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Genital Tract Infections

Vulvovaginal Candidiasis/Thrush

This is caused by Candida Albicans.


It presents with:

  • Symptoms - Cottage cheese-like discharge, Vulval irritation, Superficial dyspareunia

  • Signs - Vaginal discharge, Excoriation, Erythema, Fissuring, Vulval swelling

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“Speculum exam in candidal vulvovaginitis, showing thick, curd-like plaque on the anterior vaginal wall. A slightly erythematous base is visible close to the center of the image, where some of the plaque was scraped off.” © Mikael Häggström CC0 1.0 (https://en.wikipedia.org/wiki/File:Speculum_exam_in_candidal_vulvovaginitis.jpg)

Investigations:

  • Clinical diagnosis

  • Microscopy - high vaginal swab of discharge


Management - Fluconazole, Canesten cream


N.B. As this isn’t an STI, patients aren’t required to notify their partner or abstain from sex.


Bacterial Vaginosis

N.B. Most common cause of vaginal discharge in women of childbearing age.


It presents with:

  • Grey-white, fishy vaginal discharge

  • No itch/soreness


Risk factors - Vaginal douching, Use of soap products, Receptive cunnilingus, Black ethnicity, Smoking, Presence of STI


Diagnosed with the Amstel criteria, which states that, for a diagnosis, 3+ of the following is needed:

  • Vaginal pH > 4.5

  • Grey-white discharge

  • Positive whiff test - addition of potassium hydroxide to discharge produces fishy odour

  • Clue cells present on wet mount

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“Vaginal squamous cell with normal vaginal flora versus bacterial vaginosis on Pap stain. Normal vaginal flora (left) is predominantly rod-shaped Lactobacilli whereas in bacterial vaginosis (right) there is an overgrowth of bacteria which can be of multiple species.” © Mikael Häggström CC0 1.0 (https://commons.wikimedia.org/wiki/File:Normal_vaginal_flora_versus_bacterial_vaginosis_on_Pap_stain.jpg)

Management:

  • General advice - Wash with water and plain soap only, Shower instead of bath, Stop douching, Stop smoking

  • Metronidazole


N.B. As this isn’t an STI, patients aren’t required to notify their partner or abstain from sex.



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