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Vaginal Discharge - Coggle Diagram
Vaginal Discharge
Abnormal Discharge
Characteristics
Consistency: Heavier, thicker, white and clumpy
Discoloured: grey, green, yellow, bloody
Purulent
Odour: Foul smelling
Associated symptoms: Rash, discomfort, itch
Causes
Infection, cervical polyp, vaginal foreign body, vulvar or vaginal skin disease, genital tract malignancy, genital fistula
Bacterial Vaginosis
Symptoms
Thin, white, grey vaginal discharge, pain, itching, burning, strong fish-liek odor, burning when urinating, itching on outside of vagina
Etiology
Polymicrobial replacement of normal hydrogen peroxide producing lactobaccili
Increased risk of other STIs, complications after surgery, pregnancy, recurrence of BV
Physical Exam
Amsel's Criteria (need 3/4)
Adherent, homogenous discharge, clue cells on micrscopy, pH of vaginal luif >4,5, positive whiff test (amine when adding KOH)
Diagnosis
CLinical, or Gram Stain
Present with clue cells with coccobacilli and absence of lactobacilli
Risk Factors
African america, smokers, douching, intravaginal products, sexual activity (# of partners, frequency), co-existing STI, lesbian parter with BV, antibiotic use
Treatment
Metrodinazone orally, gel, or clindamycin cream
Treat symtpomatic women incluiding pregnant patients, routine treatment of sex partners is not recommended
Vulvovaginal Cadidiasis
Risk Factors
Recent antibipotic use, sexual activity, diabetic, pregnant, immunosuppresses
Signs and Symptoms
Thick white clumpy discharge, vaginal and vulvar pruritus, pain and burning, eryhtema, and/or edema, dysuria and dyspareunia
Diagnosis and Investigations
Wet mount: Budding yeast and pseudohyphae
Whiff test negative
Gram tain: Polymorphonuclear cells, nbudding yeast, pseudohyphase
Yeast and culture speication
Treatment
Topical azoles, oral fluconazole, resistant or atypical: boric acid
May need longer courses for pregnant patients
Treatment
Metronidazole
Treat partners, abstain from intercourse, and test of cure not recommended unless symptom recurrence
Trichomonias
Characteristics
Anaerobic unicellular flagellated protozoan
infectts vagina, cervix, eruthra, bladder, glands
often aympsotmatic, and infection may persist for months-years
Symptoms
Greatly increase volume of vaginal discharge
may be malodorous, green or yellow, frothy
Significant pruritious, vulvitis, vaginitis, dysuria
Symptoms typically occur 1 week after contact
Diagnosis and Investigations
Straberry cervix due to punctate hemorrhage (rare)
Wet mount: microscopic vcisualization of motile parasite
Vulvovaginal atrophy
Signs and symptoms
Post-menopausal atrophy leading to inflammatory vaginitis
Yellow discharge, petechai,m and dry irritate feeling
Spontaneous bleeding
Treatment
Vaginal estrogen (ring, tablet or cream) - 3 months for full effect
Lichen scleorosis
Cuases
Hormonal: Premenarcha, postmenopasual
Autoimmune: alopecia, vitiligo, thyroid disorders, percicnious anemia
Sings and symptosm
Pale, thin tisue, lack of labia minoa, lack of clitorus
Diagnosis
Biopsy
Treatment
High potency topical steroid
Lihcen Simplex CHronicus
Signs and Symptoms
Eczema of vulva (itch caused by irritant
Treatmen
Minimize irritants, steroid oiintment and then taper
Physiologic Vaginal Discharge
Normal function of vagina and cervix
Mostly cervical mucous
Varies throughout menstrual cycle
thicker and stickier when low estrogen
clearer wetter more stretchy as estrogen rises
Decreases during menopause
Clear, white, variable odour
Normal vaginal flora consists of aerobic and anaerobic bacteria