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VAGINAL DISCHARGE

VAGINAL DISCHARGE. VAGINAL DISCHRGE. OBJECTIVES : 1.WHAT IS LEUCORRHOEA? 2.IS IT NORMAL? 3. NORMAL VS BNORMAL 4.CLASSIFICATION 5.COMMON CAUSES 6.CLINICAL FEATURES 7.EVALUATION 8.MANAGEMENT. LEUCORRHOEA. EXECESSIVE VAGINAL DISCHARGE NOT DUE TO INFECTION(EXECESSIVE

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VAGINAL DISCHARGE

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  1. VAGINAL DISCHARGE

  2. VAGINAL DISCHRGE OBJECTIVES : 1.WHAT IS LEUCORRHOEA? 2.IS IT NORMAL? 3. NORMAL VS BNORMAL 4.CLASSIFICATION 5.COMMON CAUSES 6.CLINICAL FEATURES 7.EVALUATION 8.MANAGEMENT

  3. LEUCORRHOEA • EXECESSIVE VAGINAL DISCHARGE NOT DUE TO INFECTION(EXECESSIVE CERVICAL MUCUS OR VAGINAL TRANSUDATION) ECTROPION, CERVICAL TEARS.

  4. IS VAGINAL DISCHARGE NORMAL? • COULD BE PATHOLOGICAL • YES –SOME SITUATIONS IT CAN BE - PUBERTAL - PREGNANCY - PREMENSTRUAL - OC PILLS -SCANTY,NO SMELL,WHITISH,NO ITCHING NOT BLOOD STAINED.

  5. PHYSIOLOGY OF THE VAGINA • The vagina is lined by non-keratinized stratified squamous epithelial influenced by estrogen and progesterone • In children the pH of the vagina is 6-8 predominant flora is gram positive cocci and bacilli • At puberty, the vagina estrogenized and glycogen content increase.

  6. Lactobacilli (Duoderline Bacilli) Convert glycogen to lactic acid pH of the vagina is 3.5-4.5

  7. Vaginal Ecosystem • Dynamic equilibrium between microflora and metabollic by products of the microflora, host estrogen and vaginal pH • The predominant organism is aerobic

  8. Factors affecting the vaginal Ecosystem • Antibiotics • Hormones or lack of hormones • Contraceptive preparations • Douches • Vaginal Medication • Sexual trauma • Stress • Diabetes Mellitus • Decrease host immunity – HIV + STEROIDS

  9. Vaginal Desquamated Tissue • Reproductive age – superfacial cells (est) • Luteal phase- Intermediate cells (prog) • Postmenopausal women- parabasal cells ( absence of hormone)

  10. NORMAL CERVIX

  11. CLASSIFICATION • PHYSIOLOGICAL • PATHIOLOGICAL - INFECTIVE - NON INFECTIVE- NEOPLASTIC - ATROPHIC - ALLERGIC,FB

  12. INFECTIVE CAUSES • VAGINAL - CANDIDA VAGINITIS - TRICHOMONIAL VAGINITIS - BACTERIAL VAGINOSIS • CERVICAL - GONORRHOEA CERVICITIS - CHLAMYDIA CERVICITIS

  13. CANDIDA VAGINITIS AGE- 20-40Y COMMON IN – PREGNANCY DIABETIC OBESE WOMEN FEATURES - CURDY WHITE,ITENSE ITCHING EXCORATION OF VULVA SMEAR- 10%KOH-FUNGAL HYPHE SEEN TREATMENT-CLOTRIMAZOLE-100MG BDx7D 200MGBDx3D RECURRENT -FLUCONOZLOE 150 MG WX4W

  14. Symptoms: 20% asymptomatic • Pruritus • Vulvar burning • External dysuria • Dyspareunia • Vaginal discharge ( white, highly viscous, granular, has no odor)

  15. Signs • Erythema • Oedema • Excoriation • Pustules • Speculum: cottage cheese type of discharge • Adherent thrush patches attached to the vaginal wall - pH is < 4.5

  16. Investigation 1.Clinical 2. pH of the vagina norma < 4.5 3. Fungal element either budding yeast form or mycelia under the microscope 4. Whiff test is negative 5. Culture with Nickerson or Sabouraud media (Candida tropicalis)

  17. CANDIDA VAGINITIS

  18. CANDIDA VAGINITIS

  19. Management • Standard • Topically applied azole ( nystatin) - 80% - 90% relief 3. Oral antifungal (Fluconazole) 4. Adjunctive treatment topical steroid - 1% hydrochortisone

  20. TRICHOMONIAL VAGINITIS • AGENT - TRICHOMONIA VAGINALIS • AGE -20-40YRS,SEX ACTIVITY FEATURES GREENISH,FROTHY,COPIOUS,ITCHING STRAWBERRY SPOTS ON VAGINA VAG. SMEAR-MOTILE ORGANISMS TREATMENT- METRONIDAZOLE - 200XBDX7D OR400XBDX3 -COUPLE TREATED TOGETHER

  21. TRICHOMONIAL VAGINITIS

  22. BACTERIAL VAGINOSIS AGENT–G.VAGINALIS+ANAEROBIC AGE -20-40 YRS FEATURES-WHITISH GREY,COPIOUS NO ITCHING,FISHY SMELL VAG.SMEAR-CLUE CELLS TREATMENT-METRONIDAZOLE500XBD X7DAYS

  23. SIGNS AND SYMPTOMS Symptoms: • 30-40% asymptomatic • Unpleasant vaginal odour (musty or fishy odor) • Vaginal discharge: thin, grayish, or white Signs: • Discharge is not adherent to the vagina, itching, burning is not usual

  24. BACTERIAL VAGINOSIS

  25. Diagnosis: • pH: 5-6.5 • Positive odor test- mix discharge with 10% KOH – fishy odor(metabollic by product of anaerobic amins the Whiff test) • Absence of irritation of the vagina and vulvar epithelium • Wet smear – clue cells -Vaginal epithelial cells with clusters of bacteria adherent to their external surface (2% - 5%). -Wet smear shows absent and lack of inflammatory cells.

  26. Complication • Increase risk of pelvic inflammatory disease • Post operative cuff infection after hysterectomy • In pregnancy, it increase the risk of premature rupture of membrane • Premature labour, chorioamnionitis, endometritis

  27. Management • Metronidazole 500 mg twice daily for 7 days Cure is 85% it fall to 50% if the partner is not treated • Clindamycine 300 mg twice daily • Vaginal

  28. HOW TO ASSES..? DETAILED HISTORY COLOUR AMOUNT,SMELL,ITCHING RELATION TO COITUS /MENSES,pH CLINICAL EXAMINATION-EX GENITAL P/S EXAM INVESTIGATIONS-VAGINAL SMEAR -CULTURE

  29. CERVICAL INFECTIONS GONORRHOEA-NEISS. GONORRHOEAE -85 %ASYMPTOMATIC - MUCOPURULANT - SMEAR FROM CX O&URETHRA - INTRACELL. GM –VE DIPLOCOCCI -SINGLE DOSE CEFETRIOXONE

  30. CERVICAL INFECTIONS • CLAMYDIA-CL.TRACHOMATIS • AGE -20-40 • MUCOPURULANT • SEXUAL TRANSMITTED • FLOROSCENT ANTIBODY TEST/CULT. • DOXYCYCLINE 100XBDX7D

  31. CERVICAL INFECTIONS

  32. IDENTIFY

  33. IDENTIFY

  34. THANK YOU

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