Vaginal Discharge and Itching

33 Vaginal Discharge and Itching

Vaginal discharge, which may be accompanied by vulvar itching or burning, is one of the most common problems seen in the physician’s office. These symptoms usually indicate bacterial vaginosis (a polymicrobial superficial infection characterized by an increase in aerobic bacteria, especially Gardnerella, and a decrease in lactobacilli), candidiasis (moniliasis) (Candida albicans), or trichomoniasis (Trichomonas infection). Other common causes of vaginal discharge are acute cervicitis, gonorrhea, and herpes genitalis. Sexual abuse and sexually transmitted diseases such as gonorrhea must always be considered in all prepubescent girls with vaginal discharge.

Vulvar itching (which often accompanies vaginal discharge) is common and can occur by itself. The most common vulvar dermatoses are dermatitis, psoriasis, and lichen sclerosus. Streptococcal vulvovaginitis is seen only in children, whereas chronic vulvovaginal candidiasis occurs only after puberty because it is estrogen dependent.

Many discussions of vaginitis emphasize a typical appearance of the discharge: cheesy, frothy, or mucoid. However, appearances may be misleading. In addition, 15% to 20% of patients in one series had two coexisting infections. Other studies of patients with vaginitis have shown that 35% had bacterial vaginosis, 25% had candidiasis, and 20% had trichomoniasis. The remaining 20% had less common types of vaginitis.

In contrast to cervicitis, vaginitis is an inflammatory change of the vaginal mucosa in the absence of a profuse discharge from the cervix. A vaginal discharge can be produced by cervicitis without a significant vaginal infection, as can be the case with gonorrhea. Chlamydia also causes mucopurulent cervicitis.

Nature of Patient

Nature of Symptoms

Vulvovaginitis in premenarchal girls usually causes only minor discomfort, which may consist of perineal pruritus, burning, and a discharge that may be profuse or scanty.

The duration and type of symptoms do not consistently distinguish the common infectious causes of vaginitis. However, certain symptoms and findings strongly suggest the diagnosis. For instance, although an acute onset of vaginal discharge or vulvar irritation indicates that a yeast infection is the probable cause, these symptoms are often unreliable. Likewise, a curdlike discharge (resembling cottage cheese) strongly suggests yeast vaginitis; however, the gross appearance is less sensitive and specific in establishing the diagnosis than microscopic examination of the vaginal discharge. A curdlike appearance virtually eliminates the possibility of trichomonal vaginitis, which usually produces a profuse, frothy, white or grayish green, malodorous discharge. The discharge from trichomonal vaginitis is typically described as frothy, whereas the discharge from bacterial vaginosis is described as homogeneous.

Because itching and burning may occur with virtually all forms of vaginitis, these symptoms are not particularly helpful in differentiating the cause. Women who diagnose themselves as having a yeast infection have been shown to be only 11% to 34% accurate (bacterial vaginosis being the other most likely diagnosis). It is important to differentiate vulvar pain from vulvar itching. Itching is most prominent in candidal vaginitis and least prominent in bacterial vaginosis. Itching and burning are uncommon with gonococcal infections, but a significant percentage of patients with a gonococcal infection have a combined infection. They may have gonorrhea with their itching that is caused by Trichomonas or Candida.

Vulvar itching is commonly caused by eczema, dermatitis, and vulvovaginal candidiasis. In prepubertal girls, atopic and irritant dermatitis are the most common causes of vulvar itching. Irritants to vulval skin can be chemical (soaps, bath oils, bubble baths, douches, perfume, lubricants, antifungal creams, retained sweat, and vaginal secretions) or physical (sanitary pads, tight clothing, synthetic underwear, excessive cleansing, and shaving). Systemic causes of vulvar itching include diabetes, which predisposes to candidiasis, liver disease, polycythemia, psoriasis, seborrheic dermatitis, and medications, such as penicillin, ampicillin, and sulfa drugs.

If a vaginal discharge is sticky, brown, or yellowish and occurs in an elderly woman, atrophic vaginitis should be suspected.

Mar 21, 2018 | Posted by in BIOCHEMISTRY | Comments Off on Vaginal Discharge and Itching
Premium Wordpress Themes by UFO Themes
%d bloggers like this: