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PubMed2002

[Vaginal discharge--diagnosis and treatment in general practice].

Based on a review of the literature, this article describes the most common causes of vaginal discharge including changes in the woman's perception of her vaginal secretion, disturbances in the vaginal microbiological environment (vulvovaginal candidiasis and bacterial vaginosis), and infection with Chlamydia trachomatis. The article attempts to answer a number of questions which this condition poses to the clinician. It is concluded that with the available diagnostic possibilities the general practitioner is in a good position to make a correct diagnosis and institute an effective treatment.

Candidiasis, Vulvovaginal↗
PubMed1975

[Vaginal discharge in childhood (author's transl)].

Report on 4 children suffering from vaginal discharge. Various radiographic techniques helped to show that this had different causes: 1) vaginal foreign bodies which could be shown in vaginography. 2) vestibular ureteral ectopy shown in IVP with increased contrast medium and retrograde pyelography. 3) rectogenital fistula in granulomatous colitis shown by direct contrast filling of the fistula. Radiologic diagnosis led to causal therapy after which the discharge disappeared.

Child↗
PubMed1986

Epidemiology and control of vaginal discharges in the sow after service.

A syndrome associated with vaginal discharge, endometritis and reproductive inefficiency in the served sow is described. In some herds pregnancy failures exceeded 15 per cent with increased returns to service and sows not in pig. Predisposing factors included the age of the herd and the hygiene and management practices from weaning to service and during the 21 days after service. No one organism was implicated but venereal transmission was considered possible. One hundred and ten breeding herds were surveyed and in 26 of these control measures were necessary. These included antibacterial therapy of the prepuce of the boar and medication of the sow from weaning until 21 days after service. Such treatment together with management changes resolved the problem in 22 of the herds. The syndrome reappeared in four out of seven herds where treatment of the boar was not continued.

Animals↗
PubMed2001

The effect of introduction of a guideline on the management of vaginal discharge and in particular bacterial vaginosis in primary care.

BACKGROUND: Bacterial vaginosis (BV) is the commonest cause of vaginal discharge, and its association with obstetric and gynaecological complications is being recognized increasingly. It was our impression that BV was poorly understood and underdiagnosed in family practice. OBJECTIVE: The aim of this study was to explore the management of patients with vaginal symptoms by family practitioners and to see if the management changed after the assimilation of best practice guidelines. METHOD: Family practitioners were invited to complete a baseline questionnaire of their perceived practice, and to record actual practice when consulted about vaginal symptoms, for a minimum of 4 weeks. Consensus best practice guidelines were then provided and practice recorded for a similar period. RESULTS: Baseline data was received from 34 practitioners and suggested that the symptoms and signs of different vaginal infections were not well known. Most symptomatic patients were only investigated at re-presentation with unresolved symptoms or at recurrence, and 43% of respondents treated with empirical antifungals as a first line approach. Pregnant patients were only occasionally asked about symptoms and only occasionally examined if symptomatic. Pre-guideline practice data from 30 practitioners showed 1.2 patient consultations/week, of which 60% were examined and 55% had a high vaginal swab (HVS) sent. Only 2% had near-patient tests done. Post-guideline data from 23 family practitioners showed a lower recorded consultation rate at 0.7/week, but 90% of these were examined, 77% had an HVS sent and 69% had near-patient tests done. Of the 36 HVS examined by Gram stain, 19 (53%) showed Lactobacillus predominant flora and 10 (28%) suggested BV. Seven (19%) were borderline or ungradable. Only three (8%) showed yeasts, one of which also showed BV. CONCLUSIONS: Baseline data supported our impression that BV was under-recognized. Guidelines appeared to improve the rate of investigation of women consulting with vaginal symptoms.

Algorithms↗
PubMed1999

Pemphigus vulgaris localized to the vagina presenting as chronic vaginal discharge.

Involvement in pemphigus vulgaris of the female genital tract including the vulva, vagina and cervix has previously been described. In all these cases other cutaneous and mucosal sites have also been affected at some time. We describe a case of pemphigus vulgaris which only involved the vaginal mucosa. The patient presented with a persistent vaginal discharge and examination showed extensive vaginal erosions. Histology of vaginal biopsies was non-diagnostic. The recognition that the vaginal changes may represent an immunobullous disease led to further vaginal biopsies on which direct immunofluorescence studies were performed. These biopsies showed IgG and C3 in the intercellular epidermis, suggesting a diagnosis of pemphigus vulgaris. During the 3-year period that the patient has been under review there have never been any other cutaneous or mucosal lesions. To our knowledge, this is the first case of pemphigus vulgaris localized exclusively to the vaginal mucosa. There was considerable delay in diagnosis and this case highlights how important it is to recognize that chronic mucosal lesions at genital sites may be caused by immunobullous diseases such as cicatricial pemphigoid and pemphigus, and to institute appropriate investigations.

