Leukorea

1. Leukorrhea ชชชชชชช ชชชชชชชชชชชชช ท
อแสง ชโยวรรณ
2. Leukorrhea • Increased vaginal discharge • Physiologic/Pathologic
3. Normal Vaginal Discharge • Creamy white discharge – Vulvar secretion • Bartholin glands • Sweat
glands • Sebaceous glands • Skene glands – Vagina – Cervix – Endometrial glands – Fallopian tubes
4. Normal Vaginal Discharge • Increased when – Ovulation—endocervical glands – Premenstrual phase –
Pregnancy – Sexual excitement—Bartholin’s glands • pH < 4.5
5. Physiological Vaginal Discharge – Newborns – Puberty – Congestion of pelvic organs – Cervical
ectopian – Contraceptives – Vaginal douche
6. Pathological Vaginal Discharge – Vaginitis in infancy and childhood – Senile vaginitis (Atrophic vaginitis)
– Candidiasis – Bacterial vaginosis – Trichomonas vaginitis – Mucopurulent cervicitis – Foreign bodies –
Neoplasm – Urinary and fecal discharge
7. Vaginitis in infancy and childhood • Low immunity • Age 1-5 years • Infection/Foreign body/Tumor •
Wet smear, Gram stain, culture, speculum • Treatment – Rest – antibiotics – estrogen
8. Atrophic vaginitis • Postmenopause • Decreased estrogen – Vaginal wall thining – Decreased acidic
environment • Yellow/Green/Bloody • Pruritic/Painful • Dysuria • Dyspareunia/Postcoital bleeding •
Vaginal wall thining, colpitis macularis, patchy ulceration, adhesive vaginitis
9. Atrophic vaginitis • PAP smear, Gram stain, culture • +- Cervical biopsy, Fractional curettage •
Treatment: – Antibiotics – estrogen (local/systemic)
10. Candidiasis • Yeast cells/Pseudohyphae • Inflammation and curd-like discharge • Predisposing
factors – Diabetes – Obesity – Pregnancy – Antibiotics – Contraceptives – Low immunity – Premenstrual
period
11. Candidiasis • KOH preparation, Gram stain (positive) • Subouraud’s/Nicerson’s media culture •
Treatment: – Uncomplicated • Clotrimazole V.P. (100) Vg suppo OD 6days • Clotrimazole V.P. (200) Vg
suppo OD 3days • Itraconazole (400) PO stat • Fluconazole (150) PO stat – Complicated • Clotrimazole
V.P. (100) Vg suppo OD 14 days then Clotrimazole V.P. (500) Vg suppo weekly for 6 months • Repeat
Fluconazole 3 days after then weekly for 6 months • Partner?
immunity, fatigue, frequent sexual intercourse, vaginal douche • Mostly asymptomatic • Increased
(foul-smelling) discharge
13. Bacterial vaginosis • Amsel criteria (3/4) – Gray-white discharge – pH > 4.5 – Clue cells – Whiff test •
Treatment: – Metronidazole (500) 1 tab PO bid pc 7 days – Clindamycin (300) 1 tab PO bid pc 7 days

2. 14. Trichomonas vaginitis • Anaerobic flagellated protozoa • Mainly sexually transmitted • Yellowish
green/white discharge • Itchy • Dysuria, dyspareunia • Vaginal mucosa inflammation • colpitis macularis,
strawberry cervix
15. Trichomonas vaginitis • Wet smear, Gram stain to rule out gonococcal infection • Treatment –
Metronidazole (500) 1 tab PO bid pc 7 days – Clotrimazole V.P. (100) Vg suppo OD 6days • Must also
treat partners, no intercourse until resolved
16. Mucopurulent cervicitis • Mucopurulent discharge • Dysuria • Vulval inflammation • N. gonorrhoeae,
17. Mucopurulent cervicitis • Dual therapy • Gonococcal infection – Ceftriaxone 125 mg IM stat •
Chlamydial infection – Doxycycline (100) 1 tab PO bid pc 7 days – Azithromycin (1g) 1 tab PO stat • Must
also treat partners, no intercourse until resolved
Foreign Bodies • Children • Adults—contraceptive devices, pessary, swabs, tampons • Purulent vaginal
discharge; foul-smelling, bloody • Speculum; may use nasal or aural speculum • Removal then
antiseptics
19. Neoplasm • Benign/Malignant • Leukorrhea • purulent, foul-smelling, bloody if infected/malignant
20. Urinary and fecal discharge • Urinary discharge – Urethro-vaginal fistula – Vesico-vaginal fistula –
Uretero-vaginal fistula • Fecal discharge – Recto-vaginal fistula
21. Summary • Physiologic • Pathologic – Vaginitis in infancy and childhood – Senile vaginitis (Atropic
vaginitis) – Candidiasis – Bacterial vaginosis – Trichomonas vaginitis – Mucopurulent cervicitis – Foreign
bodies – Neoplasm – Urinary and fecal discharge