LEUCORRHOEA
It means excessive normal vaginal discharge.
⚫Types :
A. Non-Pathological / Physiological Leucorrhoea
B. Pathological Leucorrhoea
Physiological Leucorrhoea –
This discharge is whitish, mucoid/watery, non-irritating.
Example::
▫At birth,
▫At puberty,
▫Ovulation,
▫OCP,
▫Pregnancy.
Pathological Leucorrhoea –
1) Infection/ Diseases :
Example :
▫Trichomoniasis,
▫Bacterial vaginosis,
▫Moniliasis,
▫Cervicitis,
▫Syphilis,
▫Gonorrhoea,
▫PID etc.
2) Foreign body in the uterus and vagina :
Example::
▫Application of IUCD,
▫Application of vaginal pessary
3) New growth in the genital tract :
Example:
▫Neoplasm
⚫The following points should be asked :
1) Amount (Scanty /copious)
2) Colour (White, yellow, greenish, blood stained)
3) Odour (Offensive or odourless)
4) Consistency (Watery or thick, frothy, purulent, thin).
5) Age of pt, marital status.
6) Associated with itching.
7) Associated with LAP, dyspareunia.
8) H/O sexual exposure.
9) H/O DM.
10) If married H/O contraceptive method.
11) History taking from her husband.
12) Relationship with menstruation, pregnancy.
13) Other history like UTI, Personal hygiene, any allergy etc etc.
⚫Trichomonas Vaginitis, Bacterial Vaginosis :
▪Yellowish/greenish discharge, frothy,
unpleasant,
▪Bad smell,
▪Itching (in Bacterial Vaginosis – non itching)and
▪Burning in genital area, swelling, painful coitus and urination.
Rx:
1. Metronidazole
2. Vaginal cap/supp
3. Vaginal cream
4. Oral Antihistamine
5. Antibiotic
⚫Moniliasis/Candidiasis :
▪Thick, cheesy/curd like white vaginal discharge,
▪Itching, swelling, no bad smell.
Rx:
1. Oral Antifungal
2. Antifungal cream
3. Orally Antihistamine if need
4. Vaginal VT if need
⚫Pelvic Inflammatory Disease
(PID) :
Inflammation of the genital tract including endometritis, salpingitis, oophoritis etc.
Causes :
▪ STD ( Sexually Transmitted Disease)
▪ After abortion/ MR,
▪ IUCD ( Intrauterine contraceptive device) insertion,
▪ Multiple sexual partners etc.
symptoms :
▪ LAP ( Lower abdominal pain ),
▪ LBP ( Low back pain) ,
▪ Offensive purulent vaginal discharge,
▪ Irregular menstruation,
▪ Dyspareunia ( persistent or recurrent pain that can happen during sexual intercourse)
▪ Fever,
▪ Dysuria ( pain or discomfort when urinating) ,
▪ Sometimes postcoital bleeding,
▪ On P/V exam swelling and redness of vulva-vagina, tender, congested cervix,
▪ History of sexual exposure.
Rx:
1. Analgesic
2. Antibiotic
3. Metronidazole
4. Antihistamine if need
5. Topical, VT if need
⚫Physiological Leucorrhoea :
Watery or white discharge, no bad smell, no itching.
Rx:
Counselling.
⚫Investigation for all Vaginal discharge :
1. CBC ( Complete Blood Count)
2. High Vaginal swab for gram stain & Culture and sensitivity
3. Urine analysis
4. USG of Pelvic organ/ LA
5. Blood sugar
6. Specific test for Gonorrhoea,
syphilis : VDRL (Venereal disease research laboratory test) ,
TPHA (Treponema pallidum particle agglutination assay),
7. VIA test ( Visual inspection with acetic acid) or Pap’s smear.
⚫Treatment :
According to cause/Diseases
⚫Advice :
1. Take plenty of water
2. Maintain personal hygiene
3. Void bladder properly
4. Clean the genital area
5. Micturition before and after intercourse
6. If itching clean genitalia with salt mixed lukewarm water.
⚫Prevention :
1. Avoid multiple sexual partners/sexual exposure.
2. Be faithful to couple each other
3. To maintain religious rules strictly.
4. Use barrier method incase of STD
Dr. Tania Hafiz
Z.H Sikder Women’s Medical College and Hospital
কারিতাস ঠিকানা প্রকল্প
মিরপুর, রুপনগর, ঢাকা-১২১৬,কারিতাস বাংলাদেশ
⚫প্ল্যাটফর্ম একাডেমিক / সাদিয়া কবির ⚫