Abnormal vaginal discharge is defined as vaginal discharge
color / odor / unusual consistency (p. ex. tinted, purulent, malodorous).
It is often accompanied by vulvar itching or pain during sexual intercourse
(Dyspareunia) and irritation during urination (dysuria) or lower abdominal pain. Abnormal vaginal discharge is to search systematically for patients with these symptoms.
Abnormal vaginal discharge may be a sign of an infection of the vagina (vaginitis) and / or the cervix (cervicitis) or pelvic inflammatory disease.
The flow must be observed during a clinical examination: inspection of the vulva, speculum examination (flow / inflammation of the cervix or vagina?).
Abdominal palpation and touch pelvic are systematic in any woman with vaginal discharge, looking for pelvic inflammatory disease (abdominal pain and mobilization of the cervix).
The main causative organisms are:
– In vaginitis: Gardnerella vaginalis and other bacteria (bacterial vaginosis), Trichomonas vaginalis (trichomoniasis) and Candida albicans (candidiasis).
– For cervicitis Neisseria gonorrhoeae (gonorrhea) and Chlamydia trachomatis (chlamydia).
– For pelvic inflammatory disease.
– The achievable field reviews generally allow to identify the causes of vaginitis only, their interest is limited.
Microscopic examination fresh can show T. mobile vaginalis, yeast and mycelial filaments C. albicans and target cells (“clue cells”) in bacterial vaginitis.
– Highlighting of N. gonorrhoeae by Gram stain is not sensitive in
the woman and is not recommended.
What to do:
Cervicitis is difficult to diagnose. If in doubt, treat cervicitis in women with abnormal vaginal discharge and at least one of the following risk factors:
– Urethral discharge in the partner
– Context of sexual violence or prostitution
– New partner or more than one partner in the last 3 months
Treatment of the patient:
Treating chlamydia and gonorrhea:
– Bacterial vaginosis and trichomoniasis
tinidazole PO: 2 g single dose
or metronidazole PO: 2 g single dose
If unsuccessful: tinidazole PO: 1 g / day in 2 divided doses for 5 days
or metronidazole PO: 800 to 1000 mg / day in 2 divided doses for 7 days
– Vulvovaginal Candidiasis
clotrimazole (500 mg vaginal tablet): cp single dose, inserted deep into the vagina at bedtime if, clotrimazole (200 mg vaginal tablet): one tablet inserted deep into the vagina at bedtime for 3 days or nystatin (vaginal tablet 100 000 IU): one tablet inserted deep into the vagina at bedtime for 14 days
If the patient has extensive vulvar candidiasis, it is possible to apply to the vulva miconazole cream 2% (2 applications / day for 7 days). The complete treatment with miconazole possibly clotrimazole but does not replace it.
Treatment of the partner:
For vaginitis or cervicitis, the sexual partner receives the same treatment as the patient, whether symptomatic or not.
In case of vulvovaginal candidiasis, the partner is treated only if symptomatic
(Inflammation and itching of the glans / prepuce): miconazole 2%, 2 applications / day for 7 days.