PATHOLOGIC VAGINAL DISCHARGE Common causes in lower genital tract 1)Bacterial vaginosis 2)Candidal vulvo vaginitis 3) Trichomonas vaginalis Bacterial Vaginosis Affects 25% of women 50% of women asymptomatic Commonest cause of vaginal complaint. Specific trigger not known, but BV related to o Intercourse- especially new partner, sexual aids o Spermicides, douches o Other infections
PATHOLOGIC VAGINAL DISCHARGE Common causes in lower genital tract 1) Bacterial vaginosis 2) Candidal vulvo vaginitis 3) Trichomonas vaginalis Bacterial Vaginosis ▪ Affects 25% of women ▪ 50% of women asymptomatic ▪ Commonest cause of vaginal complaint. ▪ Specific trigger not known, but BV related to: o Intercourse – especially new partner, sexual aids o Spermicides, douches o Other infections
BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS
BV DIAGNOSIS )Gray homogenous discharge adherent to vaginal walls -no erythemaledema 2) pH akaline(over 4.5) 3)Presence of"Clue cells o Cells studded with bacteria o Cell wall indistinct 4)Fishy amine odor when 10% KOH added(TV, semen also causes odor releases 5)Paucity of lactobacilli 6)Relative absence of WBCs
BV DIAGNOSIS 1) Gray homogenous discharge adherent to vaginal walls – no erythema/edema. 2) pH akaline (over 4.5) 3) Presence of “Clue cells” o Cells studded with bacteria o Cell wall indistinct 4) Fishy amine odor when 10% KOH added (TV, semen also causes odor releases. 5) Paucity of lactobacilli 6) Relative absence of WBCs
Bacterial Vaginosis
Bacterial Vaginosis
MEDICATION ALTERNATIVES 1)Oral metronidazole 400mg BD for 7 days 2) Oral clindamycin 300mg BD for 7 days 3)Metronidazole Gel (0.75%) BD for 5 days 4)Clindamycin Cream(2%)qid for 7 days 5) Single 3% Hydrogen Peroxide vaginal washout 6)No treatment for partner?(Rx unrelated to recurrence) Recurrence not uncommon-1) Repeat treatment 2)Longer course 7)In pregnancy, use Ampicillin
MEDICATION ALTERNATIVES 1) Oral metronidazole 400mg BD for 7 days 2) Oral clindamycin 300mg BD for 7 days 3) Metronidazole Gel (0.75%) BD for 5 days 4) Clindamycin Cream (2%) qid for 7 days 5) Single 3% Hydrogen Peroxide vaginal washout 6) No treatment for partner? (Rx unrelated to recurrence) Recurrence not uncommon – 1) Repeat treatment - 2) Longer course 7) In pregnancy, use Ampicillin