Vaginal discharge resident survival guide

Vaginal discharge Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Non-sexually transmitted infection

• Bacterial vaginosisis mostly happens during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora.
• Vaginal yeast infection

Sexually transmitted infection

• Chlamydia,sexually transmitted infections.
• Gonorrhea,sexually transmitted infections
• Herpes
• Trichomoniasis,a parasitic infection typically contracted and caused by having unprotected sex

Non-infective causes

Physiological:

• Puberty
• Menstrual Cycle
• Sexual Activity
• Pregnancy
• Menopause

Non-physiological:

• Foreign body vaginitis
• Cervical cancer
• Vaginal cancer
• Diabetes
• Drug side effect as antibiotic or steroid use as, Amoxicillin and Clavulanic Acid , Butoconazole Vaginal Cream , Clotrimazole , Combined oral contraceptive pill, Estradiol Topical , Estradiol Transdermal , Estrogen and Progestin (Oral Contraceptives) ,Estrogen Injection , Estrogen Vaginal , Etonogestrel and Ethinyl Estradiol Vaginal Ring , Glatiramer Injection ,Hormone replacement therapy (trans), Letrozole, Leuprolide , Medroxyprogesterone Injection , Metronidazole Topical ,Miconazole , Nafarelin , Natalizumab injection , Norelgestromin and ethinyl estradiol transdermal system , Ospemifene, Oxcarbazepine , Pramipexole, Progesterone, Tamoxifen , Terconazole Vaginal Cream, Vaginal Suppositories , Toremifene, Zoledronic Acid Injection
• Gynaeocological causes:
  • Atrophic vaginitis or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia.
  • Vulval dermatitis
  • Cervical ectopy

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Vaginal discharge.

Patient with history of Vaginal discharge

Take complete history

Record the vitals: ❑ Blood pressure ❑ Temperature ❑ Respiratory rate ❑ Heart rate

Ask the following questions about menstrual history : ❑ Age of menarche ❑Last menstrual period ❑Is the menstrual flow normal? How many pads she has to use in a day? ❑Is there any foul smell or colour change? ❑How many days does the menstrual period stay? ❑Contraceptive history for example oral contraceptives, intrauterine device

Ask the following questions about general health : ❑ Ask about medical and drug history including recent antibiotic use and type of contraceptive use ❑ Assess for the possibility of a foreign body in situ ❑Ask if there was any surgery or instrumentation to the genital region recently ❑Is there any other health conditions like Diabetes Mellitus? ❑ Is there any history of fever, lower abdominal pain?

Ask the following questions about colour, appearance of the discharge

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Dos

• The use of topical azole formulations can weaken latex condoms and diaphragms. This risk should be mentioned to the woman prior to starting these medications.
• Referral to a gynaecologist should be considered if there is a history of recent instrumentation or surgery of the genital tract, retained foreign body, cervical ectopy or polyp, or suspicion of tumour on examination; or in women with symptoms of upper genital tract infection or recurrent vulvovaginal candida infections, pregnant women with abnormal vaginal discharge, or women who have failed routine treatment strategies.

Don'ts

• Patient should be advised to avoid tight-fitting synthetic clothing.
• Patient should be told to avoid local irritants such as perfumed products and soap gels, and vaginal douching.
• There is no clear and consistent evidence across currently published studies regarding the role of probiotics for vaginal health.

References

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