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A certain amount of vaginal discharge is normal. The vaginal wall and uterine cervix contains glands that produce a small amount of fluid that helps to keep the vagina clean. This normal fluid is usually clear or milky white and does not have an unpleasant odour. The normal vaginal discharge is thicker at specific times of the menstrual cycle (at the time of ovulation) during breast feeding or during sexual arousal. An increase in amount of vaginal discharge, an abnormal odour or consistency of the fluid, or pain, itching or burning that accompanies vaginal discharge can all be signs of infection or other more serious disorders. The likely diagnosis of vaginal discharge will depend on the age of the patient.
Vaginal discharge in a neonate is usually clear or blood stained discharge and it may occur for a few days after delivery due to fall in previously high oestrogen levels. Vaginal discharge in prepubertal girls are usually due to poor hygiene, chemical vulvovaginitis, vaginal infection, sexual interference, foreign body and worms. From puberty to menopause, vaginal discharge are commonly due to normal physiological discharge, and amount varies from woman to woman. Some women find it hard to accept any discharge as normal. Other causes include ovulatory mucus, local vaginal infections such as candida albicans, Trichomonas vaginalis, bacterial vaginosis or gonorrhea, chemical vaginitis, foreign body, cervical leisons such as ectropion, polyp, cancers, pelvic infection. After menopause, vaginal discharge in women are usually due to atrophic vaginitis, local vague infections as above, cervical leisons such as polyps, or cancer, endometrial cancer, and urinary leaks due to prolapse.
CANDIDA ALBICANS (THRUSH)
This is a very common fungal infection in women. It grows very well when the vagina is less acidic than normal. There is an increased occurence of candida in the reproductive age group, in pregnancy and in those taking antibiotics or immuno suppressive therapy and in diabetics.
Candidiasis may show no symptoms and may be detected on incidental gynecological examination. It however usually causes discharge that is thick and white. Candidiasis can cause severe itching, soreness and painful intercourse. On examination, there may be white curds in the vagina with underlying redness and inflammation. Candidiasis can affect the vulva, inner aspects of thigh and in between bottom folds.
The definite diagnosis is by taking a high vaginal swab for microscopy and culture. It may be identified in a cervical swear.
This is a very common fungal infection in women. It grows very well when the vagina is less acidic than normal. There is an increased occurence of candida in the reproductive age group, in pregnancy and in those taking antibiotics or immuno suppressive therapy and in diabetics.
Candidiasis may show no symptoms and may be detected on incidental gynecological examination. It however usually causes discharge that is thick and white. Candidiasis can cause severe itching, soreness and painful intercourse. On examination, there may be white curds in the vagina with underlying redness and inflammation. Candidiasis can affect the vulva, inner aspects of thigh and in between bottom folds.
The definite diagnosis is by taking a high vaginal swab for microscopy and culture. It may be identified in a cervical swear.
TRICHOMONAS VAGINALS
This is a very common protozoal infection in women. It is usually but not always acquired by sexual contact, and it is important to treat both partners.
Trichomonas may show no symptoms and may be detected on incidental high vaginal swab test for vaginal discharge. It produces a thin, frothy and greenish discharge with an unpleasant swell. It can cause intense itching, soreness and painful intercourse, on vaginal examination there is a frothy green discharge in the vagina which is reddened and rough.
Immediate microscopy of sample of discharge placed in a drop of saliva on a slide and covered with coverslie reveals gear-shaped motile flagellated protozoa. It may be cultured in the laboratory and it may be identified in a cervical swear.
The treatment of trichommas vaginalis is by oval metronidazole, treatment of sexual partner is important. Alcohol should not be taken during treatment as it can cause flushing with severe headache.
This is a very common protozoal infection in women. It is usually but not always acquired by sexual contact, and it is important to treat both partners.
Trichomonas may show no symptoms and may be detected on incidental high vaginal swab test for vaginal discharge. It produces a thin, frothy and greenish discharge with an unpleasant swell. It can cause intense itching, soreness and painful intercourse, on vaginal examination there is a frothy green discharge in the vagina which is reddened and rough.
Immediate microscopy of sample of discharge placed in a drop of saliva on a slide and covered with coverslie reveals gear-shaped motile flagellated protozoa. It may be cultured in the laboratory and it may be identified in a cervical swear.
The treatment of trichommas vaginalis is by oval metronidazole, treatment of sexual partner is important. Alcohol should not be taken during treatment as it can cause flushing with severe headache.
BACTERIAL VAGINOSIS
This is a common condition caused by Gardnevella vaginalis. It usually causes no symptom. It causes a profuse discharge that is adherent and grey in colour like a thin flour paste. It has a strong fishy odour, vaginal walls are not inflamed in this condition.
