Page 277 - Learnwell EVS
P. 277
9. Genito-urinary diseases
Abnormal vaginal discharge
Abnorm al v ag inal d isch arg e is d efined as d isch arg e th at d iffers from usual with respect
to colour/od our/consistency (e.g . d iscoloured or purulent or m alod orous).
Abnorm al d isch arg e is often associated with v ulv ar pruritus or pain with intercourse
(d yspareunia), or painful or d ifficult urination (d ysuria) or low er abd om inal pain.
Routinely ch eck for abnorm al v ag inal d isch arg e in w om en presenting w ith th ese
sym ptom s.
Abnorm al v ag inal d isch arg e m ay be a sig n of infection of th e v ag ina (v ag initis) and /or
th e cerv ix (cerv icitis) or upper g enital tract infection.
T h e presence of abnorm al d isch arg e m ust be confirm ed by perform ing a clinical
exam ination: inspection of th e v ulv a, speculum exam (ch ecking for cerv ical/v ag inal
inflam m ation or d isch arg e).
Abd om inal and bim anual pelv ic exam inations sh ould be perform ed routinely in all
w om en presenting w ith v ag inal d isch arg e to rule out upper g enital tract infection
(lower abd om inal pain and cerv ical m otion tend erness).
T h e principal causativ e org anism s are:
– In v ag initis: Gardnerella vaginalis and oth er bacteria (bacterial v ag inosis), Trichomonas
vaginalis (trich om oniasis) and Candida albicans (cand id iasis).
– In cerv icitis: Neisseria gonorrhoeae (g onorrh oea) and Chlamydia trachomatis
(ch lam yd ia).
– In upper g enital tract infections: see pag e 240.
Case management 9
S ee alg orith m , following pag e.
Laboratory
– T ests usually av ailable in th e field can only id entify causes of v ag initis, and th us are
of lim ited usefulness.
M icroscopic exam ination of a fresh wet sm ear m ay sh ow m obile T. vaginalis, yeast
cells and h yph ae in cand id iasis, and “clue cells” in bacterial v ag inosis.
– Id entification of N. gonorrhoeae by Gram stained sm ear is not sensitiv e in wom en and
is not recom m end ed .
233
Abnormal vaginal discharge
Abnorm al v ag inal d isch arg e is d efined as d isch arg e th at d iffers from usual with respect
to colour/od our/consistency (e.g . d iscoloured or purulent or m alod orous).
Abnorm al d isch arg e is often associated with v ulv ar pruritus or pain with intercourse
(d yspareunia), or painful or d ifficult urination (d ysuria) or low er abd om inal pain.
Routinely ch eck for abnorm al v ag inal d isch arg e in w om en presenting w ith th ese
sym ptom s.
Abnorm al v ag inal d isch arg e m ay be a sig n of infection of th e v ag ina (v ag initis) and /or
th e cerv ix (cerv icitis) or upper g enital tract infection.
T h e presence of abnorm al d isch arg e m ust be confirm ed by perform ing a clinical
exam ination: inspection of th e v ulv a, speculum exam (ch ecking for cerv ical/v ag inal
inflam m ation or d isch arg e).
Abd om inal and bim anual pelv ic exam inations sh ould be perform ed routinely in all
w om en presenting w ith v ag inal d isch arg e to rule out upper g enital tract infection
(lower abd om inal pain and cerv ical m otion tend erness).
T h e principal causativ e org anism s are:
– In v ag initis: Gardnerella vaginalis and oth er bacteria (bacterial v ag inosis), Trichomonas
vaginalis (trich om oniasis) and Candida albicans (cand id iasis).
– In cerv icitis: Neisseria gonorrhoeae (g onorrh oea) and Chlamydia trachomatis
(ch lam yd ia).
– In upper g enital tract infections: see pag e 240.
Case management 9
S ee alg orith m , following pag e.
Laboratory
– T ests usually av ailable in th e field can only id entify causes of v ag initis, and th us are
of lim ited usefulness.
M icroscopic exam ination of a fresh wet sm ear m ay sh ow m obile T. vaginalis, yeast
cells and h yph ae in cand id iasis, and “clue cells” in bacterial v ag inosis.
– Id entification of N. gonorrhoeae by Gram stained sm ear is not sensitiv e in wom en and
is not recom m end ed .
233
