GENITAL INFECTION IN GYNAECOLOGY 

( MEDICAL STUDENTS LECTURE & NOTES) 2022

The Nature and Role of Physiological Vaginal Discharge.

● Normal for woman to have some degree of vaginal discharge. 

● Normal - white to yellowish (d/t oxidation). 

● Contents: Mucous, desquamated epithelial cells, bacteria and fluid from endometrial.

● There is slight odour but it’s not strong. pH: acidic (4-5). 

● The role : ○ To carry away dead cells and bacteria thus keeps the vagina clean.

                    ○ Acidic - act as defense mechanism against pathogens.

COMMON GENITAL INFECTION IN GYNAECOLOGY:

Vulvovaginal Candidiasis

Causal organism: Candida albicans (gram +ve oval yeast). 

Predisposing factors: Pregnancy (40%), DM, high-dose combined OCP, HIV. 

Signs & symptoms: Vulval itching, thick white curdy discharge (vaginal thrush), dyspareunia, dysuria, vulval oedema, redness, normal vaginal pH. 

Diagnosis: High vaginal swab -> gram stain/wet film examination. 

Treatment: Imidazole oral/pessary (oral contraindicated to pregnant women), nystatin cream/pessary, 

Tricomoniasis 

Causal organism: Trichomonas vaginalis (flagellate protozoa). 

Predisposing factors: Multiple sexual partners, unprotected sex. 

Signs & symptoms: Vulval itching, frothy yellowish green discharge, dysuria, strawberry cervix. Diagnosis: 

Investigation: High vaginal swab, μscopy of vaginal discharge, saline wet mount.

 

Treatment; Metronidazole

Bacterial Vaginosis 

Bacterial Vaginosis Causal organism: Gardnerella vaginalis, Mycoplasma hominis, Bacteroides spp., Mobilincus spp.

Predisposing factors: Multiple sex partners, douching, lack of good lactobacilli. 

Signs & symptoms: Fishy malodourous discharge, more common during menses. 

Diagnosis: Amsel criteria (≥3 criteria for diagnosing bacterial vaginosis) a) Presence of clue cells (stippled appearance) - μscopic examination. b) Creamy greyish white discharge - naked eye. c) Vaginal pH > 4.5. d) Release of a characteristic fishy odour on addition of alkali. 

Treatment: Metronidazole, clindamycin.

Gonorrhoea 

Causal organism: Neisseria gonorrhoeae (gram -ve diplococcus). 

Predisposing factors: Multiple sex partners, early age of onset of sexual activity. 

Signs & symptoms: Greenish mucopurulent discharge, pelvic tenderness, proctitis, rectal bleeding.

Diagnosis: Vaginal swab -> gram stain/Thayer-Martin agar (blood chocolate agar with antibiotics).

Treatment: Cefixime, ceftriaxone, spectinomycin.

Genitourinary Chlamydia

Causal organism: Chlamydia trachomatis (gram -ve, obligate intracellular parasite).

Predisposing factors: Multiple sex partners, early age of onset of sexual activity.

Signs & symptoms: Mucopurulent discharge, postcoital and intermenstrual bleeding, dysuria. Late stage: Conjunctivitis and pneumonia. 

Diagnosis: Nucleic acid amplification technique, RT-PCR, culture. 

Treatment: Doxycycline, azithromycin, erythromycin, amoxicillin.