain
 Post coital and inter-menstrual bleeding.
 Dyspareunia

Chlamydia trachomatis
Gram negative obligatory intracellular bacteria
Nearly 70% of females are asymptomatic
COMPLICATIONS
Pelvic inflammatory disease
Cause ectopic pregnancy and infertility
Perihepatitis
Sexually acquired reactive arthritis
In pregnancy
Pre-term births
Post-partum infections
Opthalmia neonatarum
INVESTIGATIONS
Microscopy (Not diagnostic nor
confirmatory)
Polymorphonuclear leukocytes > 30
under high power
 In absence of intracellular diplococci
diagnosed as non gonococcal cervicitis
Nuclear amplification test (Diagnostic)
TREATMENT
Doxycyclin 100mg / bd for 7 days or
azithromycin 1g stat
Azithromycin during pregnancy
Partner tracing and Epidemiological
treatment to the partner
Avoid sexual relationships until both
partners complete treatments
TRICHOMONASIS
CLINICAL FEATURES:
Profuse frothy yellow/gray discharge with foul odor
Dysuria
Abdominal discomfort
Vulval itching
Dyspareunia
Rare – strawberry cervix (multiple hemorrhagic areas in cervix )
Trichomonas vaginalis
Most common STI worldwide
Flagellated protozoa
Mainly affects vagina, urethra and para urethral glands.
10- 50% of females are asymptomatic.
COMPLICATIONS
In pregnancy
Preterm birth
Low birth weight
SAMPLES
Secretions from the posterior fornix is
collected into the swab
Observe under microscope
INVESTIGATIONS
Microscopy:
Prepare wet smear (normal saline)
Observed for motile
Flagellated organism immediately
Staining with Giemsa
Culture:
Modified diamond TYM medium
TREATMENTS
Metronidazole 400mg – 500 mg / bd for 7
days
Partner tracing and epidemiological
treatment to the partner
Avoid sexual relationships until both
partners complete treatments
Vulvovaginal Candidiasis
CLINICAL FEATURES:
Thick white (curd like) non offensive vaginal discharge
Vulval itching
Vulval soreness
Superficial Dyspareunia (due to the vulval irritation)
Signs –
 Erythema
 Fissuring
 Vulval oedema

Oval budding fungus


Pathogen – 80-92% Candida albicans
PREDISPOSING FACTORS
Diabetes mellitus
Long term steroids
Pregnancy
Prolonged antibiotic use
Immune suppression

SAMPLES: Vaginal swabs from lateral fornix


INVESTIGATION
Microscopy of vaginal smear
Gram stain or
wet film examination (KOH)
Hyphae and spores

Culture
Sabouraud agar medium
TREATMENT
Good hygiene
Remove predisposing factors
Oral Triazoles drugs- Fluconazole 150mg stat or
Itraconazole 200mg bd
Topical applications- Clotrimazole, Miconazole,
Nystatin
Pessaries and clotrimazole cream intravaginally
daily for 7-14 days
No epidemiological treatment for partner
BACTERIAL VAGINOSIS
CLINICAL FEATURES:
Greyish white homogenous vaginal discharge
Offensive fishy odor
No vaginal inflammation
Non- sexually transmitted infection
Frequent cause for vaginal discharge
Anaerobic or facultative aerobic bacteria
Normal vaginal flora of lactobacilli are replaced by
overgrowth of: Gardenerella vaginalis, Prevotella spp,
Mycoplasma hominis , Mobiluncus spp
Vaginal PH > 4.5
PREDISPOSING FACTORS
Vaginal douching
Oral sex
Smoking
Antibiotic use
Recent change in sex partner
IUCD
INVESTIGATIONS
Microscopy
Gram stained smear of vaginal discharge
(presence of clue cells)
DIAGNOSTIC CRITERIA
Presence of clue cells on microscopic examination
clue cells are epithelial cells covered with bacteria giving
a characteristic stipped appearance on examination
Yellowish grey discharge seen on naked eye
examination
Vaginal pH more than 4.5
Release of characteristic fishy odor on addition of
alkali
10% KOH

For diagnosis of bacterial vaginosis at


least three criteria should be present
TREATMENT
Metronidazole
400mg – 500 mg / bd for 7 days
Or 2g stat
Non-infective causes of vaginal discharge

Retained foreign bodies


Foul-smelling discharge
Cervical polyps
Intermenstrual bleeding
REFERENCES
Gynaecology byTen Teachers 19th edition
Medical Microbilogy Greenwood 18th
edition
www.cdc.gov

You might also like