A study on vaginal discharge in females attending sexually transmitted disease outpatient department

Sobimeena, R M (2017) A study on vaginal discharge in females attending sexually transmitted disease outpatient department. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Vaginal discharge may be a subjective complaint or an objective finding. Patient may complain of excessive, abnormally coloured or textured or malodorous secretions. The complaint must be verified by physical and laboratory examination to differentiate abnormal from physiological discharge and to determine diagnosis & treatment. The Major cause for abnormal vaginal discharge are infection due to Gardenerella vaginalis, Trichomonas vaginalis, Candida albicans, Neisseria gonorrhoeae & Chlamydia trachomatis. The study will highlight the importance of systematic approach. Proper clinical examination, basic laboratory investigation, culture methods, comorbid illness, & HIV status of the patient. AIMS & OBJECTIVES: 1. To determine the etiology for the abnormal vaginal discharge in women attending the sexually Transmitted Disease OP at Stanely Medical College, Chennai. 2. To study the presenting features co-morbidities, clinical features, wet mount results and specialized culture techniques and their outcome. METHODS AND MATERIALS: SOURCE OF DATE: Patients attending Sexually transmitted disease OPD in Stanley Medical College, Chennai. PLACE OF STUDY: Govt. Stanley Medical College. TYPE OF STUDY: Prospective, Non-Randomized, Observational study. TIME DURATION: One year. SAMPLE SIZE: 100. STUDY PROCUDURE: SPECIEMEN COLLECTION: Step 1 : Through confidential history will be taken. Step 2 : By Placing patient on lithotomy position, external genitalia will be examined And any erythema or discharge in the fourchette will be noted. Step 3 : Cusco’s self retaining bivalved speculum inserted, vagina & Cervix visualized. Step 4 : Multiple high vaginal & endo cervical swaps will be taken for smear and culture. Step 5 : Vaginal discharge in the speculum will be utilized for wetmount, KOH & whiff test. Vaginal H determined using pH strips. LABORATORY EXAMINATION: BESIDE INVESTIGATIONS: Vaginal discharge will be examined after adding one drop of normal saline for wetmount, one drop 10% potassium hydroxide added for KOH mount & whiff test. 1. WETMOUNT : To viualise normal; epithelial cells, clue cells, motile trichomonads & candida Hyphae. 2. KOH MOUNT : To visualize candidal hyphae & spores. 3. WHIFF TEST : Note for any fishy amine odour. 4. pH TEST : Vaginal pH determined using pH strips. 5. GRAM STAIN : A thin smear will be prepared by rolling the swab on a clean glass slide. After air drying & hear fixing the smear stained with Gram stain. In high vaginal smear, presence of epithelial cells, Clue cells, Candidal hyphae, spores and extracellular organisms noted. If needed, Nugents scoring done. In endo cervical smear presence of intracellular gram negative diplococci, leucocytes and other extracellular organisms noted. INCLUSION CRITERIA: 1. Age 20 to 50 years old, 2. Sexually active non pregnant women, 3. Patient consulting for vaginal discharge. EXCLUSION CRITERIA: 1. Pregnant women, 2. Post-menopausal women, 3. Women during menstrual cycle, 4. Patient who had taken antibiotic treatment or vaginal medication in previous 14 days, 5. Patients not willing for the procedure or for follow-up. INVESTIGATIONS: 1. Routine blood and urine examination, 2. Serology for HIV & VDRL. CONCLUSION: It is evident from the study that a significant proportion of general public is suffering from abnormal vaginal discharge. • Bacterial vaginosis, Vulvovaginal Candidiasis and Trichomoniasis are the principal causes for the abnormal vaginal discharge. • The present study cautions the Clinicians to be aware of emerging epidemiological data, the different presentations of vaginal discharge, and the approach to their management so that the symptoms can be treated based on their etiology. • This study has highlighted the prevalence of mixed infections in a single individual and one should be met iculous in picking up those with mixed infect ions. • The present study highlights the importance of culture over bedside investigations in coming to a microbiological diagnosis. • This study signifies the changing trend of albicans to non albicans in VVC, requiring modifications in routine treatment of azoles to flucytosine and boric acid as non albicans respond well to them. • The unidentified presence of HIV infect ion in the general population poses potential risk for infection, spread and mutation of these organisms in immuno compromised states. • A periodic study and review of this type will help the epidemiologist to identify the prevalence pattern of infections and to manage them efficiently to overcome the emergence of resistant organisms. • In the era of genome biology, it is a definite possibility of developing a single test which will identify most of the causative organism. More research is needed for such test that reduces the laboratory time and to produces rapid results. • It is concluded that every patient, who complains of vaginal discharge, should be thoroughly interrogated, examined and investigated properly and pathological discharge should be treated completely.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201330054
Uncontrolled Keywords: vaginal discharge, females, sexually transmitted disease, outpatient department.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 22 Jul 2020 15:49
Last Modified: 22 Jul 2020 15:49
URI: http://repository-tnmgrmu.ac.in/id/eprint/12638

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