VAGINAL DISCHARGE
Again, the female genital tract can be infected by all sizes of
organisms, thus a useful method for recalling the causes of a purulent
vaginal discharge is to work from the smallest to the largest organism.
Thus, we begin with herpes progenitalis and proceed to gonorrhea and
nonspecific bacterial infection (now known as Gardnerella vaginalis), trichomoniasis, and,
finally, moniliasis. This, however, does not cover all the causes of a
nonbloody vaginal discharge. Consequently, anatomy is applied as
well.
At the vulva, one encounters vulvitis, bartholinitis, and vulval
carcinoma. In the vagina, the conditions mentioned above are formed
in addition to senile vaginitis, foreign bodies, and vaginal carcinomas. One
should also not forget vesicovaginal, rectovaginal, and enteric fistulas. At
the cervix, cervicitis and endocervicitis (gonorrheal or
nonspecific), cervical polyps, and carcinomas need to be
mentioned. In the
uterus, endometritis, polyps, and carcinomas are recalled, but the latter
two conditions are usually associated with a bloody discharge. Finally,
salpingitis produces a mucopurulent discharge.
Approach to the Diagnosis
To workup a vaginal discharge, simply examining a fresh wet saline and
KOH (10%) preparation will expose the most common offenders, namely
Trichomonas and Candida. Some physicians treat all patients with negative findings on these
examinations as a nonspecific bacterial vaginitis, but this is not a
particularly scientific procedure. It is best to do a smear and culture
(especially for gonococci). Cultures are also available for Trichomonas and Candida. If
gonorrhea is suspected, material from the endocervix should be cultured.
Chlamydia cultures are routinely done in some clinics.
Obviously, if the cervix is eroded and the discharge seems to be coming from
there, biopsy and conization may be indicated. Referral to a gynecologist is
preferred if this procedure is deemed necessary; however, the primary
physician may prefer to cauterize the superficial lesions. Patients with
discharges thought to be due to lesions beyond the cervix should probably be
referred.
Other Useful Tests
-
CBC (PID)
- Sedimentation rate (PID)
- VDRL test
- Tuberculin test (pelvic tuberculosis)
- Rectal culture (gonorrhea)
- Vaginal and cervical cytology after infection subsides
(carcinoma of the cervix or endometrium)
- D & C and biopsy (endometrial carcinoma)
- Sonogram (PID)
- Laparoscopy (PID)
- Trial of systemic antibiotics
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Vaginal discharge
Read excerpts from these other book chapters related to Vaginal discharge:
Medical Books Excerpts
- ODOR
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Urethral Discharge
- "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 ]
- Breath odor, fecal
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal discharge
» Next page: AURAL DISCHARGE (OTORRHEA) (Differential Diagnosis in Primary Care)
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