Introduction:
Fluid or mucus that comes from the vagina & made up of skin cells of the vagina and cervix under the influence of the female hormone, estrogen.
Vaginal discharge is called abnormal when it occurs with the following symptoms :
- Itching of the vagina (in & around)
- Redness, pain, or swelling around the vagina.
- Foamy, greenish-yellow/ bloody discharge
- Discharge with bad smells
- Pain during urination or sex
- Pain in the lower abdomen
- Fever
Causative organisms:
- Gardnerella vaginalis
- Mycoplasma
- Candida albicans
- Trichomonas vaginalis
☝If the discharge is:
- Milky white or clear
- (oxidises to yellow or brown)
- Thin or mucoid
It is Physiological
No Treatment required, Maintain hygiene
☝If the discharge is:
- Gray in color
- Watery, profuse & bubbly
- Malodorous with fishy odor
๐
It is Bacterial vaginosis due to overgrowth of Gardnerella vaginalis and other anaerobes such as Mobiluncus species
๐Treatment is:
- Metronidazole 400 mg per oral twice a day for 5 days
- Clindamycin 300 mg per oral twice a day for 7 days or clindamycin 2% cream at night for 7 nights
- Restore pH with douches (e.g. topical Acigel or vinegar, 3–4 tbsp/L water)
- Male sexual partner usually not treated
☝If discharge is:
- White in color
- Thick (cream cheese)
- Non-odorous
๐
It is Vaginal thrush (Candidal vaginitis)
๐For Treatment we can use amphotericin, clotrimazole, econazole, isoconazole, miconazole, nystatin, ketoconazole or fluconazole.
Examples are:
- Clotrimazole 500 mg vaginal tablet stat, and/or clotrimazole 2% cream applied to vagina and vulva (for symptomatic relief) or (esp. if recurrent)
- Nystatin pessaries, once daily for 7 days and/or Nystatin vaginal cream, 4 gm once daily for 7 days or (if reluctant)
- Fluconazole 150 mg per oral as a single dose or Ketoconazole 200 mg per oral twice a day for 5 days
- Male sexual partner usually not treated (on current evidence).
- If the male is symptomatic, treat with Clotrimazole 1% + Hydrocortisone 1% topically, twice a day until 2 weeks after symptoms resolve
Along with treatment:
- Wash genital area twice/thrice a day
- Dry the area thoroughly
- Wear loose-fitting cotton underwear
- Avoid wearing tight clothing or using tampons
- Avoid vaginal douches, powders or deodorants
☝If discharge is:
- Yellow/green
- Bubbly, profuse (muco-purulent)
- Malodorous with fishy odor
๐
It is Trichomonas vaginalis
๐Treatment is:
- Oral Metronidazole 2 g as a single dose (preferable) or 400 mg bd for 7 d (if relapse) or tinidazole 2 g as a single dose
- Use Clotrimazole 2% vaginal cream daily for 3 nights during pregnancy
- Attention to hygiene
- The sexual partner must be treated simultaneously
- The male partner should use condom during intercourse
- For resistant infections a 3–7 days course of either Metronidazole or Tinidazole
☝If discharge is:
- Yellow (may be bloody)
- Thin—slight to moderate
๐
It is Atrophic vaginitis
๐Treatment is
- Oral hormone replacement therapy
- Local oestrogen cream or tab (e.g. Vagifem).The tab is preferred as it is less messy
If Vaginal discharge is present along with
- Burning while passing urine, increased frequency
- Genital complaints by sexual partners
- Low backache
๐Treatment is:
- Tab. Secnidazole 2 g OD Stat + Cap. Fluconazole 150 mg OD Stat
- Treat partners when symptomatic
- Rule out pregnancy
☝If the discharge is:
- Yellow green (from cervix)
- Thick—mucopurulent
- Usually malodorous
- Associated with Burning while passing urine, increased frequency, Genital complaints by sexual partners, Low backache
๐
It is Cervical discharge (Cervicitis)
Treatment is
- Tab. Azithromycin 1 gm OD Stat + Tab. Cefixime 400 mg OD Stat
- Treat partners when symptomatic
- Rule out pregnancy
References:
- Murtagh J, Leggat PA. John Murtagh’s General Practice Companion Handbook.
- Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
- Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
- https://www.stepwards.com/?page_id=184 photo credit
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