Vaginal Discharge
Vaginal discharge is a common complaint that is often accompanied by concerns about the presence of a sexually transmitted disease. Candida may present with extremely intense, often unbearable itch. Whenever one sexually transmitted disease is identified, a search for all other STDs is indicated in an effort to treat the individual patient as well as to prevent spread to others in the community or beyond. If an STD is identified, the patient should be encouraged to inform all sexual partners of the diagnosis.
Differential Diagnosis
- Physiologic
–Many women will have a consistent, slightly clear, non-odor-producing discharge, either midcycle or premenstrually, particularly if they are on oral contraceptives
–A change in odor, consistency, or color of discharge may signify that evaluation is necessary
–Increased discharge is associated with pregnancy
- Sexually transmitted disease
–Trichomonas vaginalis: “Strawberry cervix” with punctate erythema, flagellated oval organisms on wet mount
–Gonorrhea/Chlamydia may be associated with pelvic pain/dysmenorrhea and dyspareunia
- Bacterial vaginosis
–Various organisms and changes in normal flora with a characteristic fishy odor
–Not considered an STD
–Increases the risk of preterm delivery in
pregnant women
- Alteration of normal vaginal flora and/or inflammatory response
–Candida albicans overgrowth is more common with recent antibiotic use, poorly controlled diabetes, and/or pregnancy; presents with intensely pruritic, inflamed, and erythematous introitus
–Doderlein's cytolysis (caused by an
overgrowth of lactobacilli)
-
Atrophic vaginitis
–Common in postmenopausal women, especially those not on HRT
–Poor coital lubrication, dyspareunia
–Dysuria due to atrophic urethral tissue
-
Foreign body vaginitis (e.g., retained tampon)
-
Noninfectious irritant/allergic contact vaginitis (e.g., soaps, feminine pads, perfumes)
-
Cervicitis (usually due to gonorrhea or Chlamydia)
-
Cervical dysplasia, cancer, or polyps
-
Vaginal or vulvar trauma or cancer
Workup and Diagnosis
- A focused history and physical examination are crucial, including a complete sexual and exposure history, and full abdominal and pelvic examination
–A wet mount and KOH of the discharge are imperative
–pH of the discharge may aid in diagnosis
–A whiff test is done by smelling the discharge after KOH
is added; a positive test reveals a fishy odor characteristic of bacterial vaginosis
-
Initial labs may include CBC, urinalysis, urine culture, β-hCG, and gonorrhea and Chlamydia cultures
-
Test and treat for other STDs when one STD is found (HIV, hepatitis B and C, syphilis)
| pH | Discharge | Odor | Wet Mount |
|---|
|
| Trich >4.5 | yellow-green, copious | present | motile, flagellated |
| BV >4.5 | white-grey | fishy | clue cells |
| Candida <4.5 | white, curd-like | none | pseudo-hyphae |
| GC/chlamydia | mucopurulent | varies | PMNs |
|
| Atrophic vaginitis | thin, gray, watery | none | few epithelial cells |
Treatment
-
See most recent CDC guidelines for all STDs
-
Trichomonas
–Metronidazole single dose or for 7 days (avoid alcohol with metronidazole use)
–Intravaginal clotrimazole if pregnant or unable to use metronidazole
Gonorrhea
–Oral ciprofloxacin or IM ceftriaxone
Chlamydia –Azithromycin or doxycycline orally
Bacterial vaginosis
–Metronidazole single dose or for 7 days
Candida
–Clotrimazole cream or intravaginal suppository
–Fluconazole single dose
Atrophic vaginitis
–Topical or oral hormone replacement if appropriate
Advise to avoid douching/perfumed hygiene products
>
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to Female sexual symptoms
Read excerpts from these other book chapters related to Female sexual symptoms:
Medical Books Excerpts
- Dyspareunia
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Dyspareunia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Female sexual symptoms
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Vaginal Discharge (In A Page: Pediatric Signs and Symptoms)
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