Anti-Inflammatory Agents↗
PubMed1984

Single dose of tinidazole in the treatment of vaginal discharge.

Seventy-nine unselected women whose main symptom was abnormal vaginal discharge were seen at the Department of Obstetrics and Gynecology at Helsinki University Central Hospital between October 1980 and September 1981. All patients and their current sex partners were randomly treated either with a 2-gram single dose of tinidazole or with identical placebos. Those excluded were 9 patients who did not attend the follow-up examination, 15 who had specific cervicovaginal infections (6 with chlamydial infection, 4 with trichomoniasis and 5 with yeast infection), and 22 with normal Döderlein flora seen on vaginal Pap smear. Response to the treatment was analysed among the remaining 33 women, of whom 17 received tinidazole and 16 placebo. The symptoms and signs that best discriminated between those who had normal Döderlein flora and those who had non-Döderlein flora were malodour, other than white colour of the discharge, and the presence of clue cells on Pap smear. When these findings were used to evaluate the response to treatment, tinidazole proved to be more effective than placebo. Disappearance of clue cells best (p less than 0.01) discriminated between tinidazole and placebo.

Adult↗
PubMed1998

[An rare cause of vaginal discharge: sarcoma botryoides].

A general practitioner was consulted by a 15-year-old girl, virgo, suffering from foetid vaginal discharge. The girl was seen by a gynaecologist after antimicrobial treatment had failed. Further investigations revealed that a embryonal rhabdomyosarcoma was present, a sarcoma botryoides. The tumour originating from the cervix uteri was resected completely after which chemotherapy was started. One year later there were no sequelae or indications of metastases. Sarcoma botryoides has a better prognosis than other types of rhabdomyosarcoma. The prognosis is also influenced by the site of origin, which is favourable for the cervix.

Adolescent↗
PubMed1987

Human versus machine: a comparison of a computer 'expert system' with human experts in the diagnosis of vaginal discharge.

A model system has been designed which generates 'cases' of vaginal discharge. Each such case is presented to a human for diagnosis, and this is then compared with a computer diagnosis using two forms of Bayes' theorem. Six subjects (2 medical; 4 non-medical) participated in the trial and each examined 100 successive 'cases'. When the humans had forewarning of the trial and full access to the knowledge-base their performance was superior to that of Bayes' theorem using positive features only and equivalent to that using both positive and negative features. When the trial was repeated without forewarning the human performance was markedly inferior to that of the machine. It is concluded: that human and computer-aided diagnosis can be of approximately equal efficiency for complex and non-definitive data; that the imperfections of human memory give an obvious potential advantage to the machine in this type of situation.

Computer Simulation↗
PubMed1998

Validation of the WHO diagnostic algorithm and development of an alternative scoring system for the management of women presenting with vaginal discharge in Malawi.

OBJECTIVE: To evaluate the performance of the WHO algorithm for the detection of cervical infection in women presenting with vaginal discharge and modify the risk assessment score for optimum effectiveness in Malawi. METHODS: 550 consecutive women presenting with non-ulcerative genitourinary complaints were interviewed and examined. Cervical infection was defined as presence of Neisseria gonorrhoeae on culture and/or Chlamydia trachomatis by EIA. Other laboratory investigations included wet mount microscopy, serology for syphilis and HIV, LED testing of cervical and vaginal secretions, and pH testing of vaginal fluid. Sensitivity, specificity, and positive predictive values (PPV) of different algorithms were determined in the analysis. RESULTS: Cervical infection was identified in 19.5% of women (17.1% gonorrhoea, 3.7% chlamydial infection). The sensitivity/specificity/PPV of the WHO risk assessment were 43%/73%/28%, respectively by history and 62%/61%/27% with the addition of speculum examination. Using Malawi results to modify the risk assessment improved the performance to 61%/68%/31% respectively by history alone, which increased to 73%/64%/33% with bimanual examination and 72%/56%/29% with speculum examination. CONCLUSION: The sensitivity of the WHO risk assessment is low for the detection of cervical infection in Malawi. Although the Malawi risk assessment performed somewhat better on history alone, this study identified external and bimanual examination variables that improved the diagnostic performance of the algorithm in settings where speculum examination is not possible. Although the PPVs of the algorithms are low, country specific risk assessments can provide a framework for management until simple, affordable diagnostic tests for the definitive diagnosis of cervical infection are available.

Adolescent↗
PubMed1977

[Epidemiology and diagnosis of vaginal discharge. First Report (author's transl)].

