What is the yellow stuff coming out from below?

The yellow substance that flows out from below is called leucorrhea in medicine. Female leucorrhea is normal physiological, egg white-like or white paste, viscous, odorless and in small amounts. The secreted leucorrhea changes to yellow, which is mostly caused by vaginitis. Next, we will introduce the relevant knowledge of four aspects: the causes of vaginitis, symptoms, how to diagnose and treatment methods.

Vaginitis, or inflammation of the vagina, is a group of conditions that cause vulvovaginal symptoms such as itching, burning, irritation, and abnormal discharge.

Causes

1. Bacterial vaginosis

In a normal vagina, lactobacilli that produce hydrogen peroxide are dominant. Bacterial vaginosis is an endogenous mixed infection caused by a decrease in Lactobacillus and an increase in Gardnerella and anaerobic bacteria in the vagina.

2. Candidal vaginitis

(1) 80% to 90% of pathogens are Candida albicans, which grow easily in an acidic environment and are diphasic (yeast phase and hyphae phase).

(2) The patient's vaginal pH is 4.0-4.7, usually <4.5.

(3) Conditionally pathogenic bacteria (yeast phase → mycelium phase).

(4) Common causes: pregnancy, diabetes, and large-scale use of immunosuppressants and broad-spectrum antibiotics.

(5) Other contributing factors: gastrointestinal Candida, wearing tight synthetic underwear, and obesity.

3. Trichomonas vaginitis

(1) Trichomonas vaginalis grows best in a humid environment with a temperature of 25℃ to 40℃ and a pH of 5.2 to 6.6.

(2) The vaginal pH changes before and after menstruation, becoming close to neutral after menstruation, making it easier for Trichomonas to reproduce.

(3) The vaginal pH of patients is generally between 5.0 and 6.5, and most of them are > 6.0.

(4) Parasitic on the vagina, urethra or paraurethral glands, bladder, renal pelvis, male foreskin folds, urethra, and prostate.

(5) Often coexists with other vaginitis.

4. Senile vaginitis

Postmenopausal women have declining ovarian function, lower estrogen levels, vaginal wall atrophy, thinning mucosa, increased vaginal pH, reduced local resistance, and other pathogenic bacteria may over-multiply or easily invade and cause inflammation, mainly aerobic bacteria.

5. Vaginitis in young girls

It is caused by poor development of the vulva, low estrogen levels and foreign objects in the vagina of infants and young children, which trigger infection. Common pathogens include Escherichia coli, Staphylococcus aureus, Streptococcus aureus, etc.

Clinical manifestations

1. Bacterial vaginosis

10% to 40% of patients have no clinical symptoms. Those with symptoms mainly present with increased vaginal discharge with a fishy odor, which is especially aggravated after sexual intercourse and may be accompanied by mild vulvar itching or burning sensation. Examination showed no signs of congestion or inflammation in the vaginal mucosa. The secretions were grayish white, uniform, thin, and often adhered to the vaginal wall, which could be easily wiped off.

2. Candidal vaginitis

(1) Vulvar itching, burning pain, and pain during sexual intercourse.

(2) Frequent and painful urination. The characteristic of dysuria is that urine irritates the edematous vulva and vestibule during urination, causing pain.

(3) Characteristic secretion: white, thick, and resembling curd or bean curd residue.

(4) Vulvitis presents with geographic erythema, edema, and scratches.

(5) Vaginitis may cause edema, erythema, and white membrane.

3. Trichomonas vaginitis

(1) Characteristics of increased vaginal discharge: thin, purulent, yellow-green, foamy, and smelly.

(2) Location of vulvar itching: vaginal opening and vulva.

(3) If combined with urinary tract infection: frequent urination, urgency, pain, and sometimes hematuria.

(4) Infertility: Trichomonas vaginalis can devour sperm, hinder the production of lactic acid, and affect its survival in the vagina.

(5) Examination revealed: congestion of the vaginal mucosa with scattered bleeding spots, and a large amount of "strawberry-like" leucorrhea from the posterior fornix of the cervix, which was grayish yellow, yellowish-white thin liquid, or yellowish-green purulent secretions, often in a foamy state. There are no abnormal changes in the vaginal mucosa of carriers.

