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PubMed2005

Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community.

BACKGROUND: Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge. METHODS: We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge. RESULTS: Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6). CONCLUSIONS: Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.

Adolescent↗
PubMed2006

Vaginal discharge and bleeding in girls younger than 6 years.

PURPOSE: Persistent unexplained vaginal discharge or bleeding in the pediatric population may be the only manifestation of a serious underlying medical or social problem. Therefore, these symptoms require careful and complete evaluation to identify the primary pathology accurately. We retrospectively reviewed charts of patients who presented for evaluation of persistent vaginal discharge or bleeding to determine if noninvasive imaging was a sensitive means of screening for gynecological pathology. MATERIALS AND METHODS: The records of 24 girls younger than 6 years who presented with vaginal discharge or bleeding were reviewed retrospectively. All patients were evaluated with noninvasive imaging, a pelvic examination while under anesthesia, vaginoscopy and cystoscopy. RESULTS: Noninvasive imaging was useful in identifying 5 of 7 vaginal foreign bodies. However, noninvasive imaging identified only 2 of 6 malignancies. These malignancies consisted of rhabdomyosarcoma (3 patients) and endodermal sinus tumor (3). Two girls also had benign vaginal mullerian papillomas that were not identified by noninvasive imaging. Noninvasive imaging did not aid in the diagnosis of sexual abuse. CONCLUSIONS: Based on these data, we recommend that all girls younger than 6 years who present with persistent vaginal discharge or bleeding be evaluated with pelvic examination while under anesthesia, to be followed by vaginoscopy and cystoscopy if no readily identifiable pathology is found by simple genital examination alone, regardless of the results of noninvasive imaging studies.

Child, Preschool↗
PubMed1984

Chemical studies of hamster vaginal discharge: effects of endocrine ablation and protein digestion on behaviorally active macromolecular fractions.

Our previous studies have demonstrated that macromolecular fractions of hamster vaginal discharge elicit intense genital investigation and facilitate copulatory behavior toward anesthetized males (female surrogates) whose hindquarters have been scented with these fractions, and that the aphrodisiac activity is significantly reduced in the vaginal discharge of ovariectomized (OVEX) or hypophysectomized (HYPOX) females. The present series of studies compared the protein compositions of estrous, diestrous, OVEX, and HYPOX vaginal discharge, and assessed whether protein digestion of estrous vaginal discharge affects its aphrodisiac activity. Polyacrylamide gel electrophoresis of vaginal lavages showed that the endocrine status of females has a profound effect on the protein composition of the vaginal discharge. The concentration of the major proteins dropped by about ten-fold in going from the estrous to the diestrous condition. The concentration of these same proteins appear to be at least another order of magnitude lower in the vaginal discharges of OVEX and HYPOX females. These major proteins had molecular weights greater than 10,000 Daltons. A macromolecular fraction of estrous vaginal discharge isolated by gel filtration at elevated temperature (conditions known to separate some protein-bound steroids) and containing proteins of molecular weight greater than 10,000 Daltons was found to be modestly but significantly less active than estrous discharge in its ability to elicit intense genital investigation, and not significantly different from estrous discharge in its ability to facilitate overt copulatory behavior toward scented surrogates. Pronase digestion of the proteins in this fraction did not alter its effects on investigatory behavior toward scented surrogates but significantly reduced its ability to facilitate copulatory behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Vaginal discharge in general practice--women's perceptions, beliefs and behaviour.

OBJECTIVES: To describe women's perceptions and beliefs about their vaginal secretion and to relate these to their behaviour with respect to complaints of vaginal discharge. DESIGN: A multi-practice study including questionnaires for women and doctors and a semi-structured interview study. SETTING: North Jutland County and Aarhus County, Denmark. SUBJECTS: 283 women with and 417 women without complaints of vaginal discharge answered a questionnaire about their vaginal secretion. Ten women with vaginal discharge took part in the in-depth interviews. RESULTS: 179/274 (65%) women with and 111/417 (27%) women without complaints of vaginal discharge were bothered by their usual secretion. In 54/269 (20%) women with complaints, the pelvic examination was normal. In 59/416 (14%) women without complaints, the doctor found an abnormal vaginal secretion. Most women complaining of vaginal discharge had an external locus of control in relation to their symptoms, but an internal locus of control in relation to health in general. Fear of having a serious disease or a sexually transmitted disease was the reason for the visit to the general practitioner in 164/281 (58%). CONCLUSION: Women's perceptions and beliefs about their vaginal secretion varied and were related to their health seeking behaviour. In addition to information about possible biological causes of vaginal discharge, the general practitioner should also actively seek information about the women's perception of normality and beliefs in relation to the symptoms she experiences.