In 700 patients, 1336 tests of vaginal discharge were performed by culture, wet mount with the phase contrast microscope and the Papanicolaou stain. The diagnosis of yeast is best done by culture. Yeast was found only in 68% of the culture positive cases by the wet mount method and in 47% of the cases by the Papanicolaou stain. Wet mount and Papanicolaou stain results for yeast are therefore only useful if they are positive. In the diagnosis of trichomonas, culture and wet mount are of the same effeciency. The incidence of yeast and trichomonas was dependant upon the age of the patients. In pregnancy and in cases with diabetes, yeast was found more often but no increase of yeast was found in cases on oral contraception. The diagnosis of bacterial mixed infections poses the most difficult problem and can only be improved by expensive culture methods.

Candidiasis, Vulvovaginal↗
PubMed2006

[Investigation of Trichomonas vaginalis in patients with nonspecific vaginal discharge].

Trichomoniasis, a protozoan infection, has a worldwide distribution and is the most common nonviral, sexually transmitted disease. In this study, we examined the vaginal swab samples of 114 patients who presented at the obstetrics and gynecology outpatient clinic in Ankara in 2004, for the presence of Trichomonas vaginalis (T. vaginalis) using direct microscopy and culture methods. The samples were taken from patients with nonspecific vaginal discharge during their gynecological examination. Twenty of the samples were obtained from postmenopausal women. T. vaginalis was found in 8 (7%) out of 114 patients and 2 of the samples were from post menopausal women. As a result, the T. vaginalis rate among patients who presenting at outpatient clinics with nonspecific vaginal dis-charge was found to be comparable with the results of the other studies which were carried out in Ankara and other regions of Turkey. Further studies with more samples are needed in order to explain the high rate found among postmenopausal women in this study.

Adolescent↗
PubMed1978

The prevalence and clinical diagnosis of vaginal candidosis in non-pregnant patients with vaginal discharge and pruritus vulvae.

Two hundred and thirteen nonpregnant female patients complaining of vaginal discharge or pruritus vulvae were recruited to the study by 45 general practitioners in the Yorkshire region. Of these patients, 102 (48 per cent) were found to have demonstrable vaginal mycosis on an initial swab and a further 10 to be swab positive after one week of placebo treatment. The total prevalence in this population of women consulting their practitioner was thus 52.6 per cent.Analysis of symptomatology and of physical findings showed that a clinical diagnosis of vaginal mycosis cannot be made with acceptable reliability.The occurrence of spontaneous swab conversion is noted, and its possible origins are discussed.

Female↗
PubMed1977

[The diagnosis and treatment of mixed anaerobic vaginal dischargs (authors' transl)].

In about 5% of 3355 patients the microscopic examination of the vaginal discharge in normal saline showed a characteristic fast moving rod. More than 80% of these patients complained of a discharge with a foul smell during the menstrual period. Bactriology showed an anaerob gram negative rod which was difficult to grow and is as yet unclassified. Following treatment with one gram of Mimorazol every 12 hours for 3 doses, 71,5% of the patients were cured and showed a normal vaginal flora without further treatment. In around 24,13% of the patients the gram negative rod disappeared but a persistent mixed flora required further treatment. In 4.3% of the patients a recurrence occurred. An attempt was made to prevent recurrent infection prior to the follow-up examination by prohibition of sexual intercourse with an untreated partner, bathing in public swimming pools, and the use of sponges or wash cloths. In the course of the investigation the suspicion of contamination from the water of public pools became apparent. The diagnosis, treatment and transmission and the pathogenecity of the fast moving negative rod is discussed.

Female↗
PubMed1994

In vitro adhesiveness of Gardnerella vaginalis strains in relation to the occurrence of clue cells in vaginal discharge.

G. vaginalis was isolated from 52.4 per cent patients with non-specific vaginitis. The haemagglutinating activity of G. vaginalis was strongest with human 'O' red cells and weaker reactions were observed with sheep and chick erythrocytes. Haemagglutinating activity of G. vaginalis with human 'O' cells (1:16 titre) could be correlated with clue cells in vaginal discharge in 73 per cent patients while in lower titres, this correlation was not observed.

Adolescent↗
PubMed1975

Male hamster preference for odors of female hamster vaginal discharges: studies of experiential and hormonal determinants.

Male hamsters approach sources of odors from female hamster vaginal discharges and spend significantly more time around these odor sources than around control locations in the test box. This preference for female hamster vaginal odors appears in sexually inexperienced as well as experienced males, even in individuals isolated from females since the time of weaning. Castration significantly reduces the sex odor preference, and treatment with testosterone propionate partially restores it.

Animals↗