Syndrome

Vaginal
Discharge
By: Afiqah Binti Mohd Rashid
Thursday, December 09, 2021
VAGINAL AND
VULVOVAGINAL
CANDIDIASIS

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 Recurrent vagina candidiasis
Risk factors and Pathogenesis

1 Pregnancy-change hormone

These factors disrupt vaginal

2 Genital cleansing solutions

flora of lactobacili
3 Frequent Sexual intercourse
That serve to inhibit
overgrowth Candida 4 Semen allergy

5 Immunosuppresion

VVC 3
 Risk factors and Pathogenesis
Pathogenesis

1 Systemic antibiotic or steroid

These factors disrupt vaginal

2 Diabetes Mellitus

flora of lactobacili
3 Using intrauterine device (IUD)
That serve to inhibit
overgrowth Candida 4 Wearing of tight-fitting

5 Immunosuppresion

VVC 4
Clinical Diagnosis
ANAMNESIS & PHYSICAL EXAMINATIONJ
 FROM ANAMNESIS & PE

1 Vulvar pruritus

2 Burning

3 Dysuria (painful urination)

4 Dyspareunia (Painful intercourse)

5 PHYSICAL EXAMINATION: Thick curd-like whitish plaques

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MICROSCOPIC STUDIES

KOH 10%

Pseudohyphae
Septate hyphae

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 TREATMENT

Topical
Prophylacti
Imidazole Oral
c Regimens

Over the counter Prescription To prevent recurrence

BUTOCONAZOLE Fluconazole ORAL: Clotrimazole 500mg tablet –
Intravaginal/Weekly
MICONAZOLE Itraconazole
Fluconazole 150mg/week
CLOTRIMAZOLE
Ketoconazole
CREAM:Clotrimazole cream/
3-7 days of treatment
SINGLE ORAL:150mg dose Fluconazole

treatment 8
TRICHOMONIAS
IS

9
AFIQAH
 10

Presentation Title Here

ETIOLOGY AND PATHOGENESIS
Trichomoniasis
 PATHOGENESIS
Sexual Transmitted Disease 1
5 steps

2 By parasitic protozoan

• Increase in vaginal acidity (favourable for

Microulceration 3 parasitic growth and reproduction
• Infects Muosal epithelium

4 Incubation period
Between 4-28 days

Symptomatic 5

• Can be asymptomatic carrier

state Tricomoniasis 12
CLINICAL FINDINGS
ANAMSESIS
PHYSICAL EXAMINATION
 • Malodorous (bad odor)

ANAMNESI • Yellow green vaginal discharge

• Vulvar – pruritus
S • swelling
• erythema
• Dyspareunia (Painful
intercourse)
• Lower abdominal discomfort
• Dysuria (Painful urination)

Trichomoniasis 14
Symptoms
Occur during or after
menstruation

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Physical Examination
16
Add picture here – 16:9

Yellow green vaginal discharge

Yellow green vaginal discharge
Yellow green vaginal discharge

Yellow Green Vaginal Discharge “Strawberry” Cervix

• Cervix appearance with punctate
bleeding erosions.
• Can also be seen on the vaginal wall
• Also called as colpitis macularis

trichomoniasis
Laboratory Test
Road to diagnosis 17
Vaginal Discharge
Vaginal PH 3 BASIC Specimens
METHODS
Fx: To search causative parasite
1. Saline wet mount  OSOM Trichomonas Rapid test
PH > 4.5  Most common diagnostic (immunochromatographic test)
test  10 minutes
 Simplest  Nucleic acid probe test
Non specific  Low cost
findings 2. Dark-field examination
 45 minutes

(contrast)  Latter test

• Ovoid-shaped protozoa
3. Anaeobic culture Rapid result
• Positive within 48 hours Sensitivity 83%
• costly Specificity 97%

Tricomoniasis
 Trichomonas vaginalis
Contrast Microscopy

Ovoid shaped protozoa

Trichomoniasis 18
COMPLICATIONS
TEICHOMONIASIS
 Complications

01 02 03 04
In pregnancy Newborn sexual Less
• Premature delivery • Low birth transmitted commonly
• Early rupture of weight in
membranes
newborns • HIV • Atypical PID
Transmission

trichomoniasis 20
T
r
e
21
a
t
m
e
n
t

Trichomoniasis
Bacterial
Vaginosis

AFIQAH 24
Pathogenesis
H
O 26
G
E 1 Polymicrobial syndrome
N
Imbalance of normal bacterial flora that
E 2
present in vagina
S Bacterial 3
Shift occurs from hydrogen peroxide-producing
lactobacilli to greater concentration
I Vaginosis
S 4
Not known to be transmitted through sexual
contact

BV
 POLYMICROBIAL
Variety of microbe

01 02 03 04
Giardia Mobiluncus Gram negative
Mycoplasma Genera:
rods
Vaginalis sp hominis Prevotella
Porphyromonas
Bacteroides
Peptostreptococcus sp

- Gram positive( normal bacterial) and gram negative rods can be differentiate by
Gram staining
BACTERIAL VAGINOSIS 27
 Risk factors
Most Common: Women of (childbearing age) productive age

1 Sex at early age 2 Multiple sex 3 Use of bidet toilets

partners

Frequent use of Sharing vaginal Sexual contact (not

4 lubricant 5 6 known)
toys

Bacterial vaginosis 28
DIAGNOSIS
BV
 Clinical Diagnosis
Anamnesis
Physical examination

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 Clinical Findings-Anamnesis

1 Asymptomatic-Ph >4.5

2 Vaginal Discharge : Fishy odor and thin

3 White or gray vaginal Discharge

4 Vulvo-vaginal pruritus

5 Inflammtaion: Rare

Bacterial Vaginosis 31
 Physical Examination

Milky, homogenous vaginal coating

May be seen at vaginal wall
Putih abu2
Bacterial vaginosis 32
Microscopic Findings
Bacterial Vaginosis

Clue cells

Large epithelial cells

covered with bacteria
(Most indicator)

Bacterial Vaginosis 33
 Laboratory Test

1 Whiff test

2 Saline wet mount-microscopic examination

3 Gram staining

4 DNA Probe –based test (affirm VP III)

5 Immunochromatographic test (OSOM BVBLUE)

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 COMPLICATIONS

Pregnancy Cervical intraepithelial

• Premature labor
neoplasia
• Preterm birth in pregnancy

HIV transmission Postpartum fever

BACTERIAL VAGINOSIS 35
 Diagnose Bacterial Vaginosis
by Amstel criteria

Thin,Homogenous vaginal Discharge

Whiff test positive

Amin test-Fishy odor

Mixing vaginal discharge fluid with 10% potassium hydroxide

PH>4.5

Microscopic: Clue cells AFIQAH 36

TREATMENT
BV
 38

Bacterial vaginosis
 43
ETIOLOGY
The Difference
VAGINAL &
VULVOVAGINAL BACTERIAL
DISCHARGE TRICHOMONIASIS VAGINOSIS

• Candida.albicans-80%- • Trichomonas • Gardnerella Vaginalis
90% vaginalis
• Mobiluncus sp
• Candida glabrata • Parasitic protozoan
• Anaerobic Gram-negative
rods:
 Genera Prevotella,

 Porphyromonas

 Bacteroides spp

 Peptosteptococcus sp
  The Differences

VVC TRICHOMONIA Bacterial

SIS Vaginosis

KOH 10% Direct Clue cells

microscope (epithelial cells
• Pseudohyphae or
examination: covered with
• Septate hyphae bacteria
• Ovoid-shaped
protozoa
DIFFERENCES

AFIQAH 45