Adult↗
PubMed1991

Vaginal discharge.

The problem of vaginal discharge requires careful attention to the diagnostic process with analysis of the nature of the discharge, physical examination including a thorough inspection and the performing of a wet film. Physiological discharge and other non infective causes, including feminine hygiene preparations, should be considered. Treatment should be tailored to the cause and psychosexual sequelae should be prevented by proper advice and counselling.

Anti-Bacterial Agents↗
PubMed1998

Evaluation of two clinical protocols for the management of women with vaginal discharge in southern Thailand.

OBJECTIVES: (1) To compare the effectiveness of two clinical protocols for the management of vaginal discharge in the situations where no laboratory facilities are available but speculum examination is possible and where basic laboratory facilities are available. (2) To determine clinical and simple laboratory indicators for diagnosis of patients with vaginal discharge in the local setting. DESIGN: Alternate allocation of subjects to one of two management protocols. SUBJECTS: Women presenting to university gynaecology outpatients department with a complaint of vaginal discharge. METHODS: Subjects were alternately allocated management according to one of two protocols: one without (group A) and one with (group B) immediate access to results of basic laboratory tests. Full clinical assessment including speculum examination and microbiological assessment for infection with gonorrhoea, chlamydia, candida, trichomonas, and bacterial vaginosis was performed on all women. Follow up assessment of clinical and microbiological response was performed 1-2 weeks later. RESULTS: At initial assessment, both groups were similar in all respects except that more group B women had inflammation of the vulva. The prevalences of various conditions were: candidiasis 22%, bacterial vaginosis 38%, trichomoniasis 4%, chlamydia 4%, gonorrhoea 0.4%. There was no association between any demographic characteristic and diagnosis of cause of the discharge. Both protocols resulted in clinically and statistically significant improvements for women with candidiasis, bacterial vaginosis, and trichomoniasis. There were no clinically important differences in outcomes between the two protocols. The sensitivities and specificities of various indicators were: curd-like vaginal discharge for candidiasis, 72% and 100%; homogeneous vaginal discharge for bacterial vaginosis or trichomoniasis, 94% and 88%; absent or scanty lactobacilli for bacterial vaginosis, 99% and 68%; > 20% clue cells for bacterial vaginosis, 81% and 99%; visible endocervical mucopus for chlamydia or gonorrhoea, 36% and 86%; microscopic endocervical mucopus for chlamydia or gonorrhoea, 64% and 69%. CONCLUSIONS: Both protocols were equally effective in managing women with abnormal vaginal discharge. Simple clinical indicators for candidiasis, bacterial vaginosis, or trichomonas as in protocol A are sufficiently sensitive and specific for use in situations with no laboratory support. A modification to protocol A could increase detection of bacterial vaginosis at basic health service level. Further work is needed to identify appropriate indicators for infection with chlamydia or gonorrhoea.

Adult↗
PubMed1991

[Microbial assessment of patients with vaginitis, vaginal discharge and urine cultures].

In 150 patients with the complaint of vaginitis, direct light microscopical examination of vaginal discharge specimens and the cultures of vaginal discharge and urine have been studied. According to the results of vaginal discharge cultures, the most frequent microorganism yielded was E. coli, the following Candida species and Staphylococcus aureus being the second and the third respectively. Meanwhile, in light microscopical examination, in 5 patients Trichomonas vaginalis was seen, while Candida species were the microorganism diagnosed in 30 patients. In the urine cultures, again E. coli was the first microorganism, and Candida and coagulase (-) Staphylococcus being the second and the third frequently seen.

Adult↗
PubMed1993

Somatization misattributed to non-pathological vaginal discharge.

Lay explanations and attributional patterns about somatization related to vaginal discharge, a folk illness characterized by undue concern about passing (normal) vaginal discharge and believing that their symptoms are caused by this, were surveyed systematically in 200 consecutive women patients with predominant somatic complaints and 138 normal healthy women. Misattribution was reported 3.5 times more often by women with somatic complaints as compared to the normal women. Sixteen women were absolutely certain that their discharge was totally responsible for their symptoms and illness. Thus, somatization related to vaginal discharge seems to be a frequent undetected problem in women with somatic symptoms.

Adolescent↗
PubMed2004

Vaginal discharge: perceptions and health seeking behavior among Nepalese women.

