Vaginal discharge: Difference between revisions
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'''For patient information, click [[Vaginal discharge (patient information)|here]]''' | '''For patient information, click [[Vaginal discharge (patient information)|here]]''' | ||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}}; {{AE}} [[User: Shankar Kumar|Shankar Kumar, M.B.B.S.]] [mailto:kumarshankar@wikidoc.org] | ||
{{SK}} Discharge from the vagina | |||
== Laboratory Findings == | == Overview == | ||
Vaginal discharge is a common patient complaint that is paired with [[anxiety]] regarding [[sexually transmitted diseases]]. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis. | |||
==Causes== | |||
===Common Causes=== | |||
* [[Atrophic vaginitis]] | |||
* [[Bacterial vaginosis]] | |||
* [[Cervical cancer]] | |||
* [[Chlamydia]] | |||
* [[Foreign body vaginitis]] | |||
* [[Gonorrhea]] | |||
* [[Herpes]] | |||
* [[Trichomoniasis]] | |||
* [[Vaginal cancer]] | |||
* [[Vaginal yeast infection]] | |||
===Causes by Organ System=== | |||
{| style="width:80%; height:100px" border="1" | |||
| style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |||
| style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Chemical / poisoning''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Dermatologic''' | |||
| bgcolor="Beige"| [[Scabies]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Drug Side Effect''' | |||
| bgcolor="Beige"| [[Amoxicillin and Clavulanic Acid ]], [[Butoconazole Vaginal Cream ]], [[Clotrimazole ]], [[Combined oral contraceptive pill]], [[Estradiol Topical ]], [[Estradiol Transdermal ]], [[Estrogen and Progestin (Oral Contraceptives) ]],[[Estrogen Injection ]], [[Estrogen Vaginal ]], [[Etonogestrel and Ethinyl Estradiol Vaginal Ring ]], [[Glatiramer Injection ]],[[Hormone replacement therapy (trans)]], [[Letrozole]], [[Leuprolide ]], [[Medroxyprogesterone Injection ]], [[Metronidazole Topical ]],[[Miconazole ]], [[Nafarelin ]], [[Natalizumab injection ]], [[Norelgestromin and ethinyl estradiol transdermal system ]], [[Ospemifene]], [[Oxcarbazepine ]], [[Pramipexole]], [[Progesterone]], [[Tamoxifen ]], [[Terconazole Vaginal Cream, Vaginal Suppositories ]], [[Toremifene]], [[Zoledronic Acid Injection ]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Ear Nose Throat''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Endocrine''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Environmental''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Gastroenterologic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Genetic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Iatrogenic''' | |||
| bgcolor="Beige"| [[Colposcopy]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Infectious Disease''' | |||
| bgcolor="Beige"| [[Pelvic inflammatory disease]], [[Urethritis]], [[Cervicitis]], [[Vaginitis]], [[Vulvitis]] | |||
<u>'''Bacteria'''</u>: | |||
[[Bacterial Vaginosis]], [[Chlamydia]], [[Gonorrhea]], [[Syphilis]] | |||
<u>'''Viral'''</u>: | |||
[[Herpes simplex]], [[HIV]], [[Human Papillomavirus infections]] | |||
<u>'''Fungal'''</u>: | |||
[[Candidiasis]] | |||
<u>'''Parasitic'''</u>: | |||
[[Trichomonas vaginalis]], [[Trichomoniasis]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Musculoskeletal / Ortho''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Neurologic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Nutritional / Metabolic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Obstetric/Gynecologic''' | |||
| bgcolor="Beige"| [[Lochia]], [[Menstrual cycle]], [[Postnatal]], [[Pregnancy]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Oncologic''' | |||
