VVC; Vulvo vaginal candiasis : Diag dilemma & Treatment and recurrence

•       vaginal mucosaà prevents entry of bacteria into the mucosa.

Reproductive Hormones are the key regulators of amount, character of Discharge.

•       The microscopical  examinations are done:-

•       1) Wet mount preparations.- one/two drops of vaginal . Fluid are taken and put on glass slide and a cover slip is put- seen without any stain-

•       1

Hanging Drop Preparations-At OPD/ at Clinics.

•       1) Flagellate organisms:- Trichomonas infections.

•       2) Hyphae- Monilial infections- Fungal vaginitis.

 

We often hear the term Bacterial Vaginosis.

•       It is a mixed infection caused by some specific organisms e.g. Gardnerella  Vaginalis, Mobiluncus, Mycobact hominis, and Bacteroid  species .

•       This term was coined by Spiegel in 1983.

•       It causes white homogenous discharge sticking to vaginal walls.

•       It is possibly the most common cause of vaginal discharge seen amongst reproductive age group.

Bacterial Vaginosis.- How to diagnose?

•       Clinically- the entire vaginal  wall is covered / painted/ coated by a thick white discharge.  KOH  test:-Fishy smell- 10% KOH test at your clinic

•       Microscopy- Gm stain-  CLUE  cells.,

•       Ansell's Criteria, Nugent Scoring system.

What is KOH test?

•       In cases of Bacterial Vaginosis – if a small amount of KOH solution is added then there will be fishy smell from the vaginal fluid   treated with KOH solution- Diagnostic of BV.

What are the most rarely performed Tests?

•       1) Gas Liquid Chromatography.

•       2)Culture of Vaginal Fluid – Aerobic and anaerobic culture often with sensitivity tests

•       3) PCR Technique is becoming increasingly popular..

What next microscopically??

•       Gm Stain:- Lacto bacilli, Doderlein Bacilli, Diff cocci, Supllemenation. Desquamated vaginal cells and pus cells which must not exceed 1  HPF.

 

•       What  are CLUE  Cells ? – These are big vaginal desquamated cells on the surface of which there many small bacteria sticking.- seen in Bacterial Vaginosis.

When we should be worried- call abnormal vaginal discharge???

•       Persistently  heavy,  Malodorous, purulent, blood   pruritus,  cause much irritation/ cause pain or one has to wear a vulvae pad. For excessive  normal secretion.

•       These are the situation one has to investigate and treat.

“Whites”- is a term / expression by patients.

•       Excessive discharge falls under two basic groups:-

•       A) Noninfective- Excessive normal secretion- designated by lay public as leucorrhoea.

•       B) Infective:- pathological- a matter of concern- may be caused by a variety of organisms.

•       One has to elicit history, Sometimes too much Lab tests  to arrive at a definitive diagnosis.

What are the common causes of whites?

•       1) Trichomoniasis.

•       2/ Candida albicans- diabetes, Oral pill intake, antibiotics prolonged use, sometimes resistant type Candida- most difficult to diagnose and treat.

•       3) Chlamydial Trachomatis.

What are the less common causes of Whites?

•       5) Gardnerella vaginalis infection.

•       6) N Gonorrhoeae.

•       7)  HSV(Herpes simplex Virus).

Other but uncommon causes of Whites?

•       9) E. Histolytica- often not considered.

•       10) E. Coli.

•       11)  Staphylococci. Mycobacterium family, Cl. Welchi, Streptococcus.

What are the rare causes of whites?

•    Senile vaginitis, Allergic, Foreign body, Worm infestations, Benign and Malig neoplasms.