BIMBINGAN LEUKORRHEA

Vikas Indru Moorjani – 406171053

Pembimbing – dr. Miko Ssanto, Sp.OG
Kepaniteraan Obstetri dan Ginekologi
RS Sumber Waras- FK UNTAR
Flora normal
 Asymptomatic caused by aerobic or facultative & obligate anaerobic.
Aerobic species is dominant 10:1
 Produces lactic acid H2O2 & other antimicrobial compounds (bacteriocins-
peptides attach to vaginal epithelial cells)
 Vagina secrets leukocyte protease inhibitor (protecting tissue from
inflammatory products and infection)
 Upper reproductive tract is not sterile explains the potential acceleration
of local acute infection (GO)
 Vaginal pH- 4-4.5 – normal
 Said to originate from lactobacillus species production of lactic acid + fatty
acids etc.
 Other bacteria can contribute protein catabolism & anaerobic bacteria
contribute by amino acid formation
 Glycogen- nutrient for species in vaginal ecosystem; menopause causes
glycogen decrease making pH increase 6-7.5 (asymptomatic)
 FSH- +ve correlation with pH
 Estrogen replacement therapy postmenopausal women can restore
lactobacillus sp.
 Menstrual fluid can also provide nutrient to flora (causes overgrowth)
 Women with symptomatic Gonococcal upper reproductive tract  usually
during mens or after
 Broad spectrum AB may cause inflammation due to candida sp.
 Hysterectomy with cervix removal changes flora
 Post op- anerob bacteriodes fragillis
 Aerob Enterococus & E.coli
 Bacterial Vaginosis
 Vaginal flora overgrown of Anaerobic sp.  Gardnerella vaginalis,
Ureaplasma, Urealyticum, Mobiluncus sp., Mycoplasma homonis &
preuotella sp.
 There is significant reduction in lactobacillus sp (H2O2 decrease). (Weather
or not reduction is a result or cause of BV is unclear)
 Risk factor
 Smoking sex during mens
 Oral sex
 IUD
 Douching
 New or multiple partners
 Black race
 Sexual activity with other women
 Early age of intercourse
BV
 Diagnosis
 Irritating (-)
 Order (-)
 Discharge +/-
 Vagina non-erythematous
 Non abnormalities in cervical examination

1. Microscopic evaluation of secretion + saline “wet prep  clue cell 

95% +ve
2. Release of Amines (produced by anerobic metabolisim)  KOH  Bau
amis (fishy). Wiff test
3. Vaginal pH >4.5 (due to decrease in acid production)
 Male partners do not
need to be treated
 Introduction of lactobacilli,
acidifying vaginal gels,
probiotics – can help
 Metronidazole 500 mg
PO 2x – 7 days
Leukorrhea
 Leukorrhea: whitish yellow discharge of mucous from vagina
 Infection – Vaginitis
 BV-foul discharge odor
 Normal discharge- valvular burning irritation or itching  vaginitis

 7-70% of women have no definite cause  imp to offter STD screening

 NaCl prep

 KOH 10% osmotic swelling lysis of squamous cell membrane.

 fungal buds & hyphae seen clearly

 pH analysis (upper vaginal wall)
 Fungal infection
 Candida most common (C. tropicalis, C.  Uncomplicated- sporadic & infrequent, mild-
glabrata) moderate symptoms severity for non
 Can be asymptomatic immunocomprmised
 Seen in warmer climates, immunosupression,  Recurrent- 4x/year fluconazole
DM, pregnancy, recent abuse 100/150/200 mg intravaginally 1-4-7 day
 Symptoms:  Complicated 
 Pruritus, pain, valvular erythema & edema. +/-  moderate –severe symptoms from possibly
excoriation other species than albicans
 Vaginal discharge  cottage cheese  Reccurent cases
 Microscopic- KOH 10%- Haifa +blastospora  Immunocompramised (suppression)
(yeast bud)  Recurrent thx:
 Culture not routine but can be done for fail in  Suppressive maintenance- fluconazole 100-200
empiric treatment mg
 Non-albicans not responsive to azole
600mg boric acid –gelatin capsule
intravaginally daily for 2 wk
Trichomonas Vaginalis - Protozoa
 Incidence increase with patient age
 Most men asymptomatic  mainly seen in Women (70% who’s male partners will have in
their urinary tract)
 Co-infection is frequent – GO
 Ventricle transmission – during birth is possible
 Diagnosis- incubation – 3 days – 4 wk. can affect vagina, urethra, endocervix & bladder
 50% women asymtomatic
 Colnizatoin can persist for months –years
 Foul smell, thin, yellow –green – Discharge
 Symptoms
 Dysuria
 Dyspareunia
 Pain
 Vaginal spotting
 Valvular pruritus (erythematous, edematous, excoriated)