Leukorrhea

Leukorrhea
Increased vaginal discharge
Physiologic/Pathologic
Normal Vaginal Discharge
Creamy white discharge
Vulvar secretion
Bartholin glands
Sweat glands
Sebaceous glands
Skene glands
Vagina
Cervix
Endometrial glands
Fallopian tubes
Normal Vaginal Discharge
Increased when
Ovulationendocervical glands
Premenstrual phase
Pregnancy
Sexual excitementBartholins glands
pH < 4.5
Physiological Vaginal Discharge
Newborns
Puberty
Congestion of pelvic organs
Cervical ectopian
Contraceptives
Vaginal douche

Pathological Vaginal Discharge
Vaginitis in infancy and childhood
Senile vaginitis (Atrophic vaginitis)
Candidiasis
Bacterial vaginosis
Trichomonas vaginitis
Mucopurulent cervicitis
Foreign bodies
Neoplasm
Urinary and fecal discharge
Vaginitis
in infancy and childhood
Low immunity
Age 1-5 years
Infection/Foreign body/Tumor
Wet smear, Gram stain, culture, speculum
Treatment
Rest
antibiotics
estrogen
Atrophic vaginitis
Postmenopause
Decreased estrogen
Vaginal wall thining
Decreased acidic environment
Yellow/Green/Bloody
Pruritic/Painful
Dysuria
Dyspareunia/Postcoital bleeding
Vaginal wall thining, colpitis macularis, patchy
ulceration, adhesive vaginitis

Atrophic vaginitis
PAP smear, Gram stain, culture
+- Cervical biopsy, Fractional curettage
Treatment:
Antibiotics
estrogen (local/systemic)
Candidiasis
Yeast cells/Pseudohyphae
Inflammation and curd-like discharge
Predisposing factors
Diabetes
Obesity
Pregnancy
Antibiotics
Contraceptives
Low immunity
Premenstrual period
Candidiasis
KOH preparation, Gram stain (positive)
Subourauds/Nicersons media culture
Treatment:
Uncomplicated
Clotrimazole V.P. (100) Vg suppo OD 6days
Clotrimazole V.P. (200) Vg suppo OD 3days
Itraconazole (400) PO stat
Fluconazole (150) PO stat
Complicated
Clotrimazole V.P. (100) Vg suppo OD 14 days then Clotrimazole V.P.
(500) Vg suppo weekly for 6 months
Repeat Fluconazole 3 days after then weekly for 6 months
Partner?
Bacterial vaginosis
Decreased amount of Lactobacilli
Increased amount of anaerobes
Low immunity, fatigue, frequent sexual
intercourse, vaginal douche
Mostly asymptomatic
Increased (foul-smelling) discharge
Bacterial vaginosis
Amsel criteria (3/4)
Gray-white discharge
pH > 4.5
Clue cells
Whiff test
Treatment:
Metronidazole (500) 1 tab PO bid pc 7 days
Clindamycin (300) 1 tab PO bid pc 7 days
Trichomonas vaginitis
Anaerobic flagellated protozoa
Mainly sexually transmitted
Yellowish green/white discharge
Itchy
Dysuria, dyspareunia
Vaginal mucosa inflammation
colpitis macularis, strawberry cervix
Trichomonas vaginitis
Wet smear, Gram stain to rule out gonococcal
infection
Treatment
Metronidazole (500) 1 tab PO bid pc 7 days
Clotrimazole V.P. (100) Vg suppo OD 6days
Must also treat partners, no intercourse until
resolved


Mucopurulent cervicitis
Mucopurulent discharge
Dysuria
Vulval inflammation
N. gonorrhoeae, C. trachomatis, HSV
Gram stain intracellular gram negative
diplococci
Mucopurulent cervicitis
Dual therapy
Gonococcal infection
Ceftriaxone 125 mg IM stat
Chlamydial infection
Doxycycline (100) 1 tab PO bid pc 7 days
Azithromycin (1g) 1 tab PO stat
Must also treat partners, no intercourse until
resolved


Foreign Bodies
Children
Adultscontraceptive devices, pessary,
swabs, tampons
Purulent vaginal discharge; foul-smelling,
bloody
Speculum; may use nasal or aural speculum
Removal then antiseptics
Neoplasm
Benign/Malignant
Leukorrhea
purulent, foul-smelling, bloody
if infected/malignant
Urinary and fecal discharge
Urinary discharge
Urethro-vaginal fistula
Vesico-vaginal fistula
Uretero-vaginal fistula
Fecal discharge
Recto-vaginal fistula
Summary
Physiologic
Pathologic
Vaginitis in infancy and childhood
Senile vaginitis (Atropic vaginitis)
Candidiasis
Bacterial vaginosis
Trichomonas vaginitis
Mucopurulent cervicitis
Foreign bodies
Neoplasm
Urinary and fecal discharge

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