Vaginal Discharge
The pubertal vaginal flora is primarily lactobacillus, and the vagina has an acidic pH with a thick, estrogenized epithelium acting as a protective mechanism. The prepubertal vagina is less estrogenized and has a thinner epithelium, predisposing it to irritation. Any complaint of a vaginal discharge must be taken seriously as it may be a sign of an infection, underlying medical disorder, or sexual abuse.
Differential Diagnosis
- Physiologic leukorrhea
–In newborns for 2–3 weeks, due to maternal estrogen effect, and in pubertal girls
–Discharge typically clear to white, sticky, and
nonirritating
–Newborns may have withdrawal bleeding
- Infections
–Bacterial vaginosis: Previously known as nonspecific vaginitis; polymicrobial in etiology (coliforms, streptococci, Gardnerella); discharge may be gray and malodorous (fishy smell) but generally nonirritating
–Candida: Discharge may be cheesy and white with erythematous, pruritic, irritated vulva; typical discharge is rarely seen in prepubertal children; discharge typically has no odor
–Trichomonas: Discharge may be frothy, malodorous, creamy, green, bloody, or pruritic (or asymptomatic)
–Chlamydia: Commonly asymptomatic or a nonspecific discharge
–Gonorrhea: Infection is commonly asymptomatic or has a gray-white, thick, purulent discharge
–Group A β-hemolytic streptococci:
Discharge may be bloody
–Shigella: Discharge may be bloody
-
Irritation/hygiene
–Due to bubble baths and other chemical irritants, tight clothing, obesity, poor wiping
-
Foreign body
–Commonly includes toilet paper, forgotten tampon
–Discharge is often bloody and malodorous
-
Anatomic
–Ectopic urethra
–Rectovaginal fistula
–Urethral prolapse
-
Urinary tract infection
-
Masturbation
-
Sarcoma botyroides
-
Oral contraceptives (estrogen effect)
Workup and Diagnosis
- History
–Age of girl (pubertal vs prepubertal)
–Sexual activity and number of partners
–Possibility of sexual abuse
–Medications (e.g., steroid, oral contraceptive,
antibiotic)
–PMH of diabetes mellitus or immunocompromised
–Type of discharge and duration of symptoms
–Hygiene practices including feminine hygiene
products, soaps, wiping techniques
–Therapy tried at home
- Physical exam
–Frog-leg or lithotomy position; examine external genitalia for abnormalities; speculum exam in sexually active adolescents
–Amount, odor, color, consistency of discharge
- Labs
–pH: Normal in the pubertal female is 3.8–4.4; if >5,
consider bacterial vaginosis or Trichomonas
–Vaginal gram stain and culture
–Cultures for gonorrhea and Chlamydia (DNA
amplification may not hold up in court for abuse cases)
–Wet prep: Trichomonas has motile trichomonads; bacterial vaginosis has clue cells (vaginal epithelial cells coated with bacteria)
–KOH for Candida
–Whiff test (KOH added to discharge yields a fishy smell in Trichomonas)
- Urine culture and pregnancy test as indicated by history
Treatment
-
Physiologic leukorrhea: Provide reassurance
-
Irritative vaginal discharge: Educate on proper wiping techniques, avoidance of tight clothing and irritants
-
Foreign bodies such as toilet paper can usually be removed with gentle vaginal lavage, sitz baths
-
Treatments for infectious causes of vaginal discharge:
–Bacterial vaginosis: Metronidazole or topical
clindamycin
–Candida can be treated with topical or oral antifungals
–Trichomonas is treated with metronidazole
–Group A β-hemolytic streptococci: Penicillin
–Chlamydia is treated with doxycycline or azithromycin
–Gonorrhea: Ceftriaxone, ciprofloxacin, or ofloxacin
–Shigella is treated with trimethoprim-sulfamethoxazole
- Encourage barrier contraception in sexually active adolescents
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Vaginal dryness
Read excerpts from these other book chapters related to Vaginal dryness:
Medical Books Excerpts
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal dryness
|
|
More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
|
|
» Next page: VAGINAL DISCHARGE (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
