2. I. Due to specific infections
II. Due to sensitive reaction
III. Due to vg discharge or urinary contamination
BACTERIAL:
1. Pyogenic (non gonoccocal)
2. STD: gonorrhea, syphilis, chancroid, LGV, granuloma
inguinale
3. Tubercular
VULVAL INFECTIONS
3. VIRAL: condyloma acuminata, H. genitalis, H. zoster,
molluscum
FUNGAL: moniliasis, ringworm
PARASITIC: pediculosis, scabies, threadworm
Bartholinitis- gonococcal, junction of ant 2/3rd post 1/3rd ,
painful swelling, dyspareunia, t/t by marsupialization.
4. NORMAL VAGINA:
Composed of secretions from skene, bartholin, sweat glands, vulva,
endometrium, cervix (alkaline), squamous cells, micro organisms m/c
lactobacilli.
Vaginal epithelial cells: superficial (estrogen responsive), intermediate
(progesterone), parabasal (E & P absence)
Vaginal flora: E stimulated epithelial cells are rich in glycogen broken
down by epithelial cells to monosacharrides & by lactobacilli
producing lactic acid (ph <4.5)
Normal secretions: floccular, white, located in post fx, leucorrhea-
pregnancy, early puerperium, ovulation, before menstruation
Moderate increase: freq change of under garments
Excessive: use of pad
VAGINAL INFECTIONS
5. Structure: superficial, middle & deep (basal and parabasal)
layer. Cornification index for E activity.
Acidity: Newborn- 5.7, children- 6-8, puberty-4, childbearing
period-4.5, pregnancy-4, menopause-7.
Defence: stratified sq epi, no glands, low ph
VAGINITIS: vulvovaginitis in childhood, trichomoniasis,
moniliasis, vaginitis by chlamydia, atrophic vaginitis,
nonspecific vaginitis, TSS, bacterial vaginosis.
6. BACTERIAL VAGINOSIS
Alteration in flora. Lactobacilli, ph, h2o2, gardnerella(m/c),
mobilincus, H. vaginalis, M. hominis.
c/o white discharge without itching.
Characteristics:
1. Gray, thinly coat vg wall.
2. Fishy odour (whiff test)
3. Ph >4.5
4. Clue cells. Advanced cases >20%
Complications: PID, cuff cellulitis, miscarriage, PROM, Preterm,
endometritis
Dx: A) Amsel’s criteria: homogenous vg discharge, ph>4.5, whiff
test+(10% KOH), clue cells(cells covered with coccobacilli appear as
stippled/ granular)>20%. B) Gram stain
T/t: Metronidazole 500mg BD 7 days po or 0.75% gel OD intravg 5 days,
clindamycin 2% cream or 300mg OD 7 days, Lacteal gel LA
7. VULVOVAGINITIS IN CHILDHOOD
Due to lack of E
CAUSES: non specific, foreign body, intestinal
infestation, candida, gonococcus.
C/F: pruritus, discharge, painful micturation
I/v: gram stain, culture, vaginoscopy
T/t: hygiene, E cream.
8. 2nd m/c
CAUSED BY: trichomonas vaginalis (protozoa)
MODE: sexual contact
PATHO: thrive when defence is gone
C/F:
1. Profuse, thin, greenish, creamy, irritating, frothy, offensive discharge
2. Angry looking vg, strawberry vg, punctate h’agic spots, pruritus
3. Urinary symp, abd pain, dyspareunia.
Dx :
1. Wet mount prep/ hanging drop
2. Culture with added antibiotics
T/t: Metronidazole 200mg TID 7day, vinegar douching or betadine gel in
pregnancy, recurrent inf by tinidazole & vg pessary, use of condom
TRICHOMONAS VAGINITIS