STD clinics in Singapore are no stranger to the problem of an abnormal vaginal discharge. As a Family Physician who performs STD testing and screening on a regular basis, the complaint of an abnormal vaginal discharge often necessitates investigations and therapy. Likewise, in the ancient Near East, gynecological problems involving abnormal genital discharge are mentioned in antiquated medical literature, the treatment of which involves elaborate rites and esoteric, archaic knowledge.
In an ancient Egyptian papyrus, the origin of an abnormal vaginal discharge was attributed to excess fluids from the eyes. Treatment involved exposing the patient to frankincense and fresh oil, and feeding her with the raw liver of a donkey. In Mesopotamia, Greece and China, strange concepts of “locked fluids” and “humors” were proposed to explain the unusual manifestations of feminine discharge.
Although pharmaceutical and medical knowledge in ancient societies were to a certain degree based upon empirical observations of patients, these ancient medical systems are understandably limited in their knowledge of internal human anatomy, the physiological workings of the inner body, and the pathological and microbiological causes of disease.
Fortunately for the modern woman, the diagnosis and treatment of Trichomoniasis – one of the major causes of abnormal vaginal discharge – is not dependant upon donkey-derived black pudding or temple incense offered to Moloch.
Trichomoniasis is a common sexually transmitted disease (STD). It has been estimated that up to 15% of women undergoing PAP smears have Trichomonas vaginalis infection. More than half of affected female patients and nearly all infected men have no symptoms at all. This makes Trichomoniasis difficult to eradicate, as many asymptomatic patients serve as reservoirs for this pathogen without ever being diagnosed. Hence, regular STD testing and screening in an STD clinic Singapore is important for good sexual health.
In the United States alone, there are approximately five million new cases of Trichomoniasis annually. Routine microscopic examination of vaginal specimens only detects about half of these cases.
Trichomoniasis is caused by a unicellular protozoan. Although the organism does not invade the underlying tissues it resides in, it precipitates a local inflammatory response that is remarkably intense. The main mode of transmission is via sexual contact and intercourse. Although fomite transmission is a possibility, it is rarely the cause of infection in humans.
Trichomoniasis increases the susceptibility of the patient to HIV acquisition. The intense local inflammatory response it creates causes epithelial disruptions that provide ready entry for the HIV virus. Furthermore, infection with trichomoniasis increases the likelihood of HIV transmission to others.
Case Study in Trichomoniasis
Mona, a fresh graduate from a tertiary institution and currently unemployed, had been in numerous relationships with different boyfriends. She consulted me for an unbearable increase in vaginal discharge that had a creamy-yellowish, frothy appearance and foul odor. She mentioned occasional bubbles in her genital discharge. She also had mild vulva pruritus, dyspareunia and post-coital spotting. These symptoms had tormented her for a few weeks. Of note, she was in a recent relationship with a male student from another tertiary institution.
Physical examination revealed normal looking external genitalia. There was a profuse, malodorous, slightly yellowish vaginal discharge on speculum examination. The cervix appeared friable with mild ectopy and purulent cervical discharge. Her abdomen was soft and there was no adnexal tenderness or masses felt.
The differential diagnoses were trichomoniasis or bacterial vaginosis, with a necessity to rule out vulvovaginal candidiasis, chlamydia and gonorrhea infection. Laboratory test results were as follow: positive culture for Trichomonas vaginalis, NAAT test (nucleic acid amplification test) for Chlamydia was positive, NAAT for gonorrhea was negative, VDRL was negative, and HIV serology was negative. A PAP smear was also taken, which was negative for malignancies but positive for the presence of Trichomonas vaginalis.
It is interesting to note that Chlamydia infection is a risk factor for trichomonas infection. About thirty percent of women with Chlamydia infection will also have trichomoniasis.
Diagnosis was therefore quite straightforward. Mona had trichomoniasis and Chlamydia infection, and had to be treated for both with a course of metronidazole and azithromycin. Her boyfriend was contacted and advised to consult us for STD testing and treatment in our STD clinic Singapore.
Mona was profoundly relieved that there was no need for donkey derivatives and frankincense with the advent of antibiotics. Trichomoniasis can be treated with metronidazole or tinidazole. A single dose of metronidazole 2g has a cure rate of up to ninety-five percent, while an alternative of 500mg twice a day for seven days is associated with poor patient compliance. The incomplete eradication of Trichomonas vaginalis with inadequate antibiotic therapy had resulted in emergence of resistant strains. Tinidazole is likewise given as a single dose of 2g.
As this case study has demonstrated, the acquisition of one STD might increase the risk of acquiring another. Sometimes, a patient might have several STDs all at once. Our clinic therefore recommends patients to have regular sexual health screening and STD testing in our STD clinic Singapore to rule out occult infections and subsequent complications.
Consult our board accredited Family Physician if you have any questions concerning abnormal discharges, itchiness in the nether region, painful intercourse, or abnormal spotting after intimate moments.