4. Senile vaginitis

Increased vaginal discharge, vulvar itching, etc., are often accompanied by pain during sexual intercourse.

5. Childhood vaginitis

The main symptoms are vaginal purulent discharge and vulvar itching.

diagnosis

1. Bacterial vaginosis

(1) Vaginal discharge is milky and homogeneous with a foul odor.

(2) Vaginal pH>4.5.

(3) Amine test is positive.

(4) Clue cell positive (>20%).

A clinical diagnosis can be made if 3 of the above 4 items are positive, and the 4th item is the gold standard for diagnosis.

2. Candidal vaginitis

For women with symptoms or signs of vaginitis, the diagnosis can be confirmed by finding spores or pseudohyphae of Candida albicans in vaginal secretions. pH determination has differential significance: pH 4.5 indicates mixed infection, especially mixed infection of bacterial vaginosis.

3. Trichomonas vaginitis

(1) The diagnosis can be confirmed by finding Trichomonas in vaginal secretions. Hanging drop method (accuracy 80% to 90%); culture method (accuracy 98%).

(2) Avoid washing, applying medicine, or examining the sample 24 to 48 hours before sampling. Keep the sample warm after sampling and send it for examination promptly.

4. Senile vaginitis

The diagnosis is generally not difficult based on the history of menopause, ovarian surgery, pelvic radiotherapy or drug-induced amenorrhea and clinical manifestations, but other diseases should be excluded before diagnosis.

5. Vaginitis in young girls

Infants and young children have poor language expression ability, so collecting medical history often requires detailed questioning of the girl's mother, and also asking the mother whether she has a history of vaginitis. A preliminary diagnosis can usually be made based on symptoms and physical examination findings.

treat

Generally, the drug treatment for vaginitis is mainly external use. Patients with pelvic inflammatory disease or recurrent vaginitis can take oral medications. If necessary, couples can be treated together. Note that long-term oral antibiotics may inhibit normal flora and cause secondary fungal infection.

1. Bacterial vaginosis

The principle of treatment is to use anti-anaerobic drugs, mainly metronidazole, tinidazole, and clindamycin. Caution: Disulfiram-like reactions may occur with both oral and topical metronidazole.

(1) Oral medication: Metronidazole is the first choice.

(2) Local drug treatment.

(3) Sexual partners do not require routine treatment.

2. Candidal vaginitis

(1) Eliminate the cause: If you have diabetes, you should be treated actively and stop using broad-spectrum antibiotics, estrogen and cortisol in time. Change your underwear frequently, and wash used underwear, basins, and towels with boiling water.

(2) Topical medications: miconazole suppositories, clotrimazole suppositories, and nystatin suppositories.

(3) Systemic medications (for patients with recurrent attacks or who cannot take vaginal medication): fluconazole, itraconazole, and ketoconazole. Fluconazole has a lower risk of hepatotoxicity and should be used instead of ketoconazole.

(4) Sexual partners should be tested and treated for Candida albicans.

(5) Pregnancy complicated by Candida vaginitis is mainly treated with local treatment, and oral azole drugs are contraindicated.

3. Trichomonas vaginitis

(1) Local vaginal medication: Metronidazole vaginal effervescent tablets or 0.75% metronidazole gel, 1% lactic acid or 0.5% acetic acid solution flushing can relieve symptoms.

(2) Systemic medication: Metronidazole can be used for initial treatment, but the medication should be discontinued if side effects are detected. Do not drink alcohol during the use of metronidazole and within 24 hours of stopping the medication, and do not drink alcohol during the use of tinidazole and within 72 hours of stopping the medication. The efficacy and side effects of metronidazole and tinidazole are similar, including possible disulfiram-like reactions. Do not breastfeed while taking medication.

(3) Sexual partners should receive treatment at the same time and avoid unprotected sexual intercourse before recovery.

4. Senile vaginitis

The principle of treatment is to supplement estrogen, enhance vaginal immunity and inhibit bacterial growth.

5. Vaginitis in young girls

The principles of treatment are to keep the vulva clean, treat symptoms, and select antibiotics targeting the pathogen.