Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
9. Physiological Vaginal Discharge
• White or clear
• Thick or thin
• Mostly odorless/ slight odor
• Normal vaginal discharge in reproductive aged
women
10. HISTORY TAKING
History of Presenting Complaint
•Color
•Odour
•Presence of blood
•Relationship to the menstrual cycle
•Associated symptoms
11. Past Medical History
Sexual History
Obstetric History
Gynaecological History
Contraceptive History
Menstrual History
Drug History
Family History
Social History
12. NATURE OF THE DISCHARGE
Physiological
Clear/ white
Gonnorrhoea, Pelvic inflammatory disease,
Chlamydia
Mucopurulent
Vulvovaginal candidiasis
Thick, curdy
Trichomonasis
Frothy, yellowish
green
Bacterial vaginosis
Greyish white
16. CLINICAL FEATURES
• Endocervical mucopurulent discharge
• When complicated with PID
• Dysuria
• Lower abdominal pain
• Post coital and intermenstrual bleeding.
17. GONOCOCCAL INFECTION
• Pathogen – Neisseria gonorrhoeae
• Intracellular Gram negative diplococci
• Mainly affect endocervix
• 50% of females are asymptomatic
• I.P. 2-7 days
• Common age of onset 15 - 24
18. COMPLICATIONS
• Bartholin’s abscess
• Pelvic inflammatory disease
• Due to ascending infection
• Disseminated gonococcal infections
• Fever,
• Septic arthritis,
• Blisters near small joints
• Perihepatitis, infertility
• Mother to child transmission
• Opthalmia neonatorum
Opthalmia neonatorum
20. INVESTIGATIONS
Microscopy of Gram stained endocervical smear for Gonorrhea
• Gram negative intracellular diplococci
• Rapid diagnosis
Culture for Gonorrhea
• Thayer Martin medium- gray colonies
Nucleic acid amplification test (NAAT)
• Vulvovaginal swab is used
21. TREATMENT
•Cefexime 400mg stat
•IM Ceftriaxone 250mg
•Partner tracing and Epidemiological
treatment to the partner
•Avoid sexual relationships until both
partners complete treatments
27. INVESTIGATIONS
• Microscopy (Not diagnostic nor confirmatory)
• Polymorphonuclear leukocytes > 30,
• under high power
• In absence of intracellular diplococci
• diagnosed as non gonococcal cervicitis
• Nuclear amplification test (Diagnostic)
28. TREATMENT
• Doxycyclin 100mg / bd for 7 days or
azithromycin 1g stat
• Azithromycin during pregnancy
• Partner tracing and Epidemiological
treatment to the partner
• Avoid sexual relationships until both
partners complete treatments
30. CLINICAL FEATURES
• Profuse frothy yellow/gray discharge with foul odor
• Dysuria
• Abdominal discomfort
• Vulval itching
• Dyspareunia
• Rare – strawberry cervix (multiple hemorrhagic
areas in cervix )
31. Trichomonas vaginalis
• Cause trichomoniasis
• Most common STI worldwide
• Flagellated protozoa
• Mainly affects vagina, urethra and para urethral
glands.
• 10- 50% of females are asymptomatic.
32. • In pregnancy
• Preterm birth
• Low birth weight
COMPLICATIONS
• Secretions from the posterior fornix is
collected into the swab
• Observe under microscope
SAMPLES
33. INVESTIGATIONS
Microscopy
• Prepare wet smear (normal saline)
• Observed for motile
• Flagellated organism immediately
• Staining with Giemsa
Culture
• Modified diamond TYM medium
34. TREATMENTS
• Metronidazole 400mg – 500 mg / bd for 7
days
• Partner tracing and epidemiological
treatment to the partner
• Avoid sexual relationships until both
partners complete treatments
45. DIAGNOSTIC CRITERIA
• Presence of clue cells on microscopic examination
• clue cells are epithelial cells covered with bacteria giving
a characteristic stipped appearance on examination
• Yellowish grey discharge seen on naked eye
examination
• Vaginal pH more than 4.5
• Release of characteristic fishy odor on addition of
alkali
• 10% KOH
For diagnosis of bacterial vaginosis at least three criteria
should be present.
48. Case scenario 1
• 27 year old female, presenting with a
mucopurulent vaginal discharge for 1 day, also
complains of dysuria,lower abdominal pain and
post coital bleeding. She has a recent history of
having unprotected sex.
49. Case scenario 2
• 27 year old female, presenting with a profuse
frothy yellow/gray discharge with foul odor for 1
day also complains of dysuria, vulval itching and
dyspareunia. She has a recent history of having
unprotected sex.
50. Case scenario 3
• 25 year old female, presenting with a thick curdy
vaginal discharge for 1 day, also complains of
external dysuria, vulval itching & soreness.
51. Case scenario 5
• 33 year old female, presenting with a creamy
vaginal discharge with a fishy odor for 2 days, no
vulval itching or soreness.
52. REFERENCES
• Kumar and clark clinical medicine 9th edition
• Gynaecology byTen Teachers 19th edition
• Medical Microbilogy Greenwood 18th edition
• www.cdc.gov