Doctors Lounge - Gynecology Answers
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Forum Name: Gynecology
|javama - Thu Dec 08, 2005 1:29 am||
I am taking seasonale birth control, and i understand that taking b.c. can make you more suseptible to yeast infections. i have had a few since i started taking the pill about 1.5 yrs ago, but the bigger problem seems to be this constant, lingering clumpy white discharge that always seems to be there. it does not have a foul odor, nor do i have any other symptoms of a yeast infection (itching, etc). I had a culture done at my dr's office,which confirmed it was not a yeast infection, but he did not provide any alternative solutions to the problem.
I tried taking azo yeast tablets, 2 a day, for about amonth with hardly noticible improvement.
Thanks for you help!
|Dr. Tamer Fouad - Sun Jan 01, 2006 10:05 am||
The 3 most common causes of vaginitis and vaginal discharge are bacterial vaginosis, vulvovaginal candidiasis (yeast infection) and trichomoniasis. Vaginal discharge may also result from sexually transmitted diseases such as gonorrhea or chlamydia.
A white, curdlike discharge that looks like cottage cheese is a classic sign of yeast infection. Yellow, green or gray discharge is usually a sign of trichomonas or bacterial vaginosis. Bacterial vaginosis also has an unusual, fishy odor. Gonorrhea and chlamydia usually don't cause any symptoms at all. In some cases they present as a new vaginal discharge accompanied by fever, abdominal pain or pain during intercourse.
Itching is usually most noticeable with a yeast infection, though it may occur with any type of infection or irritation.
Differentiating the various causes of discharge can be achieved by clinical examination and several tests. Let me go through the methods used by a gynecologist to reach a diagnosis in each of these cases, so that you can discuss them with your doctor.
Examination may suggest cervicitis which is caused by sexually transmitted diseases (gonorrhea or chlamydia).
On examination trichomoniasis presents with vulvar and vaginal edema and erythema
"Strawberry" cervix in up to 25 percent of affected women as well as the presence of frothy, purulent discharge. Lab tests reveal an elevated vaginal pH (>4.5), the presence of motile trichomonads on wet-mount preperation as well many polymorphonuclear cells. In some cases your doctor may request DNA probe tests which have a sensitivity of 90 percent and specificity of 99.8 percent or a culture which has a sensitivity of 98 percent and specificity of 100 percent in detecting trichomonas infection.
Bacterial vaginosis presents on clinical examination with a normal appearance of vaginal tissue in most cases, accompanied by the presence of discolored discharge with abnormal odor or a homogeneous discharge that adheres to vaginal walls. Lab tests reveal an elevated vaginal pH (>4.5), the presence of "Clue cells" (vaginal epithelial cells coated with coccobacilli) in addition to few lactobacilli and occasionally the presence of motile, curved rods (Mobiluncus species). Amsel's criteria (three of four criteria must be met): provides correct diagnosis in 90 percent of affected women. Criteria of Nugent or Spiegel for Gram stain can also be used to diagnose bacterial vaginosis.
Vulvovaginal candidiasis may present on clinical examination with vulvar and vaginal erythema, edema and fissures that may be accompanied by thick, white discharge that adheres to vaginal walls. Vaginal pH is normal while microscopy reveals pseudohyphae, mycelial tangles or budding yeast cells. Characteristic hyphae may show on KOH microscopy or Gram stain. In some cases culture may be needed.
1. Carr PL, Felsenstein D, Friedman RH. Evaluation and management of vaginitis. J Gen Intern Med 1998;13:335-46, and Sobel JD. Vaginitis. N Engl J Med 1997;337:1896-903.
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