• Normal vaginal discharge in a non pregnant is small
in quantity and white to colourless • During pregnancy there is increased vaginal discharge which is known as Leucorrhea • RX is counseling and advice on personal hygiene Pathological vaginal discharges • In all cases there is abnormal increase of vaginal discharge • Trichomoniasis causes a classic frothy yellow- green discharge, with a fishy smell, itching of the vulva • Gonorrhea produces a thin mucoid slightly yellow pus discharge with no smell • Chlamydia may cause a non itchy, thin colourless discharge • Candidiasis-intense vulval pruritus,soreness with often a thick white curdy discharge Differential diagnosis Ca of the cx especially in older women who are multiparous- causes a blood stained smelly discharge Bacterial infections include: Chlamydia, Gonorrhea and syphilis Trichomoniasis • Is almost exclusively sexually transmissible • It is caused by infection with the parasite trichomonas vaginalis, around or oval flagellated protozoan • It has been linked with a small risk of preterm delivery and low birth weight and an increase in the risk of HIV via sexual intercourse • It may be acquired perinatally and occurs in about 5% of babies born to infected mothers Clinical signs and symptoms • Burning sensation of the vulva sometimes with itching, dysuria • A greenish vaginal discharge containing small bubbles or having a foamy appearance • An inflammatory reaction on the vaginal walls and cervix presenting with red patches or dots • A vague lower abdominal pain may be present RX; -Metronidazole 5-7 days -Clotrimazole pessaries daily for 7 days -Treat partners and advise against coitus until Rx is completed Chlamydia • the most prevalent bacterial STI ,most common cause of PID, is as a result of the Chlamydia trachomatis bacterium, which can infect the urethra and cervix. • The disease is easily treated, but like other STIs, chlamydia tends to be silent and therefore go undiagnosed until it becomes more serious than in its early stages. • 3in 4 women and one in two men have no symptoms. • In 40 % of cases, by the time a female seeks medical attention, the disease has progressed to a PID, a major cause of female infertility and pelvic pain Symptoms Always asymptomatic in≈ 80% of cases. Some women may have: • Purulent vaginal discharge • Post coital or intermenstrual bleeding • Lower abdominal pain • Mucopurulent cervitis and/ or contact bleeding • Mild dysuria • Progression to PID • Rx- Macrolides e.g. Erythromycin • Tetracyclines & floroquinolones are currently contraindicated in pregnancy • TEO for opthalmia neonatorum Gonorrhea • Chlamydia infection is sometimes confused with gonorrhea, another bacterial infection. Not only do they share many of the same symptoms, the two diseases can occur together. • Gonorrhea usually begins in the urethra or the cervix. However, the rapidly proliferating Neisseria gonorrhoea bacterium can migrate to the uterus and the fallopian tubes, giving rise to PID. • The infection, like chlamydia, may also involve the rectum symptoms • yellow or bloody vaginal discharge • Lower abdominal pain • Dysuria • Intermenstrual bleeding & menorrhagia • Fever • Progression to PID Incidence in pregnancy is low 1 to 5% Maternal gonococcal infection is associated with: spontaneous abortion, very low birth weight, PROM, chorioamnitis, preterm delivery, postpartum endometritis and pelvic sepsis Diagnosis and RX:
• A dx is made by endocervical and rectal swabs
for culture and sensitivity • RX: Azithromycin, ceftriaxone • TEO for opthalmia neonatorum prophylaxis Syphilis • caused by Treponema pallidum bacteria • It can also be congenitally transmitted • It is a complex systemic disease that can involve almost any organ in the body • Syphilis in pregnancy and congenital syphilis remain a major cause of fetal and neonatal loss in developing countries • Every pregnant woman should be screened for syphilis stages • Stage 1: Primary Syphilis • Initial symptoms typically occur 2 to 6 weeks after exposure and last 4 to 6 weeks. • Painless chancre on the vulva, vagina, cervix or around the mouth • Inflamed lymph nodes Stage 2: Secondary Syphilis • Symptoms typically occur one to six weeks after the chancre heals and last three to six months • Light rash with brown sores roughly the size of a penny, typically on the palms of the hands and soles of the feet; may also cover the rest of the body • Sores in or around the genitals or anus • Mild fever • Fatigue • Headaches • Sore throat • Patchy hair loss • Appetite loss • Weight loss Stage 3: Tertiary Stage • Symptoms typically occur anywhere from 3 years to more than 20years after the onset of infection . • Syphilis in multiple systems, including the heart and blood vessels, skin, bones and brain. • untreated syphilis may result in spontaneous abortion, preterm birth, still birth, neonatal deaths and significant infant morbidity • Congenital syphilis in majority of live born infected infants do not have any signs & symptoms at birth will present over weeks, months or years • Investigations- RPR,TPHA • Rx: erythromycin Viral infections • Genital Warts • Caused by HPV 6 &11 • Genital warts may cause physical discomfort, are disfiguring and are psychologically distressing • Most cases can be managed with topical treatment of the warts, i.e. podophylum paint though the lesions tend to return & is contraindicated in pregnancy • It is advised that no RX is given during pregnancy. Other alternatives are: -cryosurgery (freezing), -electrocautery (burning). A C/S can be done if warts are extensive Genital Herpes • HSV-2 is the most common cause of genital herpes and is sexually transmitted • HSV infection may be asymptomatic, but painful, vesicular or ulcerative lesions of the skin and mucous membranes occur frequently • Dysuria, vaginal or urethral discharge, fever, myalgia • Dx- viral cultures from open leisions can be done • Rx-Acyclovir 200mg every 5hrs for 5days Prevention of STIs • Give health education about STIs • Provide specific education on the need for early reporting and compliance with treatment. • Ensure notification and treatment of sexual partners. • Counsel patient on risk reduction, eg. Practice of safe sex by using condoms, remaining faithful to one sexual partner, personal hygiene. • Provide condoms