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
- Fishy Vg odour noticed following intercourse with Vg discharge
- Grey colour, coated the Vg wall
- pH 4.5 to 5.7
- Microscopically ↑ No. of clue cells
- 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
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