| bgcolor="Beige"| [[Cervical cancer]], [[Endometrial cancer]], [[Uterine sarcoma]], [[Vaginal cancer]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Opthalmologic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Overdose / Toxicity''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Psychiatric''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Pulmonary''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Renal / Electrolyte''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Rheum / Immune / Allergy''' | |||
| bgcolor="Beige"| [[Allergic vaginitis]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Sexual''' | |||
| bgcolor="Beige"| [[Atrophic Vaginitis]], [[Cervical cancer]], [[Cervical polyp]], [[Cervicitis]], [[Endometrial cancer]], [[Foreign body vaginitis]], [[Salpingitis]], [[Uterine sarcoma]], [[Vaginal cancer]], [[Vaginitis]], [[Vesicovaginal fistula]], [[Vulvitis]],[[Colposcopy]], [[Pelvic inflammatory disease]], [[Allergic vaginitis]], [[Vaginal trauma]], [[Bacterial Vaginosis]],[[Candidiasis]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Trauma''' | |||
| bgcolor="Beige"| [[Vaginal trauma]] | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Urologic''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Dental''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|- bgcolor="LightSteelBlue" | |||
| '''Miscellaneous''' | |||
| bgcolor="Beige"| No underlying causes | |||
|- | |||
|} | |||
===Causes in Alphabetical Order === | |||
{{MultiCol}} | |||
* [[Allergic vaginitis]] | |||
* [[Amoxicillin and Clavulanic Acid ]] | |||
* [[Atrophic Vaginitis]] | |||
* [[Bacterial Vaginosis]] | |||
* [[Butoconazole Vaginal Cream ]] | |||
* [[Candidiasis]] | |||
* [[Cervical cancer]] | |||
* [[Cervical polyp]] | |||
* [[Cervicitis]] | |||
* [[Chlamydia]] | |||
* [[Clotrimazole ]] | |||
* [[Colposcopy]] | |||
* [[Combined oral contraceptive pill]] | |||
* [[Endometrial cancer]] | |||
* [[Estradiol Topical ]] | |||
* [[Estradiol Transdermal ]] | |||
* [[Estrogen and Progestin (Oral Contraceptives) ]] | |||
* [[Estrogen Injection ]] | |||
* [[Estrogen Vaginal ]] | |||
* [[Etonogestrel and Ethinyl Estradiol Vaginal Ring ]] | |||
* [[Foreign body vaginitis]] | |||
* [[Glatiramer Injection ]] | |||
* [[Gonorrhea]] | |||
* [[Herpes simplex]] | |||
* [[HIV]] | |||
* [[Hormone replacement therapy (trans)]] | |||
* [[Human Papillomavirus infections]] | |||
{{ColBreak}} | |||
* [[Leuprolide ]] | |||
* [[Lochia]] | |||
* [[Medroxyprogesterone Injection ]] | |||
* [[Menstrual cycle]] | |||
* [[Metronidazole Topical ]] | |||
* [[Miconazole ]] | |||
* [[Nafarelin ]] | |||
* [[Natalizumab injection ]] | |||
* [[Norelgestromin and ethinyl estradiol transdermal system ]] | |||
* [[Oxcarbazepine ]] | |||
* [[Pelvic inflammatory disease]] | |||
* [[Postnatal]] | |||
* [[Pregnancy]] | |||
* [[Salpingitis]] | |||
* [[Scabies]] | |||
* [[Syphilis]] | |||
* [[Tamoxifen ]] | |||
* [[Terconazole Vaginal Cream, Vaginal Suppositories ]] | |||
* [[Trichomonas vaginalis]] | |||
* [[Trichomoniasis]] | |||
* [[Urethritis]] | |||
* [[Uterine sarcoma]] | |||
* [[Vaginal cancer]] | |||
* [[Vaginal trauma]] | |||
* [[Vaginitis]] | |||
* [[Vesicovaginal fistula]] | |||
* [[Vulvitis]] | |||
* [[Zoledronic Acid Injection ]] | |||
{{EndMultiCol}} | |||
== Laboratory Findings == | |||
Initial tests include: | Initial tests include: | ||
*[[CBC]] | |||
*[[ | * [[CBC]] | ||
*[[ | * [[Urinalysis]] | ||
*[[ | * [[Urine]] culture | ||
*[[ | * [[Beta-hCG]] | ||
*[[ | * [[Gonorrhea]] culture | ||
* [[Chlamydia]] culture | |||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
{| style="background:silver; color:black" | {| style="background:silver; color:black" | ||
|- | |- | ||
| Type | | Type | ||
| pH | | pH | ||
Line 46: | Line 297: | ||
| present | | present | ||
| motile, flagellated | | motile, flagellated | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| BV | | BV | ||
| >4.5 | | >4.5 | ||
Line 52: | Line 303: | ||
| fishy | | fishy | ||
