Vaginal_Discharge_and_Infections_A_Comprehensive_Overview.pptx

Vaginal_Discharge_and_Infections_A_Comprehensive_Overview.pptx

1. Introduction to Vaginal Discharge Vaginal discharge is a normal physiological process in adult women. Normal discharge may be excessive in the presence of cervical ectopy Composed of tissue fluid, cell debris, carbohydrate, lactobacilli, and lactic acid pH is typically around 4.5, inhibiting growth of organisms other than lactobacilli Sources of vaginal discharge: Vulva: Greater vestibular glands, glands of vulval skin Vagina: Desquamated epithelial cells liberating glycogen, vaginal transudate Cervix: Alkaline mucous secretion (copious during ovulation) Uterus: Uterine glands also contribute to discharge Vaginal Discharge and Infections: A Comprehensive Overview

2. Normal Vaginal Discharge Normal vaginal discharge has specific characteristics: Color: White, may stain yellow/pale brown on clothing Odor: Mild, non-offensive Consistency: Variable throughout menstrual cycle pH: Approximately 4.5 (acidic) Microscopic features: Predominance of lactobacilli (rod-shaped bacteria) Squamous epithelial cells Few white blood cells Absence of pathogenic organisms Lactobacilli metabolize glycogen to lactic acid, maintaining acidic pH Normal vaginal flora with predominant lactobacilli Microscopic view of Lactobacillus acidophilus Vaginal Discharge and Infections: A Comprehensive Overview

3. Clinical Assessment of Vaginal Discharge Women typically complain of vaginal discharge when: Excessive staining on clothing Offensive smell Local irritation Examination Process: Inspect vulva, perineum, and thighs for excoriation Examine vaginal walls and cervix through speculum Perform bimanual examination Collect specimens for microscopy and culture Key Clinical Features: Volume: Need for continuous pad/tampon suggests excess Onset: May relate to pregnancy, contraceptives, antibiotics Color: Indicator of possible infection or blood Irritation: Common with Candida and Trichomonas Vaginal Discharge and Infections: A Comprehensive Overview

4. Candida Albicans Candida albicans is a yeast that exists in two forms: slender branching hyphae or small globular spores that multiply by budding. Predisposing Factors Pregnancy (altered microclimate and glycogen content) Immunosuppressive therapy Glycosuria (diabetes or pregnancy-related) Antibiotic therapy (destroys normal bacterial flora) Clinical Features Most common in women aged 20-40 years Irritant discharge and dyspareunia Inflamed and tender vagina and vulva White plaques resembling curdled milk Red inflamed areas beneath plaques Treatment Single 500 mg clotrimazole pessary External application of 1% clotrimazole cream Oral antifungal medication as alternative Partner treatment generally not effective for recurrence Candida albicans showing hyphae and yeast forms Candida albicans infection in vaginal epithelium Vaginal Discharge and Infections: A Comprehensive Overview

5. Bacterial Vaginosis Bacterial vaginosis is characterized by a non-irritating, foul-smelling discharge containing a mixture of bacteria. Previously labeled as "non-specific" vaginitis due to uncertainty regarding the infective agent. Clinical Features Foul-smelling discharge (primary complaint) Thin, greyish discharge, sometimes with bubbles Presence of 'clue cells' on vaginal smear Few pus cells and scanty lactobacilli Raised vaginal pH (>4.5) Some patients experience pruritus, frequency, dysuria, and dyspareunia Diagnostic Features 'Clue cells' are vaginal squamous epithelial cells with stippling of cytoplasm due to adherent cocco-bacilli. Gram staining is usually negative but can be variable. Treatment Oral metronidazole Alternative: Clindamycin vaginal cream Male partners should also be treated Bacterial vaginosis with clue cells Comparison of normal cells and clue cells Vaginal Discharge and Infections: A Comprehensive Overview

