Vaginal discharge
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2] Samah Obaiah
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[4]
- Chlamydia,sexually transmitted infections.
- Foreign body vaginitis
- Gonorrhea,sexually transmitted infections[4]
- Herpes[5]
- Trichomoniasis,a parasitic infection typically contracted and caused by having unprotected sex[6]
- 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[7], Pregnancy, and Menopause. -Abnormal vaginal discharge as
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). - ↑ 4.0 4.1 4.2 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/j.ogrm.2016.08.002 Check
|pmid=value (help). - ↑ Wathne B, Holst E, Hovelius B, Mårdh PA (1994). "Vaginal discharge--comparison of clinical, laboratory and microbiological findings". Acta Obstet Gynecol Scand. 73 (10): 802–8. doi:10.3109/00016349409072509. PMID https://pubmed.ncbi.nlm.nih.gov/7817733 Check
|pmid=value (help). - ↑ Spence D, Melville C (2007). "Vaginal discharge". BMJ. 335 (7630): 1147–51. doi:10.1136/bmj.39378.633287.80. PMC 2099568. PMID https://pubmed.ncbi.nlm.nih.gov/18048541 Check
|pmid=value (help). - ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID https://pubmed.ncbi.nlm.nih.gov/25905282 Check
|pmid=value (help).
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