Discharge from the vagina. Differential diagnosis

November 1, 2016

Active substances:
Trade names:
ICD-10:
XIV.N70-N77.N77.1 *    Vaginitis, vulvitis and vulvovaginitis in infectious and parasitic diseases classified elsewhere
XIV.N70-N77.N76.1    Subacute and chronic vaginitis
XIV.N70-N77.N76.0    Acute vaginitis
Vaginosis, vaginitis, candidiasis, gonorrhea, chlamydia, venereal diseases, obstetrics and gynecology, zalain, differential diagnosis

Vaginal discharge (leukemia) is one of the key complaints from patients in the practice of a gynecologist. This syndrome requires careful differential diagnosis, because diseases that manifest themselves with leukemia are not equal in their predictions, clinical significance and therapeutic tactics. The material describes the main causes of vaginal discharge, diagnostic approaches to them and The methods of treatment.

Bacterial vaginosis
Causal agent: Gardnerella vaginalis.
Clinical picture: It occurs asymptomatically in 50-75% of cases; fishy odor, especially after sexual intercourse; whitish homogeneous discharge of liquid consistency; sometimes - dysuria and dyspareunia (pain during sexual intercourse). Risk factors include the change of a sexual partner or more than three partners during the last year, douching, smoking.
Diagnostic criteria:
Treatment: drug of choice - metronidazole.
Dosage:
500 mg 2 times a day for 7 days OR
2 g once or
Metronidazole long-acting: 750 mg once a day for 7 days.
In pregnant women: 500 mg 2 times a day for 7 days OR 250 mg 3 times a day for 7 days.

Trichomoniasis
Causal agent: Trichomonas vaginalis.
Clinical picture: Purulent, liquid discharge with an unpleasant odor. Perhaps a burning sensation, itching, dysuria, dyspareunia. Symptoms may worsen during menstruation. Usually there is pronounced erythema of the vulva and vaginal mucosa. On the cervix of the uterus it is possible to detect pinpoint hemorrhages (a symptom of a strawberry neck).
Diagnostics:
Microscopy of a wet swab of vaginal discharge: detectable Trichomonas vaginalis.
Tests of amplification of nucleic acids and determination of antigens in vaginal discharge.
Gold standard: tothe vaginal discharge.
Treatment:
Metronidazole 2 g once. In addition to the patient, treatment should be prescribed to all sexual partners.

Candidiasis
Causal agent: Candida albicans.
Clinical picture: Typical complaints: itching and burning sensations in the vagina, dysuria, dyspareunia. Allocations are usually ungrowner, white, curdled. On examination, erythema and swelling of the vaginal mucosa are noted.
Diagnostics: Microscopy of a wet swab of vaginal discharge: mycelium of yeast fungi.
Additional studies: culture of vaginal discharge. The analysis of fasting blood glucose (for the exclusion of diabetes mellitus,which often serves as a background disease for vaginal candidiasis).
Treatment: effective antifungal agent is sertaconazole (tradename - Zalain), which is prescribed in the form of vaginal suppositories. With candidiasis of severe course, various oral medications are prescribed.

Chlamydia
Causal agent: Chlamydia trachomatis.
Clinical picture: Often flows asymptomatically. There may be purulent or mucopurulent discharge from the cervix, and bleeding between periods, after intercourse, dysuria, dyspareunia, vulvar irritation. Rarely is pain and fever. On examination: wThe uterus is friable, erythematous and edematous.
Diagnostics: the method of choice is the amplification of nucleic acids (PCR). Additional methods: culture, general urine analysis, pregnancy test.
Important! Patients with chlamydia should be tested for all key sexually transmitted infections!
Treatment: Azithromycin 1 g once (preferably) OR
Doxycycline 100 mg once a day for 7 days.

Honorher
Causal agent: Neisseria gonorrhoeae.
Clinical picture: Gonorrhea of ​​the lower part of the urogenital tract often proceeds asymptomatically.With severe manifestations of the disease, dysuric phenomena, itching and burning in the vagina, puffy cream-like discharge from the cervical canal are noted. On examination, there is flushing and swelling of the urethral cavity and cervical canal.
Diagnostics: microscopy of smears from the urethra and vagina with Gram staining, amplification of nucleic acids. Gold standard: culture examination (mandatory for pregnant women, adolescents and children).
Important! Patients with gonorrhea should be tested for all key sexually transmitted infections!
Treatment: drug of choice - ceftriaxone 250 mg intramuscularly once. Important! Since co-infection with chlamydia is extremely common, simultaneous administration of 1 g of azithromycin is recommended once.