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 | ||
==Overview== | == 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== | ||
{|style="width:80%; height:100px" border="1" | ===Common Causes=== | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying 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" | |- bgcolor="LightSteelBlue" | ||
| '''Chemical / poisoning''' | | '''Chemical / poisoning''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dermatologic''' | | '''Dermatologic''' | ||
|bgcolor="Beige"| [[Scabies]] | | bgcolor="Beige"| [[Scabies]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''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)]], [[Leuprolide ]], [[Medroxyprogesterone Injection ]], [[Metronidazole Topical ]],[[Miconazole ]], [[Nafarelin ]], [[Natalizumab injection ]], [[Norelgestromin and ethinyl estradiol transdermal system ]],[[Oxcarbazepine ]], [[Tamoxifen ]], [[Terconazole Vaginal Cream, Vaginal Suppositories ]], [[Zoledronic Acid Injection ]] | | 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" | |- bgcolor="LightSteelBlue" | ||
| '''Ear Nose Throat''' | | '''Ear Nose Throat''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Environmental''' | | '''Environmental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Gastroenterologic''' | | '''Gastroenterologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Genetic''' | | '''Genetic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Hematologic''' | | '''Hematologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Iatrogenic''' | | '''Iatrogenic''' | ||
|bgcolor="Beige"| [[Colposcopy]] | | bgcolor="Beige"| [[Colposcopy]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| [[Pelvic inflammatory disease]], [[Urethritis]], [[Cervicitis]], [[Vaginitis]], [[Vulvitis]] | | bgcolor="Beige"| [[Pelvic inflammatory disease]], [[Urethritis]], [[Cervicitis]], [[Vaginitis]], [[Vulvitis]] | ||
<u>'''Bacteria'''</u>: | <u>'''Bacteria'''</u>: | ||
Line 85: | Line 87: | ||
[[Trichomonas vaginalis]], [[Trichomoniasis]] | [[Trichomonas vaginalis]], [[Trichomoniasis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal / Ortho''' | | '''Musculoskeletal / Ortho''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Nutritional / Metabolic''' | | '''Nutritional / Metabolic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Obstetric/Gynecologic''' | | '''Obstetric/Gynecologic''' | ||
|bgcolor="Beige"| [[Lochia]], [[Menstrual cycle]], [[Postnatal]], [[Pregnancy]] | | bgcolor="Beige"| [[Lochia]], [[Menstrual cycle]], [[Postnatal]], [[Pregnancy]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| [[Cervical cancer]], [[Endometrial cancer]], [[Uterine sarcoma]], [[Vaginal cancer]] | | bgcolor="Beige"| [[Cervical cancer]], [[Endometrial cancer]], [[Uterine sarcoma]], [[Vaginal cancer]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Opthalmologic''' | | '''Opthalmologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Overdose / Toxicity''' | | '''Overdose / Toxicity''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Psychiatric''' | | '''Psychiatric''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Pulmonary''' | | '''Pulmonary''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Renal / Electrolyte''' | | '''Renal / Electrolyte''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Rheum / Immune / Allergy''' | | '''Rheum / Immune / Allergy''' | ||
|bgcolor="Beige"| [[Allergic vaginitis]] | | bgcolor="Beige"| [[Allergic vaginitis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Sexual''' | | '''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="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" | |- bgcolor="LightSteelBlue" | ||
| '''Trauma''' | | '''Trauma''' | ||