6. Trichomonas Vaginalis Trichomonas vaginalis is a protozoan organism that infests the vagina in women and the urethra, prepuce, and prostate in men. It is a single-cell organism about 20μm × 10μm, with four flagellae and an undulating membrane giving it a characteristic jerky movement. Clinical Features Acute phase: Severe vaginal tenderness and pain Inflamed vagina, sometimes with patchy "strawberry vaginitis" Copious, offensive, frothy discharge Burning sensation, pruritus, dysuria, and dyspareunia Latent phase: Asymptomatic but organism detectable Epidemiology & Pathology Affects approximately 18% of female population Transmitted primarily during sexual intercourse Associated with gonorrhea and cervical dysplasia Raises vaginal pH to about 5.5, allowing bacterial pathogens Diagnosis & Treatment Diagnosis: Observation of motile organisms in fresh saline smear and laboratory culture Treatment: Metronidazole (Flagyl) 400 mg thrice daily for a week, or 2 g orally once daily Treatment should include sexual partner Trichomonas vaginalis under microscope Trichomonas vaginalis showing characteristic flagellae Vaginal Discharge and Infections: A Comprehensive Overview

7. Atrophic Vaginitis Atrophic vaginitis occurs when ovarian activity ceases, typically with the onset of menopause, after surgical removal of the ovaries, or following ablation by radiotherapy or chemotherapy. Clinical Features Irritation and vaginal dryness Discharge may occur if superimposed infection is present Rash of petechial hemorrhages on vaginal mucosa Possible ulceration In neglected cases, intravaginal adhesions may develop Microscopic Features Rounded epithelial cells with no glycogen Many polymorphs (white blood cells) Presence of bacteria Parabasal epithelial cells predominate Treatment Topical vaginal estrogen (creams or pessaries) Silicon vaginal ring containing estrogen Treatment quickly reverses atrophic changes Microscopic view of atrophic vaginitis showing parabasal cells and polymorphs Comparison of normal and atrophic vaginal tissue Vaginal Discharge and Infections: A Comprehensive Overview

8. Other Causes of Vaginitis Vulvovaginitis in Children Less common condition arising from specific circumstances: Sexual interference (physical damage to tissues) Insertion of foreign bodies (infection from bowel commensals) Threadworm infestation (diagnosed with Sellotape test) Scratching can lead to skin maceration, encouraging bacterial contamination. Foreign Bodies Occasionally seen in adults: Forgotten tampons, contraceptive devices, or supportive pessaries Results in offensive purulent discharge Treatment involves removal of the foreign body and appropriate antibiotics Secondary Vaginitis May arise from contamination through fistulous openings: Vesicovaginal or rectovaginal fistulas Following injury, surgical operations, or tumor growth Treatment involves repair of the fistula where possible Important Note: In all cases of vaginal discharge, the possibility of malignant disease in the reproductive tract must be considered. Vaginal Discharge and Infections: A Comprehensive Overview

9. Summary and Key Points Condition Discharge Characteristics Key Diagnostic Features Treatment Normal White, odorless, non-irritating pH ~4.5, predominant lactobacilli, few WBCs No treatment needed Candida albicans White, curd-like, irritating Hyphae/spores on microscopy, inflamed vagina/vulva Clotrimazole pessary/cream, oral antifungals Bacterial vaginosis Thin, gray, fishy odor, non-irritating Clue cells, raised pH, few WBCs, scanty lactobacilli Oral metronidazole, clindamycin cream Trichomonas vaginalis Copious, frothy, offensive, yellow-green Motile trichomonads on wet mount, raised pH Metronidazole (patient and partner) Atrophic vaginitis Variable, may have superimposed infection Parabasal cells, many WBCs, petechial hemorrhages Topical vaginal estrogen Proper clinical assessment and laboratory testing are essential for accurate diagnosis Consider patient's age, hormonal status, and sexual history in evaluation Always consider the possibility of malignant disease in persistent or unusual cases Partner treatment is important in sexually transmitted infections Vaginal Discharge and Infections: A Comprehensive Overview