| clue cells | | clue cells | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Candida | | Candida | ||
| <4.5 | | <4.5 | ||
Line 60: | Line 311: | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| GC | | GC | ||
| | | | ||
| mucopurulent | | mucopurulent | ||
| varies | | varies | ||
Line 66: | Line 317: | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| A.V. | | A.V. | ||
| | | | ||
| thin,gray,watery | | thin,gray,watery | ||
| none | | none | ||
| few epithelial cells | | few epithelial cells | ||
|} | |} | ||
== Treatment == | == Treatment == | ||
Line 109: | Line 327: | ||
'''See most recent CDC guidelines for all STD's''' | '''See most recent CDC guidelines for all STD's''' | ||
=== Acute Pharmacotherapies === | === Acute Pharmacotherapies === | ||
====Bacterial Vaginosis==== | ==== Bacterial Vaginosis ==== | ||
*[[Metronidazole]] single dose for 7 days | * [[Metronidazole]] single dose for 7 days | ||
====[[Candida]] and [[Chlamydia]]==== | ==== [[Candida]] and [[Chlamydia]] ==== | ||
*[[Azithromycin]] | * [[Azithromycin]] | ||
*[[ | * [[Doxycycline]] | ||
====Gonorrhea==== | ==== Gonorrhea ==== | ||
* Oral [[ciprofloxacin]] or IM [[ceftriaxone]] | |||
*[[Metronidazole]] single dose for 7 days | ==== Trichomonas ==== | ||
*Intravaginal [[clotrimazole]] if pregnant or unable to use [[Metronidazole]] | |||
* [[Metronidazole]] single dose for 7 days | |||
* Intravaginal [[clotrimazole]] if pregnant or unable to use [[Metronidazole]] | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{Symptoms and signs | {{Symptoms and signs}} | ||
[[Category:Primary care]] | |||
[[Category:Obstetrics]] | [[Category:Obstetrics]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Medical signs]] | |||
[[Category:Symptoms]] | |||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} |
Revision as of 16:01, 16 June 2015
For patient information, click here
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US National Guidelines Clearinghouse on Vaginal discharge NICE Guidance on Vaginal discharge
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Patient resources on Vaginal discharge Discussion groups on Vaginal discharge Patient Handouts on Vaginal discharge Directions to Hospitals Treating Vaginal discharge Risk calculators and risk factors for Vaginal discharge
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Causes & Risk Factors for Vaginal discharge |
Continuing Medical Education (CME) |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]
Synonyms and keywords: Discharge from the vagina
Overview
Vaginal discharge is a common patient complaint that is paired with anxiety regarding sexually transmitted diseases. If a STD is detected, a search for all other STDs should be done. Advise the infected patient to inform all sexual partners of their diagnosis.
Causes
Common Causes
- Atrophic vaginitis
- Bacterial vaginosis
- Cervical cancer
- Chlamydia
- Foreign body vaginitis
- Gonorrhea
- Herpes
- Trichomoniasis
- Vaginal cancer
- Vaginal yeast infection
Causes by Organ System
Causes in Alphabetical Order
Laboratory Findings
Initial tests include:
Other Diagnostic Studies
Type | pH | Discharge | Odor | Wet Mount |
Trich | >4.5 | yellow-green, copious | present | motile, flagellated |
BV | >4.5 | white-grey | fishy | clue cells |
Candida | <4.5 | white, curd-like | none | pseudo-hyphae |
GC | mucopurulent | varies | PMNs | |
A.V. | thin,gray,watery | none | few epithelial cells |
Treatment
See most recent CDC guidelines for all STD's
Acute Pharmacotherapies
Bacterial Vaginosis
- Metronidazole single dose for 7 days
Candida and Chlamydia
Gonorrhea
- Oral ciprofloxacin or IM ceftriaxone
Trichomonas
- Metronidazole single dose for 7 days
- Intravaginal clotrimazole if pregnant or unable to use Metronidazole
References
Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs