What is Leucorrhoea?
Leucorrhoea is flow of a whitish, yellowish, or greenish discharge from the vagina of the female that may be normal or that may be a sign of infection.
It is considered normal when the discharge is thin, white, and relatively odourless.
However, in many cases, Leucorrhoea is a sign of infection, especially when the discharge is yellow or green, has an offensive odour, and is accompanied by irritation, itching, pain, or tissue inflammation.
Abnormal Leucorrhoea may be caused by infections with bacteria, yeast, or other microorganisms.
From where normal vaginal secretions come?
- Vulvar secretions from sebaceous, sweat, bartholin, & skene glands
- Transudate from vaginal wall
- Exfoliated vaginal & cervical cells
- Cervical mucus
- Endometrial & oviductal fluids
- Micro-organisms & their metabolic products
How normal vaginal secretions look like?
- Floccular in consistency
- White in color
- Usually located in dependent portion of vagina (posterior fornix)
What is microscopy of normal vaginal secretions?
- Many superficial epithelial cells
- Few white blood cells (less than 1 per epithelial cell)
- Few, if any, clue cells
Clue cells are Superficial Vaginal Epithelial Cells with adherent bacteria, usually Gardnerella vaginalis, which obliterates the crisp cell border when visualized microscopically.
Normal Vaginal Flora
- Mostly AEROBIC
- With average of SIX different species of bacteria
- Most common of which is hydrogen peroxide–producing LACTOBACILLI
Ability of bacteria to survive
- Vaginal pH
- Availability of glucose for bacterial metabolism
The pH level of normal vagina is lower than 4.5, which is maintained by production of lactic acid.
ESTROGEN-stimulated vaginal epithelial cells are rich in GLYCOGEN.
Vaginal epithelial cells break down glycogen to monosaccharides, which can then be converted by cells themselves, & lactobacilli to lactic acid.
What is bacterial vaginosis?
Bacterial vaginosis (BV) has previously been referred to as nonspecific vaginitis or Gardnella vaginitis.
It is alteration of normal vaginal bacterial flora that results in loss of hydrogen peroxide– producing lactobacilli & overgrowth of predominantly ANAEROBIC BACTERIA.
Most common form of vaginitis is BV.
Anaerobic bacteria can be found in less than 1% of the flora of normal women.
In women with BV, however, the concentration of anaerobes,as well as G. vaginalis and Mycoplasma hominis, is 100 to 1,000 times higher than in normal women.
Lactobacilli are usually absent.
It is not known what triggers the disturbance of normal vaginal flora.
It has been postulated that repeated alkalinization of the vagina, which occurs with frequent sexual intercourse or use of douches, plays a role.
After normal hydrogen peroxide–producing lactobacilli disappear, it is difficult to reestablish normal vaginal flora, & recurrence of BV is common.
A FISHY VAGINAL ODOUR, which is particularly noticeable following coitus, and vaginal discharge are present.
Vaginal secretions are GRAY AND THINLY COAT the vaginal walls.
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Vaginal soreness, Dyspareunia, Vulvar Burning, & Irritation may be present.
EXTERNAL DYSURIA (“splash” dysuria) may occur when micturition leads to exposure of inflamed vulvar & vestibular epithelium to urine.
Examination reveals ERYTHEMA & EDEMA OF LABIA & VULVAR SKIN.
Discrete pustulopapular peripheral lesions may be present.
The vagina may be erythematous with an adherent, whitish discharge.
The cervix appears normal.
What are adverse sequelae of above infections?
- Pelvic Inflammatory Disease
- Post abortal PID
- Postoperative cuff infections after hysterectomy
- Abnormal cervical cytology
- Premature Rupture Of Membranes
- Preterm labor & delivery
- Post cesarean Endometritis
Are these infections curable?
Yes. With antimicrobials these can be cured completely.