OBJECTIVES: To understand women's perceptions and health seeking behavior and the association between vaginal discharge, clinical signs and laboratory findings as a presentation of sexually transmitted diseases (STD). METHODS: We conducted five focus group discussions with women attending the outpatient department in a large public hospital in Katmandu, Nepal, during May-June 1997. We also interviewed seventy women presenting with vaginal discharge to the same hospital, through structured questionnaire. Women presenting with discharge were also examined and investigated for six common sexually transmitted diseases and reproductive tract infections. RESULTS: In the focus groups vaginal discharge was identified as a common disease distinct from STDs, for which women can seek treatment. STDs were considered as social diseases transmitted to women through multiple sexual partners and not from husband. Patients with vaginal discharge preferred traditional healers and pharmacist. Clinical signs were inconclusive for type of infection. Simple laboratory tests identified etiologic agent in 64 (91%) patients and the three commonest infections were Moniliasis (78%), Bacterial Vaginosis (25%) and Trichomoniasis (17%). CONCLUSION: Vaginal discharge may be used as a risk marker for identification of STDs by Primary Health Workers. Low cost investigations should be made available at the secondary care level for identification of most common Reproductive Tract Infections. Communication campaigns should target the misconceptions that exist in the communities local context related to the prevention, treatment and control of vaginal discharge and STDs.

Adult↗
PubMed2005

The effect of post-ovulatory insemination on the subsequent embryonic loss, oestrous cycle length and vaginal discharge in sows.

The aim of present study was to study the effect of post-ovulatory insemination on the subsequent embryonic loss, oestrous cycle length and vaginal discharge in sows. Ten Large White multiparous sows were divided into two groups. Group A sows were inseminated once at 15 h after ovulation. Thereafter, they were ovariohysterectomized on day 11 (n = 5, first day of standing oestrus = day 1) and flushed for recovery of embryos. Group B sows were also inseminated once at 15 h after ovulation. They were further observed for return to oestrus and vaginal discharge (n = 5) after insemination. The endometrium tissues were biopsied from sows with vaginal discharge, embedded with paraffin, stained with haematoxylin and eosin and examined under light microscope. Only two embryos were observed in one of four sows from group A. All embryos had a spherical shape but differed in size (range 1-2 mm). In group B, only one sow had a regular return to oestrus (i.e. on day 23) and another sow had an irregular return to oestrus (i.e. on day 27). The other two sows in this group had shown vaginal discharge on days 20 and 38 after standing oestrus. For the number of leucocytes in the endometrium of sows with vaginal discharge, a large number of lymphocytes and plasma cells were observed in the connective tissue of the subepithelial layer. In conclusion, post-ovulatory insemination resulted in early embryonic loss, a subsequent prolonged oestrus interval and also vaginal discharge (i.e. endometritis) in sows.

Animals↗
PubMed1984

Male hamster investigatory and copulatory responses to vaginal discharge: an attempt to impart sexual significance to an arbitrary chemosensory stimulus.

Hamster vaginal discharge elicits intense genital investigation and facilitates overt copulatory behavior toward anesthetized males (female surrogates) whose hindquarters have been scented with this material. The ability of an arbitrary chemosensory stimulus to acquire behavioral activity like that of vaginal discharge through association with maternal stimuli and/or adult sexual experience was examined in male hamsters. Vanillin was used as the arbitrary stimulus because it is attractive to hamsters, is not likely to be a natural constituent of hamster scents, is not known to exert any adverse physiological effects, and is a subliming solid with an extremely long persistence when used as an artificial scent. The males were reared by vanillin-scented or control solvent (water)-scented foster mothers, and in adulthood were paired repeatedly with vanillin- or solvent-scented receptive females. Behavioral testing with scented surrogates was performed one week preceding, and again following, the sexual pairings. Rearing by vanillin-scented mothers modestly but significantly increased the amount of time sexually naive males spent investigating the hindquarters as compared to other body regions of vanillin-scented surrogates. However, neither neonatal nor adult interactions with vanillin-scented females imparted to this stimulus the capacity to facilitate overt copulatory behavior. Also, regardless of the males' exposure history, only vaginal discharge caused the males to direct their investigatory behavior predominantly toward the hindquarters. The characteristic investigatory and copulatory responses exhibited by male hamsters toward vaginal discharge thus do not appear to be readily developed toward arbitrary chemosensory stimuli associated with particular females to which the males have been exposed.

Animals↗
PubMed1986

Microbiology of vaginal discharge in general practice.

