Your gynae will inevitably take a history
to find out what is happening and for any
pelvic discharge a vaginal examination
is mandatory, vide the test women dread
most, the speculum exam, which is the only
option. This allows the doctor to see the
type of discharge in terms of color, texture,
consistency, amount and even odour. Just
by doing this the doctor can easily make
a diagnosis and treatment can be started.
Vaginal discharge is most often gray, thin,
and homogeneous, adherent to the vaginal
mucosa and the doctor may observe small
bubbles in the discharge fluid.
However it is recommended that a swab
be taken that will undergo microbiological
examination. This can either be a
microscopy (with use of Amsel and
Nugent scores), culture and sensitivity
that will even allow us to determine the
correct antibiotic to use in future if the
current treatment is unresponsive. The
only downside of this test is that in many
instances no pathogen can be identified.
The other option would be to do a DNA
analysis, an expensive test but quite
useful in terms of helping to know which
organisms are involved. The downside is it
does not screen for all bacteria, it screens
for gardnerella, chlamydia, gonorrhea,
group B streptococcus, and candidiasis.
It is also limited and it is common to get
a negative screen, reason being that a big
number of clients come when other self-
medication or treatment elsewhere has
failed. Prior treatment will limit yield in
either of the tests. The doctor will also
generally take a blood sample and screen
for other common STIs such as HIV and a
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general health checks such a haemogram,
urine test and or blood sugar levels.
Some of the bacteria associated with
BV are Gardnerella vaginalis (most
common),
Mobiluncus,
Bacteroides,
Peptostreptococcus,
Fusobacterium,
Veillonella, and Eubacterium. Others
are Mycoplasma hominis, Ureaplasma
urealyticum, Streptococcus viridans, and
Atopobium vaginae.
Treatment
Now we have a diagnosis how do we treat
Bacterial Vaginosis? The best agents are
metronidazole (flagyl) and clindamycin
which can be taken orally or as a vaginal
pessary. With
oral
administration
especially for metronidazole consumption
of alcohol is prohibited. Single dose
secnidazole has also been approved and
this improves compliance and treatment
as the regimen is very simple.
The challenge, even for many health
workers, is that everyone is fixated with
treating either candidiasis or a Urinary
Tract Infection - UTI. I cannot blame
them because unfortunately BV is usually
accompanied by candidiasis or chlamydia
or some other form of vaginitis. Most
women usually have a mixed infection and
treating candida alone will not clear the
symptoms and vice versa.
THE MARA
EXPEDITION
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24 MAL32/19 ISSUE
In almost every article I have always
expressed the fact that prevention is better
than cure and I will never tire of that
statement! Prevention strategies should
include avoiding use of over the counter
medication especially antibiotics. I pray
this strategy will come to fruition, the
Pharmacy and Poison’s board (I hope
that is still it’s name in view of the recent
changes in governance) should double its
efforts in monitoring of drugs that should
be prescribed by a Medical practitioner
and within their scope of practice prior
to being dispensed. They are doing well
with drugs like betapyn, which is now very
difficult to procure without a prescription.
Likewise the Medical Council should also
be vigilant in ensuring that only licensed
Medical practitioners, clinics, medical
centers or hospitals operate, ensuring that
the likes of Mugo Wa Wairimu are not
unleashed to the unsuspecting public.
Menopause is the most common state
where there can be decreased estrogen,
limiting what can be done but if that