|bgcolor="Beige"| [[Vaginal trauma]] | | bgcolor="Beige"| [[Vaginal trauma]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Urologic''' | | '''Urologic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dental''' | | '''Dental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
|} | |} | ||
=== | |||
===Causes in Alphabetical Order === | |||
{{MultiCol}} | {{MultiCol}} | ||
*[[ | * [[Allergic vaginitis]] | ||
*[[ | * [[Amoxicillin and Clavulanic Acid ]] | ||
*[[ | * [[Atrophic Vaginitis]] | ||
*[[ | * [[Bacterial Vaginosis]] | ||
*[[ | * [[Butoconazole Vaginal Cream ]] | ||
*[[ | * [[Candidiasis]] | ||
*[[Cervical | * [[Cervical cancer]] | ||
*[[ | * [[Cervical polyp]] | ||
*[[ | * [[Cervicitis]] | ||
*[[ | * [[Chlamydia]] | ||
*[[ | * [[Clotrimazole ]] | ||
*[[ | * [[Colposcopy]] | ||
*[[ | * [[Combined oral contraceptive pill]] | ||
*[[ | * [[Endometrial cancer]] | ||
*[[Estradiol | * [[Estradiol Topical ]] | ||
*[[ | * [[Estradiol Transdermal ]] | ||
*[[Estrogen | * [[Estrogen and Progestin (Oral Contraceptives) ]] | ||
*[[Estrogen | * [[Estrogen Injection ]] | ||
*[[ | * [[Estrogen Vaginal ]] | ||
*[[ | * [[Etonogestrel and Ethinyl Estradiol Vaginal Ring ]] | ||
*[[ | * [[Foreign body vaginitis]] | ||
*[[ | * [[Glatiramer Injection ]] | ||
*[[ | * [[Gonorrhea]] | ||
*[[ | * [[Herpes simplex]] | ||
*[[ | * [[HIV]] | ||
*[[Human Papillomavirus infections]] | * [[Hormone replacement therapy (trans)]] | ||
* [[Human Papillomavirus infections]] | |||
{{ColBreak}} | {{ColBreak}} | ||
*[[Leuprolide ]] | * [[Leuprolide ]] | ||
*[[Lochia]] | * [[Lochia]] | ||
*[[Medroxyprogesterone Injection ]] | * [[Medroxyprogesterone Injection ]] | ||
*[[Menstrual cycle]] | * [[Menstrual cycle]] | ||
*[[Metronidazole Topical ]] | * [[Metronidazole Topical ]] | ||
*[[Miconazole ]] | * [[Miconazole ]] | ||
*[[Nafarelin ]] | * [[Nafarelin ]] | ||
*[[Natalizumab injection ]] | * [[Natalizumab injection ]] | ||
*[[Norelgestromin and ethinyl estradiol transdermal system ]] | * [[Norelgestromin and ethinyl estradiol transdermal system ]] | ||
*[[Oxcarbazepine ]] | * [[Oxcarbazepine ]] | ||
*[[Pelvic inflammatory disease]] | * [[Pelvic inflammatory disease]] | ||
*[[Postnatal]] | * [[Postnatal]] | ||
*[[Pregnancy]] | * [[Pregnancy]] | ||
*[[Salpingitis]] | * [[Salpingitis]] | ||
*[[Scabies]] | * [[Scabies]] | ||
*[[Syphilis]] | * [[Syphilis]] | ||
*[[Tamoxifen ]] | * [[Tamoxifen ]] | ||
*[[Terconazole Vaginal Cream, Vaginal Suppositories ]] | * [[Terconazole Vaginal Cream, Vaginal Suppositories ]] | ||
*[[Trichomonas vaginalis]] | * [[Trichomonas vaginalis]] | ||
*[[Trichomoniasis]] | * [[Trichomoniasis]] | ||
*[[Urethritis]] | * [[Urethritis]] | ||
*[[Uterine sarcoma]] | * [[Uterine sarcoma]] | ||
*[[Vaginal cancer]] | * [[Vaginal cancer]] | ||
*[[Vaginal trauma]] | * [[Vaginal trauma]] | ||
*[[Vaginitis]] | * [[Vaginitis]] | ||
*[[Vesicovaginal fistula]] | * [[Vesicovaginal fistula]] | ||
*[[Vulvitis]] | * [[Vulvitis]] | ||
*[[Zoledronic Acid Injection ]] | * [[Zoledronic Acid Injection ]] | ||
{{EndMultiCol}} | {{EndMultiCol}} | ||
== Laboratory Findings == | == 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 292: | 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 298: | 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 306: | Line 311: | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| GC | | GC | ||
| | | | ||
| mucopurulent | | mucopurulent | ||
| varies | | varies | ||
Line 312: | Line 317: | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| A.V. | | A.V. | ||
| | | | ||
| thin,gray,watery | | thin,gray,watery | ||
| none | | none | ||
Line 322: | 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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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