VAGINAL DISCHARGE
Introduction
Physiologically, the region of the vulva and vagina presents a variable amount of secretion in women of
reproductive age, which originates from the regional glands, cervical and endometrial mucus, as well as the
vaginal transudate. In women of childbearing age, physiological discharge may become more noticeable
sometimes in the middle of the menstrual cycle close to the time of ovulation, during pregnancy or with
contraceptive use. Diet, sexual activity, medication, and stress can also affect the volume and character of
normal vaginal discharge.
However, when an infectious or inflammatory process is present, the characteristics of the secretion change,
characterizing pathological vaginal discharge with excessive amounts, with changes in its physiological
characteristics, causing discomfort and being determined by different etiological agents.
bacterial vaginosis
Definition: It is characterized by the imbalance of the normal vaginal microbiota, with a significant increase
in anaerobic bacteria such as Gardnerella vaginalis, Mobiluncus sp, Bacteroides fragilis, Mycoplasma
hominis, Ureaplasma urealyticum, Peptostreptococcus, Prevotella sp, with concomitant decrease in
lactobacilli from the normal flora, which alkalizes vagina and decreases local leukocytes. Frequent sexual
acts, use of vaginal douches, semen and the premenstrual period are favorable factors. Condoms and
contraceptives are protective factors.
Symptoms: The common finding is an abundant, homogeneous, grayish-white vaginal discharge that appears
after coitus and post-menstrual period, adherent to the vaginal walls. Itching and other signs of inflammation
and irritation may occur. The “fishy odor” may appear because of the production of amines by aerobic
metabolism. In the office, it is possible to volatilize these amines, collecting the material on a slide, dripping
potassium hydroxide and the fish odor appears.
Diagnosis: it is clinical, but the pH can be analyzed because it is always increased, positive amine test. You
can pass this content on the slide and the pathologist finds the "clue cells".
complications: in pregnant women, there is a risk of premature rupture of the water, which causes premature
labor and post-cesarean endometritis (infection in the uterine cavity after surgery).
Treatment: treat symptomatic women (we do not treat a partner) with Metronidazole 250mg 2cp 12-12h
for 7-10 days (not to be mixed with alcoholic beverage as it causes nausea and vomiting).
Vaginal candidiasis
Definition:caused by Candida albicans and occasionally by other “non-albicans” species, in the most
recurrent cases. It is not considered a sexually transmitted disease, as it can affect celibate women and
Candida albicans is part of the vaginal flora. Among the risk factors are estrogen use, medication or
underlying diseases, immunosuppressed patients, pregnancy,use of antibiotics, as well as eating and clothing
habits conducive to the continuous growth of fungi.
Symptoms:THEsecretion looks like curdled white milk. In addition to discharge, patients may experience
itching that increases in heat, burning, dyspareunia (pain in sex), external dysuria (pain voiding) and a white
uterine cervix. IT ISodorless.
Diagnosis:If you mix material + KOH there is no volatilization, but you can see Candida pseudohyphae.
Introduction
Physiologically, the region of the vulva and vagina presents a variable amount of secretion in women of
reproductive age, which originates from the regional glands, cervical and endometrial mucus, as well as the
vaginal transudate. In women of childbearing age, physiological discharge may become more noticeable
sometimes in the middle of the menstrual cycle close to the time of ovulation, during pregnancy or with
contraceptive use. Diet, sexual activity, medication, and stress can also affect the volume and character of
normal vaginal discharge.
However, when an infectious or inflammatory process is present, the characteristics of the secretion change,
characterizing pathological vaginal discharge with excessive amounts, with changes in its physiological
characteristics, causing discomfort and being determined by different etiological agents.
bacterial vaginosis
Definition: It is characterized by the imbalance of the normal vaginal microbiota, with a significant increase
in anaerobic bacteria such as Gardnerella vaginalis, Mobiluncus sp, Bacteroides fragilis, Mycoplasma
hominis, Ureaplasma urealyticum, Peptostreptococcus, Prevotella sp, with concomitant decrease in
lactobacilli from the normal flora, which alkalizes vagina and decreases local leukocytes. Frequent sexual
acts, use of vaginal douches, semen and the premenstrual period are favorable factors. Condoms and
contraceptives are protective factors.
Symptoms: The common finding is an abundant, homogeneous, grayish-white vaginal discharge that appears
after coitus and post-menstrual period, adherent to the vaginal walls. Itching and other signs of inflammation
and irritation may occur. The “fishy odor” may appear because of the production of amines by aerobic
metabolism. In the office, it is possible to volatilize these amines, collecting the material on a slide, dripping
potassium hydroxide and the fish odor appears.
Diagnosis: it is clinical, but the pH can be analyzed because it is always increased, positive amine test. You
can pass this content on the slide and the pathologist finds the "clue cells".
complications: in pregnant women, there is a risk of premature rupture of the water, which causes premature
labor and post-cesarean endometritis (infection in the uterine cavity after surgery).
Treatment: treat symptomatic women (we do not treat a partner) with Metronidazole 250mg 2cp 12-12h
for 7-10 days (not to be mixed with alcoholic beverage as it causes nausea and vomiting).
Vaginal candidiasis
Definition:caused by Candida albicans and occasionally by other “non-albicans” species, in the most
recurrent cases. It is not considered a sexually transmitted disease, as it can affect celibate women and
Candida albicans is part of the vaginal flora. Among the risk factors are estrogen use, medication or
underlying diseases, immunosuppressed patients, pregnancy,use of antibiotics, as well as eating and clothing
habits conducive to the continuous growth of fungi.
Symptoms:THEsecretion looks like curdled white milk. In addition to discharge, patients may experience
itching that increases in heat, burning, dyspareunia (pain in sex), external dysuria (pain voiding) and a white
uterine cervix. IT ISodorless.
Diagnosis:If you mix material + KOH there is no volatilization, but you can see Candida pseudohyphae.
