Vaginal discharge: Classification of vaginal discharge: Diffuse discharge Physiological Infectious Vaginitis Trichomonas Candida spp. Bacterial vaginosis Endocervicitis: Neisseria gonohorrhoea Chlamydia trachomatis Atrophic Irritants & allergens Localized discharge Foreign body Fistula Neoplasia Cervical discharge Physiological Pathological Endocervicitis Neoplasia Physiological vaginal discharge: Characteristics: Fluctuates with menstrual cycles (with regards to amount & consistency) No malodorous, irritating or blood stained Clear or white Non-homogenous/flocculating pH < 5 Whiff test is negative No vulvar ulcers, rash, erythema, CET Epithelial cells & lactobacilli on wet mount smear Ax: Oestrogen stimulation of lactobacilli lactic acid formation (from glycogen in the discharge) pH → → ↑ → ↓ infection non-friendly environment. (The rest of the discharge consists of endocervical mucus, exfoliated → epithelial cells & vaginal transudate) Mx: Atrophic vaginosis: General: Postmenopausal of genital atrophy Sx’s Ax: Oestrogen (MP) discharge & glycogen non-flourishing lactobacilli pH bacterial Ix ↓ → ↓ → → ↑ → 2˚ Sx: SC fat less prominent labia majora ↓ → Introitus narrows Epithelium pale & shiny → Vaginal rugae ↓ ± Small bleedings Cx smaller with smaller diameter; intravaginal portion; no endocervical mucus → ↓ ± Urethral mucosa prolapse (may be small) Dx: Vaginal pH 6.5-7.0 ↑ → On wet mount more pus cells (polymorphs) than epithelial cells AND no lactobacilli – Mx:
Vaginal discharge: Classification of vaginal discharge: Diffuse discharge Physiological Infectious Vaginitis Trichomonas Candida spp. Bacterial vaginosis Endocervicitis: Neisseria gonohorrhoea Chlamydia trachomatis Atrophic Irritants & allergens Localized discharge Foreign body Fistula Neoplasia Cervical discharge Physiological Pathological Endocervicitis Neoplasia Physiological vaginal discharge: Characteristics: Fluctuates with menstrual cycles (with regards to amount & consistency) No malodorous, irritating or blood stained Clear or white Non-homogenous/flocculating pH < 5 Whiff test is negative No vulvar ulcers, rash, erythema, CET Epithelial cells & lactobacilli on wet mount smear Ax: Oestrogen → stimulation of lactobacilli → ↑ lactic acid formation (from glycogen in the discharge) → ↓ pH → infection non-friendly environment. (The rest of the discharge consists of endocervical mucus, exfoliated epithelial cells & vaginal transudate) Mx: Atrophic vaginosis: General: Postmenopausal Sx’s of genital atrophy Ax: ↓ Oestrogen (MP) → ↓ discharge & glycogen → non-flourishing lactobacilli → ↑ pH → 2˚ bacterial Ix Sx: ↓ SC fat → less prominent labia majora Introitus narrows Epithelium → pale & shiny ↓ Vaginal rugae ± Small bleedings Cx → smaller with smaller diameter; ↓ intravaginal portion; no endocervical mucus ± Urethral mucosa prolapse (may be small) Dx: Vaginal pH ↑ → 6.5-7.0 On wet mount – more pus cells (polymorphs) than epithelial cells AND no lactobacilli Mx:
gynaecology_summary.docx