One of the most common gynecological complaint. Has to
be differentiated from physiological discharge such as in mid menstrual cycle
and during pregnancy.
The natural vaginal
discharge may vary considerably, especially under differing hormonal influences
such as puberty, pregnancy or prescribed contraception. A sudden or recent
change in discharge, especially if associated with alteration of colour and/or
smell, or vulval itch/irritation is more likely to indicate an infective cause
than a gradual or long-standing change.
Causative
organisms:
Vaginal
infection (vaginitis):
1. Trichomonas Vaginalis
2. Bacterial
vaginosis
3. Candida
albicans
Cervical
infection (cervicitis):
1 Neisseria gonorrhoea
Clinical Features
Symptoms:
1. Discharge
2. Itching
3. Vaginal soreness and smell
4. Pain during intercourse (Dyspareunia)
Signs:
Discharge from the vaginal opening. A sequel of either vaginitis or
cervicitis.
Bacterial
Vaginosis, the discharge is characteristically homogeneous
and off-white in colour. And vaginal pH is greater than 4.5.
Candidiasis,
there may be vulval and vaginal erythema, and the discharge is typically curdy in
nature. Vaginal pH is usually less than 4.5.
Trichomoniasis
tends to cause a profuse yellow or green discharge and is usually associated
with significant vulvovaginal inflammation.
Treatment
A. Vaginitis Treatment
Drug Dose Duration
} Tinidazole 2gm
oral single dose
Or
Metronidazole 400mg
oral 3/day 7 days
Plus
} Fluconazole 150
mg oral single
dose
Or
Clotrimazole 200 mg VP
each night for 3 nights
B. Cervicitis Treatment
Drug Dose Duration
} Azythromycin 1gm oral single
dose
Plus
} Cefexime 400
mg oral single dose
Or
Ceftriaxone 250 mg IM single
dose
Reference:
1 .
Davidson’s principal and practice of medicine 21th
edition.
2 .
Park textbook of preventive medicine 22th edition.
Related articales
1.