Diagnosis is usually by a wet vaginal discharge preparation, which shows abundance clue cells under microscope. The fish odour is increased by addition of potassium hydroxide to a drop of discharge in saliva on a slide. The treatment is by oval metronidazole for the patient and her sexual partner.
This is a common condition caused by Gardnevella vaginalis. It usually causes no symptom. It causes a profuse discharge that is adherent and grey in colour like a thin flour paste. It has a strong fishy odour, vaginal walls are not inflamed in this condition.
Diagnosis is usually by a wet vaginal discharge preparation, which shows abundance clue cells under microscope. The fish odour is increased by addition of potassium hydroxide to a drop of discharge in saliva on a slide. The treatment is by oval metronidazole for the patient and her sexual partner.
GONORRHEA
Gonorrhea is caused by a grain negative dielococcus called Neissevia gonorrhea. It is a common condition and it is nearly always acquired by sexual contact and is highly contagious. The infection usually occurs initially in the cervix, and or urethra and sometimes in the bartholina gland.
Gonorrhea is usually symptomatic in men but frequently a symptomatic in women and may persist for a long time. The incubation period is usually with in a week when symptoms occur these are usually vaginal or urethral discharge with painful micturition. The infection may cause pelvic infection, resulting in blocked tubes and subsequent infertility or subfertility resulting in ectopic pregnancy.
The diagnosis is usually by high vaginal swab test for microscopy, culture and sensitivity. Approximately 50% of women with gonorrhea also have chlamydia infection.
The treatment is with appropriately sensitive antibiotic. Contacts must be traced and also treated with appropriate antibiotics. The long term sequelae of gonorrhea is tubal infection and tubal damage resulting in chronic pelvis infection, ectopic pregnancy and infertility.
Gonorrhea is caused by a grain negative dielococcus called Neissevia gonorrhea. It is a common condition and it is nearly always acquired by sexual contact and is highly contagious. The infection usually occurs initially in the cervix, and or urethra and sometimes in the bartholina gland.
Gonorrhea is usually symptomatic in men but frequently a symptomatic in women and may persist for a long time. The incubation period is usually with in a week when symptoms occur these are usually vaginal or urethral discharge with painful micturition. The infection may cause pelvic infection, resulting in blocked tubes and subsequent infertility or subfertility resulting in ectopic pregnancy.
The diagnosis is usually by high vaginal swab test for microscopy, culture and sensitivity. Approximately 50% of women with gonorrhea also have chlamydia infection.
The treatment is with appropriately sensitive antibiotic. Contacts must be traced and also treated with appropriate antibiotics. The long term sequelae of gonorrhea is tubal infection and tubal damage resulting in chronic pelvis infection, ectopic pregnancy and infertility.
CHLAMYDIA TRACHOMATIS
Chlamydia infection is a common infection, it may cause vaginal discharge, and it usually has no symptoms. It is a common cause of pelvis inflammatory disease. There are ready made blood test strips to detect chlamydia infection now contacts must be traced examined and treated as well. The long term sequelae are pelvic inflamatory disease, ectopic pregnancy and infertility.
Chlamydia infection is a common infection, it may cause vaginal discharge, and it usually has no symptoms. It is a common cause of pelvis inflammatory disease. There are ready made blood test strips to detect chlamydia infection now contacts must be traced examined and treated as well. The long term sequelae are pelvic inflamatory disease, ectopic pregnancy and infertility.
CHEMICAL VAGINITIS
Vulvovaginal discomforts and sometimes discharge may be due to local reactions to chemicals in soae and washing powder, bath salts, douches or deodorants or spermicide and condoms.
Vulvovaginal discomforts and sometimes discharge may be due to local reactions to chemicals in soae and washing powder, bath salts, douches or deodorants or spermicide and condoms.
FOREIGN BODY
The commonest foreign body causing vaginal discharge in reproductive age group is a forgotten tampon. Foreign body should be suspected in child with a persistent vaginal discharge. Other causes of vaginal discharge include cervical ectropion or polyp or cervical carcinoma, endometrial polyps and cancers and pelvic inflammatory diseases.
The commonest foreign body causing vaginal discharge in reproductive age group is a forgotten tampon. Foreign body should be suspected in child with a persistent vaginal discharge. Other causes of vaginal discharge include cervical ectropion or polyp or cervical carcinoma, endometrial polyps and cancers and pelvic inflammatory diseases.
Dr. Tunde St Ives Okewale
St Ives Hospital
6, Maitama Sule Street, Ikoyi.
St Ives Hospital
6, Maitama Sule Street, Ikoyi.
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