Vaginal Discharge

INTRODUCTION
Vaginal discharge is the commonest Gynaecological symptom. The vagina produces a variant amount of discharge normally. It is physiological, small in amount, and it does not cause any irritation or offensive smell. It contains a mixture of secretions from endometrial and endocervical glands, exfoliated vaginal cells, bacterial flora and white blood cells. Excessive vaginal discharge should always be investigated.

Causes of vaginal discharge

Vaginal discharge is not always due to pathological causes. It can be also due to physiological causes.

A) Physiological causes

Important physiological causes are:
1. Immediately proceeding and following menstruation.
2. In the mid cycle 3. After sexual excitement

B) Pathological causes:

Infection: .Moniliasis. Trichomoniasis
.Gonorrhoea. Thread worms infestation in the childhood
C) Foreign body in the vagina: .Tampons in the adult .Small Child may introduce foreign body by themselves

D) Erosion: .Erosion of the cervix

E) Neoplasm: .Cervical polyp. Cervical carcinoma .Vaginal carcinoma

F) Allergy

To make the diagnosis, a thorough history and clinical examination. followed by relevant investigation is helpful.

Moniliasis and Trichomoniasis are the two major causes of vaginal discharge with vulvar itching.

Moniliasis is a very common fungal infection of the vagina and vulva. It is caused by Candida albicans. The discharge is typically curdy white. When the white flakes are removed, there appear petechial bleeding. Gram staining will show hypae / pseudohypae. The organism can be cultured in Sabored Agar Medium. Many conditions like Candidiasis. There are speckled Gram-positive spores and long oral pill pregnancy pseudohyphae visible There are numerous polymorphs presentbd' , and the bacterial flora is abnormal, resembling bacterial roa spectrum vaginosis. antibiotic therapy, immunosuppresion, diabetes etc pre- dispose to moniliasis. Infact when there is repeated monilial infection, diabetes should always to be ruled out.

Tricomoniasis is caused by the organism Triconads vaglnalis. It is a parasite. The discharge is yellowish or yellowish

T richomoniasis- an unstained 'wet mount' of vaginal fluid from a woman-with T richomonas vaginalis infection. There is a cone-shaped flagellated organism in the centre with a terminal spike and 4 flagellae visible. In practice the organism is identified under the microscope by movement, with amoeboid motion and its flagellae waving.

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Dr. M. Anwar Hussain, MBBS (DMC), FRCOG (London),
FICS, P!ofessor, Department of Obstetrics and Gynaecology
Bangabandhu Sheik Mujib Medical University, Dhaka.