Three groups of women were examined by culture for Gardnerella vaginalis and Candida. Group I consisted of 427 women, who complained spontaneously of vaginal discharge, group II of 311 women who did not complain of vaginal discharge until questioned prior to gynaecological examination, and group III of 100 women who denied vaginal discharge. Groups I and II also had cultures made for Trichomonas vaginalis and Neisseria gonorrhoica. In group I with spontaneous complaints the one-year prevalence rate of vaginal discharge was 3.4%. Candida, Trichomonas vaginalis and Neisseria gonorrhoica were cultured in 24%, 8% and 1% respectively. Gardnerella vaginalis was cultured in half of the women in all groups. A characteristic discharge or a positive microscopic finding was related to high concentration of Gardnerella vaginalis. A characteristic discharge even without spontaneous complaints of vaginal discharge was related to a high prevalence of Gardnerella vaginalis. Women complaining from discharge had higher concentrations of Gardnerella vaginalis than non-complaining. This leads to the conclusion that clinical disease may not be present unless concentrations of Gardnerella vaginalis have risen above some minimum level. The Gardnerella vaginalis syndrome defined by positive culture, clinical finding and microscopy was found in 20% of symptomatic women.

Adolescent↗
PubMed2001

Prevalence of trichomonas vaginalis in patients with vaginal discharge in Lagos, Nigeria.

Trichomonas vaginalis is the most prevalent, non-viral sexually transmitted infection worldwide and probably the most commonly treatable in Africa and worldwide. The purpose of this study was to determine the prevalence of T. vaginalis among women with vaginal discharge attending a gynaecologic clinic in Lagos and to identify the common characteristics of the vaginal discharge in T Vaginalis. High vaginal swabs were taken from consenting adults with vaginal discharge. The quantity, colour and odour of the discharge were noted. Amine (10% KOH) test and pH were determined. Wet-mount microscopy Giemsa staining and culture in Oxoid (R) Trichomonas Medium were performed on each swab. A total of 200 patients were examined. One hundred and forty-nine (74.5%) had T. vaginalis. There was no statistically significant association between age, marital status, parity, number of sexual partners and prevalence of T vaginalis. The colour of the discharge was white in 104 (69.8%), yellow in 30 (20.1), clear in 15 (10.1%). None was frothy or greenish. The discharge was heavy in 50 (33.6%) and malodorous in 51 (34.2%). The pH range was 4-7 and 42 (28.2%) normal pH of4. In 47 (31.5%) the amine test was negative. The prevalence of T vaginalis among women with vaginal discharge is high. Women complaining of vaginal discharge should be thoroughly screened for T. vaginalis using all available methods.

Adolescent↗
PubMed2004

Relationship between the morphology of Candida cells and vaginal discharge.

The aim of this study was to detect whether there is a correlation between the dimorphic pattern of Candida cells and various types of vaginal discharge. For this purpose, 2861 Papanicolaoustained cervicovaginal smears were examined cytologically and 265 of 2861 (9.26%) were diagnosed as having Candida cells. The 88 of 295 (29.83%) were identified as having blastospores only, 135 of 295 (45.76%) as having "hyphae only", and 47 of 295 (15.93%) as having both blastospores and hyphae of candida cells. There was a significant correlation between the type of candida cells and vaginal discharge (p < 0.05). The white-cheesy type vaginal discharge was the most prominent symptom for the observation the "hyphae only" following "blastospores only" and both blastospores and hyphae of Candida cells. It was suggested that hyphael form of Candida cells is the most pathogenic pattern and white-cheesy vaginal discharge is a marker for the presence of hyphael form in the vaginal mucosa.

Candida↗
PubMed2003

Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis.

A 13-year-old presented with malodorous, purulent, vaginal discharge following each menses for the last three months since menarche. This discharge resolved following antibiotic therapy but recurred with each menses. On exam, the patient was found to have a blind ending vagina with a small, midline perforation. Ultrasound and MRI examinations done prior to surgery did not identify the vaginal foreign body. She was taken to the operating room for examination under anesthesia and vaginoscopy. During surgery this area was found to be comprised of dense adhesions which nearly obliterated the distal vagina. The vaginal adhesions were lysed and a plastic foreign body was discovered in the upper vagina. After removing the foreign body the superior vagina was undermined, pulled down, and sutured to normal inferior vagina. A Mentor mold was placed in the vagina to maintain patency.

Adolescent↗
PubMed2000

Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya.

