Vaginal discharge: Difference between revisions

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Revision as of 19:35, 2 August 2020

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2] SO

Synonyms and keywords: Discharge from the vagina

Overview

Vaginal discharge is a common patient complaint that is paired with anxiety regarding sexually transmitted diseases. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.Also there is normal vaginal discharge depends on periodic hormonal change.^[1]

Causes

Common Causes

Atrophic vaginitis or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia.^[2]
Bacterial vaginosisis mostally happen during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora.^[3]
Cervical cancer
Chlamydia,sexually transmitted infections.
Foreign body vaginitis
Gonorrhea,sexually transmitted infections
Herpes
Trichomoniasis,a parasitic infection typically contracted and caused by having unprotected sex
Vaginal cancer
Vaginal yeast infection
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

Classification

-Normal vaginal discharge as in Neonatal, Pediatric, Puberty, Menstrual cycle, Pregnancy, and Menopause. -Abnormal vaginal discharge as

Bacterial vaginosis

Vaginal yeast infection

sexually transmitted diseases

vaginal cancer

cervical cancer

Laboratory Findings

Initial tests include:

CBC
Urinalysis
Urine culture
Beta-hCG
Gonorrhea culture
Chlamydia culture

Other Diagnostic Studies

Type	pH	Discharge	Odor	Wet Mount
Trich	>4.5	yellow-green, copious	present	motile, flagellated
BV	>4.5	white-grey	fishy	clue cells
Candida	<4.5	white, curd-like	none	pseudo-hyphae
GC		mucopurulent	varies	PMNs
A.V.		thin, gray, watery	none	few epithelial cells

Treatment

See most recent CDC guidelines for all STD's

Acute Pharmacotherapies

Bacterial Vaginosis

Metronidazole single dose for 7 days

Candida and Chlamydia

Gonorrhea

Oral ciprofloxacin or IM ceftriaxone

Trichomonas

Metronidazole single dose for 7 days
Intravaginal clotrimazole if pregnant or unable to use Metronidazole

References

↑ Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://www.ncbi.nlm.nih.gov/pubmed/18048541 Check |pmid= value (help).
↑ Hainer BL, Gibson MV (2011). "Vaginitis". Am Fam Physician. 83 (7): 807–15. PMID 21524046.
↑ Cettl L, Dvorak J, Felkel H, Feuereisl R (1979). "Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement". Int J Biomed Comput. 10 (1): 67–74. doi:10.1016/0020-7101(79)90042-4. PMID http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 Check |pmid= value (help).

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources

[pmidhttps://www.ncbi.nlm.nih.gov/pubmed/18048541-1] Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://www.ncbi.nlm.nih.gov/pubmed/18048541 Check |pmid= value (help).

[pmid21524046-2] Hainer BL, Gibson MV (2011). "Vaginitis". Am Fam Physician. 83 (7): 807–15. PMID 21524046.

[pmidhttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688-3] Cettl L, Dvorak J, Felkel H, Feuereisl R (1979). "Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement". Int J Biomed Comput. 10 (1): 67–74. doi:10.1016/0020-7101(79)90042-4. PMID http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 Check |pmid= value (help).

[1]

[2]

[3]

@@ Line 14: / Line 14: @@
 ===Common Causes===
 * [[Atrophic vaginitis]] or senile vaginitis, it as a result of estrogen deficiency lead to vaginal dryness, itching, irritation, discharge, and dyspareunia.<ref name="pmid21524046">{{cite journal| author=Hainer BL, Gibson MV| title=Vaginitis. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 7 | pages= 807-15 | pmid=21524046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21524046  }} </ref>
-* [[Bacterial vaginosis]]is mostally happen  during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora.{{cite journal |vauthors=Onderdonk AB, Delaney ML, Fichorova RN |title=The Human Microbiome during Bacterial Vaginosis |journal=Clin. Microbiol. Rev. |volume=29 |issue=2 |pages=223–38 |date=April 2016 |pmid=26864580 |pmc=4786887 |doi=10.1128/CMR.00075-15 |url=}}
+* [[Bacterial vaginosis]]is mostally happen  during the reproductive age of women characterized by a shift in the vaginal flora from the dominant Lactobacillus to a polymicrobial flora.<ref name="pmidhttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688">{{cite journal| author=Cettl L, Dvorak J, Felkel H, Feuereisl R| title=Results of simulation of non-homogeneous ventilatory mechanics for a patient-computer arrangement. | journal=Int J Biomed Comput | year= 1979 | volume= 10 | issue= 1 | pages= 67-74 | pmid=http://www.ncbi.nlm.nih.gov/pmc/articles/pmc478688 | doi=10.1016/0020-7101(79)90042-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=478688  }} </ref>
 * [[Cervical cancer]]
 * [[Chlamydia]],sexually transmitted infections.

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)