Vaginal Discharge: Common Causes and Management in Women of Reproductive and Prepubertal Girls in a Primary Care Setting - A Narrative Review
Siva Achanna1, Jaydeep Nanda1* and Avanya Paloma2
1MAHSA University, Bandar Saujana Putra, Jenjarom, Selangor, Malaysia
2Bachelor of Science Biology at Sunway University, Bandar Sunway, Subang Jaya, Selangor, Malaysia
*Corresponding Author: Jaydeep Nanda, MAHSA University, Bandar Saujana Putra, Jenjarom, Selangor, Malaysia.
November 03, 2021; Published: November 30, 2021
Apart from the physiological form of vaginal discharge (VD), the early detection of pathological VD is important to prevent complications of the underlying diseases which can severely compromise a women’s health, fertility, ectopic pregnancy, cervical malignancy, pelvic inflammatory disease (PID) and vertical transmission of disease to the neonate are perhaps the most common clinical scenarios which are required to manage immediately. Partner notification and treatment is an essential part of the management. They may present to a number of different services, including primary care, family planning, genitourinary medicine and gynaecology. Many women express embarrassment, anxiety and taboo to complain in disclosing their problem, leading to self-management, home remedies and purchase of over the counter (OTC) prescriptions, without realizing the inability to differentiate between the normal physiological and pathological VD.
A thorough history, examination and investigations are needed to arrive at a diagnosis and formulation of the management plan. Sexual history should be taken in a sensitive manner to discuss regarding full sexually transmitted infection (STI) screening and other tests should be tailored appropriately to those at high risk. The prevalence of STI has risen in the United Kingdom since the 1990s. Hence, gynaecologists are required to be extra vigilant in the diagnosis and subsequent management of the sequelae.
The three main causes of VD in reproductive aged women are: bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginalis (TV). Discharge of cervical origin is the other important cause of VD with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG) and primary genital herpes simplex can also manifest as VD. These are the most common pathogens isolated. Cervicitis should be suspected in women with purulent endocervical discharge with easily inducing cervical bleeding. To detect specific pathogens causing cervicitis, laboratory testing is essential to identify the organisms involved.
Keywords: Vulvovaginal candidiasis; Trichomonas vaginalis; Bacterial vaginosis; Inflammatory Vaginitis; Neisseria gonorrhoeae; Chlamydia trachomatis; Pelvic Inflammatory Disease
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