Vaginal Discharge

Signs and symptoms

Typical symptoms of BV include the following:

·         Vaginal odor (the most common, and often initial, symptom of BV); often recognized only after sexual intercourse

·         Mildly to moderately increased vaginal discharge

·         Vulvar irritation (less common)

·         Dysuria or dyspareunia (rare)

Physical findings in BV may include the following:

·         Gray, thin, and homogeneous vaginal discharge, which adheres to the vaginal mucosa

·         Increased light reflex of the vaginal walls, but typically with little or no evidence of inflammation

·         Normal-appearing labia, introitus, cervix, and cervical discharge

·         In some case, evidence of cervicitis

Management

·         BV that does not resolve after one course of treatment may be cured by giving a second course of the same agent or by switching to another agent (eg, from metronidazole to clindamycin or from clindamycin to metronidazole)

• Patients should wash only with hypoallergenic bar soaps or no soap at all and should avoid liquid soaps and body washes

Trichomoniasis 

History

Trichomoniasis is typically found in sexually active patients. Transmission occurs predominantly via sexual intercourse.

TRichomoniasis symptoms in women range from none to severe pelvic inflammatory disease (PID). Women with trichomoniasis frequently report an abnormal vaginal discharge, which may be purulent, frothy, or bloody. Frothy vaginal discharge, which is thought to be the classic presentation of trichomoniasis, may be observed in only 12% of patients with this infection.

Women with trichomoniasis also commonly report abnormal vaginal odor (often described as musty); vulvovaginal itching, burning, or soreness; dyspareunia (pain during sexual intercourse), which is often the major complaint; and dysuria (pain during urination).^{[11, 43]} Patients may also complain of postcoital bleeding and lower abdominal pain.

metronidazole and tinidazole are FDA-approved. I

Metronidazole

Metronidazole is the treatment of choice for trichomoniasis. Single-dose therapy with 2 g orally is as effective as prolonged therapy with 500 mg twice daily for 7 days. Single-dose therapy increases drug adherence.

Vulvovaginal candidiasis

Acute vulvovaginal candidiasis

In acute vulvovaginal candidiasis, vulvar pruritus and burning are the main symptoms. Patients commonly complain of both symptoms after intercourse or upon urination. Dyspareunia may develop and become severe enough to lead to intolerance of intercourse.

Physical findings include erythema and edema of the vestibule and of the labia majora and minora. The rash may extend to the thighs and perineum. Thrush patches are usually found loosely adherent to the vulva. A thick, white, curdlike vaginal discharge is usually present

Vulvovaginal candidiasis

Some women with recurrent candidal infections opt for treatment with over-the-counter (OTC) medications, which generally are highly effective for candidiasis. Preparations for intravaginal administration of butoconazole, clotrimazole, miconazole, and tioconazole are available OTC. However, self medication with OTC preparations should be advised only for women who have been diagnosed previously with vulvovaginal candidiasis and who have a recurrence of the same symptoms.