Diagnostic aspects of primary tubal malignancy

Eleven cases of primary tubal malignancy are reported to characterize clinical symptoms and diagnostic procedures. The importance of a yellow vaginal discharge is emphasized as being a diagnostic sign.

Diagnostic value of clinical examination, direct microscopy, and culture in the Gardnerella vaginalis syndrome

In a general practice 467 women aged 15-49 years with vaginal discharge were consecutively examined in order to compare the diagnostic value in the Gardnerella vaginalis syndrome of the clinical examination, direct microscopy of the vaginal secretion, and culture. We found significant correlations between all relevant combinations of the diagnostic methods. The predictive value of a positive test for the clinical examination, the microscopy, and the clinical examination combined with microscopy, respectively, was 0.75, 0.89 and 0.90, whereas the predictive values of the negative test were 0.59, 0.72 and 0.61, respectively. Because even small numbers of Gardnerella vaginalis may yield growth on selective culture media, the clinical examination and the microscopy are often negative despite positive culture. To avoid overtreatment of a benign condition we therefore conclude that the presence of a characteristic clinical picture and positive microscopy constitute a safe basis for the diagnosis of the Gardnerella vaginalis syndrome, and that the diagnosis should be based on this combination or on the fulfilment of three of the following four criteria: 1) characteristic vaginal secretion; 2) vaginal pH greater than 4.5; 3) positive potassium hydroxide test or characteristic herring-brine smell, and 4) clue cells at microscopy. With the present methods culture for Gardnerella vaginalis should not routinely be performed, until the value of quantitated methods has been proved. Coexistence of other microorganisms rendered the diagnosis difficult. We recommend to treat the most predominant infection first.

Probability of vaginal foreign body in girls with genital complaints

We used Bayes' theorem to evaluate the probability of vaginal foreign bodies in girls with genital complaints. The prevalence of vaginal foreign bodies in outpatient girls under 13 years of age with gynecologic disorders was found to be 4%. Review of the charts of 17 pre-menarcheal girls who had foreign bodies on 19 occasions and of 28 girls with infectious or nonspecific vaginitis demonstrated that patients with foreign bodies reported vaginal bleeding more frequently than discharge (14 and two of 15 symptomatic cases, respectively), while in contrast, patients with infectious or nonspecific vaginitis reported vaginal discharge more often than bleeding (23 and five of 28 symptomatic controls, respectively). Bayes' theorem indicates that, in populations resembling the one we studied, approximately 18% of preteenage girls with vaginal bleeding with or without discharge and 50% of those with bleeding and no discharge will prove to have vaginal foreign bodies.

Atypical presentation of female genital tract tuberculosis

Three patients with atypical presentation of female genital tract tuberculosis are reported. Tuberculous hydrosalpinx with abdominal peritonitis, concomitant ectopic gestation with active salpingitis and tuberculous endometritis presenting as postmenopausal vaginal discharge are uncommon clinical manifestations. The age distribution, the importance of careful histological examination and the available methods for follow-up are discussed in the appropriate cases.

Vaginitis

The normal physiology of the vagina, the six most common causes of vaginal discharge, current accepted methods of treatment, and specific nurse practitioner implications are reviewed.

ABC of sexually transmitted diseases. Vaginal discharge: diagnosis

Images

[Metronidazole as the therapeutic choice in bacterial leukorrhea. Report from a gynecologic practice on the diagnosis and therapy of non-physiologic bacterial discharge]

Diagnosis and therapy of different kinds of fluor in gynaecological practice are reported. Subjective criteria are completed by investigations with phase-contrast-microscope. Unphysiological bacterial fluor has been found most frequently and was treated by metronidazole (Rathimed N) per os during one day without regard of bacteria species. Of 239 patients 83.7 per cent were cured, 11.3 per cent got better and only 5 per cent were not cured. According to these results metronidazole therapy is one of the shortest and most effective therapeutical methods in fluor treatment.

Vaginal discharge in children and adolescents. Evolution and management: a review

Vaginal discharge is one of the most common gynecologic problems encountered in the pediatric and adolescent populations and may have many causes. A useful way of approaching the diagnosis of a discharge is by categorizing the patient as being prepubertal of postpubertal. In the prepubertal age group, discharge is generally associated with vulvovaginitis. In the postpubertal age group, discharge may be physiologic, or may associated with cervicitis or vaginitis. In each group, gonorrhea and sexual abuse must be ruled out. A practical approach to therapy is outlined.

The management of vaginal discharge in general practice

A group of general practitioners in active practice were asked to report how they preferred to manage the symptoms of vaginal discharge presented by a woman in her twenties. Subsequently the same practitioners reported their management of such patients in their practice.A shortfall was found for all practitioners between their declared intention and their actual practice.This method of analysis offers a way of working towards a consensus in clinical care and also of auditing medical performance in general practice.

Premenarchal vulvovaginitis

The general subject of premenarchal vulvovaginitis has been reviewed. Vulvovaginal inflammations and infections in the premenarchal child are caused by a large number of etiologic agents. The symptoms, diagnosis, and treatment of the most common of these, namely, nonspecific infections, specific nongonorrheal infections, gonorrhea, protozoal infestations, helminthiasis, mycotic infections, and inflammations due to physical, chemical, and allergenic agents, have been discussed. Reference has been made not only to the older literature but also to some of the pertinent reports published during the last 10 years.

[The diagnosis and treatment of mixed anaerobic vaginal dischargs (authors' transl)]

In about 5% of 3355 patients the microscopic examination of the vaginal discharge in normal saline showed a characteristic fast moving rod. More than 80% of these patients complained of a discharge with a foul smell during the menstrual period. Bactriology showed an anaerob gram negative rod which was difficult to grow and is as yet unclassified. Following treatment with one gram of Mimorazol every 12 hours for 3 doses, 71,5% of the patients were cured and showed a normal vaginal flora without further treatment. In around 24,13% of the patients the gram negative rod disappeared but a persistent mixed flora required further treatment. In 4.3% of the patients a recurrence occurred. An attempt was made to prevent recurrent infection prior to the follow-up examination by prohibition of sexual intercourse with an untreated partner, bathing in public swimming pools, and the use of sponges or wash cloths. In the course of the investigation the suspicion of contamination from the water of public pools became apparent. The diagnosis, treatment and transmission and the pathogenecity of the fast moving negative rod is discussed.

[Epidemiology and diagnosis of vaginal discharge. First Report (author's transl)]

In 700 patients, 1336 tests of vaginal discharge were performed by culture, wet mount with the phase contrast microscope and the Papanicolaou stain. The diagnosis of yeast is best done by culture. Yeast was found only in 68% of the culture positive cases by the wet mount method and in 47% of the cases by the Papanicolaou stain. Wet mount and Papanicolaou stain results for yeast are therefore only useful if they are positive. In the diagnosis of trichomonas, culture and wet mount are of the same effeciency. The incidence of yeast and trichomonas was dependant upon the age of the patients. In pregnancy and in cases with diabetes, yeast was found more often but no increase of yeast was found in cases on oral contraception. The diagnosis of bacterial mixed infections poses the most difficult problem and can only be improved by expensive culture methods.

Adolescent genital dermatoses

The female adolescent period rivals the menopausal years as a most tumultuous interval. Hormonal changes account for many dermatoses not seen in older women. Vulvar problems that commonly affect the adolescent are discussed in reference to the pathophysiology which may induce these changes. The hormonal milium at this time period is emphasized. A concise grouping of disease processes, as well as a description, clue to diagnosis, and treatment of each entity is presented.