OBJECTIVE: To evaluate the validity of different algorithms for the diagnosis of gonococcal and chlamydial infections among pregnant and non-pregnant women consulting health services for vaginal discharge in Nairobi, Kenya. METHODS: Cross sectional study among 621 women with complaints of vaginal discharge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitted infections (STIs). Specimens were obtained for laboratory diagnosis of genital infections, HIV, and syphilis. The data were used to evaluate the Kenyan flow chart as well as several other generated algorithms. RESULTS: The mean age was 24 years and 334 (54%) were pregnant. The overall prevalence rates were: 50% candidiasis, 23% trichomoniasis, 9% bacterial vaginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pregnant women, gonococcal and chlamydial infection was significantly associated with (1) demographic and behavioural risk markers such as being single, younger than 20 years, multiple sex partners in the previous 3 months; (2) symptom fever; and (3) signs including presence of yellow or bloody vaginal discharge, cervical mucopus, cervical erythema, and friability. Among pregnant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensitive or specific enough for the diagnosis of cervical infection. Several algorithms were generated and applied to the study data. The algorithm including risk markers performed slightly better than the current Kenyan algorithm. CONCLUSION: STIs form a major problem in the Nairobi area and should be addressed accordingly. None of the tested algorithms for the treatment of vaginal discharge would constitute a marked improvement of the existing flow chart. Hence, better detection tools for the specific aetiology of vaginal discharge are urgently needed.

Adult↗
PubMed1986

Investigation of purulent vaginal discharge in cows, with particular reference to Haemophilus somnus.

The relationship between vaginal discharge, site of inflammation in the reproductive tract and species of bacteria isolated was examined in cows that were either normal, subfertile, or had had an abnormal parturition. Microbiological and cytological examinations were performed on uterine swabs from 221 cows and cervical swabs from 107 cows. There were 167 subferitle cows, 144 of which had failed to conceive to 3 or more services (FTC) and 23 of which had not had a visible oestrus since calving (NVO). Metritis was diagnosed in 22% of the FTC cows, 48% of the NVO cows, and 12% of the cows with abnormal parturition. Fifty percent of cows with metritis had purulent vaginal discharge. However, only 25% of a total of 91 cows with vaginal discharge had metritis; the remainder had cervicitis. Fifty-four percent of subfertile cows had cervicitis without metritis. Mixed infection with aerobes and anaerobes was significantly correlated with uterine inflammation and was found in 20% of cows with metritis. The rate of isolation of H.somnus from inflamed uteruses (22%) and inflamed cervixes (39%) was significantly greater than the isolation rate from normal uteruses (8%) and cervixes (10%). No bacteria were isolated from 50% of inflamed uteruses and 37% of inflamed cervixes. The number of subfertile cows with or without metritis that subsequently conceived was not significantly different.

Animals↗
PubMed2000

Syndromic management of vaginal discharge among women in a reproductive health clinic in India.

OBJECTIVES: To examine the performance of the syndromic approach in the management of vaginal discharge among women attending a reproductive health clinic in New Delhi, India. METHODS: Women who sought services from the clinic and who had a complaint of vaginal discharge were interviewed, underwent a pelvic examination, and provided samples for laboratory investigations of bacterial vaginosis, candidiasis, syphilis, trichomoniasis, and Chlamydia trachomatis and Neisseria gonorrhoeae infections. Data analysis focused on the prevalence of infection and on the performance of the algorithm recommended by the national authorities for the management of vaginal discharge. RESULTS: The most common infection among 319 women was bacterial vaginosis (26%). At least one sexually transmitted infection was detected in 21.9% of women. The prevalence of C trachomatis infection was 12.2%; trichomoniasis 10%; syphilis 2.2%; N gonorrhoeae was not isolated. An algorithm based on risk assessment and speculum assisted clinical evaluation was not helpful in predicting cervical infections associated with C trachomatis (sensitivity 5% and PPV 9%). This algorithm was sensitive (95%) though not specific (22%) in selecting women for metronidazole therapy effective against bacterial vaginosis or trichomoniasis, and overtreatment was a problem (PPV 38%). The sensitivity, specificity, and PPV of this algorithm for the treatment of candidiasis were 46%, 98%, and 88% respectively. The cost per case assessed using the algorithm was $2 and the cost per infection correctly treated was $4.25. CONCLUSIONS: The prevalence of cervical infection associated with C trachomatis was high among these "low risk" women. The syndromic approach is not an efficient tool for detecting this condition, and alternative approaches to evaluation and intervention are required. The syndromic management of vaginal discharge among women seeking family planning and other reproductive health services should focus on vaginal infections, thus enhancing quality of care and addressing women's concerns about their health.

Algorithms↗