White Discharge- A menace for Woman. Leucorrhoea-Persistent long term annoying white discharge with or without pruritus vulvae, may or may not be associated with Urinary symptoms .Possibly 1 in 5 cases of gynae cases seen at our clinic are of such symptoms, so also at OPD.
Lactobacilli are the most
abundant bacteria present in normal vaginas of women of child-bearing age (with
some exceptions due to race, geographic location and ethnic groups) .
How many of us are aware
that Lactobacilli (D Bacilli) are mainly derived from intestinal microbiota. This symptom of vaginal discharge is
strongly suspicious of some common but drug resistant infections as such come
to our clinic after some treatement by
one / two GP or even occasionally by
two-three consultants. It is therefore presumable that such cases are some resistant
strains of bacteria or fungus and therefore warrant some uncommon investigations
which are not always available in all towns(fungal culture) . Leucorrhoea /
Whites are therefore --It’s a challenge
for the Gynaecologists ll!
Q. 1: Vaginal Ecosystem & Immune system of vaginal mucosa and vaginal
fluid is the least discussed topic.
Why and how entry of offending bacteria, parasites and viruses inside
the vaginal canal are continuously prevented still remains an enigma to even the Gnaecologists of repute.
Q.2: What are the normal vaginal Flora???
•
Let us
talk about most commonly discussed bacteria- i.e. Lacto Bacilli(D. Bacilli) .
•
1)
There are about 100 species of L B.
•
2) They
principally produce Lactic Acid as well as Hydrogen Peroxide.
•
.
Q. 3 : Besides Hydrogen Peroxide and Lac acid there are the Defensins
which maintains ecosystem of vaginal mucosa .
•
Defensins: :-Usually neutrophils and macrophages of body excrete this substances to
fight against any invading organism. At vaginal fluid Lact. Bacilli also synthesize such some other antibacterial
substances to kill against invading organisms
Q.4: What are Bacteriocins. Who normally liberates Bacteriocins? It is by
Lact. Bacilli???
•
IV) Bacteriocins. These are group of
anti-bacterial substances (chemical) which are produced by one strain of
bacteria which are harmful against another strain of the same family.
Q.5. How the defense system is normally maintained?
•
It is
already known that 1) L. Acid, 2) H2O2,
3) Defensins, & 4) Bacteriocins .-all
collectively fight with the invasive organisms
. These four are important both in prevention of overgrowth of pathogenic bact
& their proliferation. Additionally one should also think of about pH of vaginal fluid- which is
normally 3.5-4.5.à This high pH is key inhibitor in preventing growth
of anaerobic organisms.
Q. 6: Persistent white discharge not responding to your diagnois!!! Please
do consider if she oestrogen-deficient clinically because of the fact that the population and work
force of L. Bacilli & Doderlein
bacilli depend much on estrogen.
•
If the
women concerned is oestrogen deficient her conc. of Doderlein
bacilli, (L. Bacilli) , H2O2
and Lac. Acid in vagina will be
less.
•
As
such, she will be a candidate for
recurrent bacterial vaginosis not amenable to the most appropriate antimicrobials
as was selected by the clinicians .
Q.7: Where are the sources of normal virginal secretions?
•
After
attaining adulthood--Vagina is almost always moist (oestrogen effect) . It comes from transudation from multilayered virginal
mucosa . Incidentally Vaginal mucosa do not contain any glands (in contrast to esophagus)
to secrete any fluid.
Q.8:-What are the normal & usual sources of vaginal secretions?
•
Sources are:- Transudates from vaginal
walls, cervical secretions, Endometrial and tubal fluids, secretions
from sebaceous glands, sweat glands, Skene glands of ext. urethral glands ,
Bartholin glands. Any such gland can pour & cause much- annoyance to the woman concerned.
Q.9:-Qualities of Normal Vaginal Fluid- How it looks and feels like? Ans:
White, Thin,
flocculent, without any smell/ pruritus. It contains many micro-organisms and
their metabolic products that are excreted in the fluid.
•
Normally
there is a bio-film of normal commensal
(Doderlein bacilli) in the vaginal mucosaà prevents entry of bacteria into the mucosa.
Reproductive Hormones are the key regulators of amount, character of
Discharge.
Q. 10 : The history of discovery of Lacto bacilli
? Ans ; Lactobacilli are the most
abundant bacteria present in normal vaginas of women of child-bearing age. In the last
decade, there have been quite a lot of scientific advances reported regarding
the immunology and pathophysiology of human vaginal microbiota. As a result,
physicians have a more comprehensive understanding of the role that
lactobacilli exert in the vaginal milieu and their interactions- with vaginal
mucosa, pathogenic bacteria and fungi. There have been advances in vaginal
microflora, vaginal epithelial cells, immunity, bacterial vaginosis (BV) and
candidiasis. Additionally, recent reports regarding
Lactobacilli are the most abundant
bacteria present in normal vaginas of women of child-bearing age (with some
exceptions due to race, geographic location and ethnic groups) .They
are mainly derived from intestinal microbiota. The significance of
lactobacilli presence for a healthy vaginal milieu has been recognized ever
since Albert S Doderlein discovered a vaginal bacillus that he named Döderlein,
in 1892. This bacillus was subsequently renamed as Lactobacillus .
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