Trip Answers

Question answered:23/05/08

We searched the NLH Women’s Health Specialist Library and the TRIP and Medline database but found little robust evidence to answer this question. In fact, we found just one article discussing the management of patients with group B streptococcus bacteria. The Medline abstract of this study reads:

 

“OBJECTIVES: The isolation of group B streptococcus (GBS) on routine swabs taken from genitourinary medicine (GUM) clinic attendees is a common finding. The relation of GBS to vulvovaginal symptoms is unclear, creating confusion about management. This case-control study tested the hypothesis that detection of GBS on routine clinical specimens is not causally related to vulvovaginal symptoms in female GUM clinic attendees. METHODS: Data were collected on all female GUM clinic attendees who had GBS isolated from anogenital swabs between July 1999 and July 2001. Controls were randomly selected from all new and rebooking female GUM clinic attendees. Controls were group matched for age with cases and were included only if a sexual health screen was performed and the results of this were available. RESULTS: 118 cases and 308 controls were identified during the study period. There was no significant difference between cases and controls in patient demographic or behavioural characteristics, the presence of genital co-infection, or vulvovaginal symptoms. There was no relation between symptoms and quantitative growth of GBS reported by the laboratory in either cervical or urethral swabs. Only nine cases had high vaginal swabs taken, in whom there was a significant association between a heavy growth of GBS and vulvovaginal symptoms (p=0.008).

 

CONCLUSION: The isolation of GBS from routinely collected genital swabs in female attendees of a GUM clinic is not causally related to vulvovaginal symptoms. We recommend that patients should receive this advice and should not be treated with antibiotic therapy for this indication.” [1]

 

This being a difficult question to answer, we sought advice from our Medical Director who recommended we undertake a literature search to answer the second part of the question, i.e. is a 5-day history of non-offensive but discoloured vaginal discharge a significant issue in a postmenopausal woman suffering from vaginal dryness?

 

We searched the CKS (formerly PRODIGY) guidelines on vaginal infections, namely the ones on bacterial vaginosis, trichomoniasis and candida and all state in the sections on differential diagnosis:

 

“Postmenopausal vaginal discharge due to atrophic vaginitis (but it is important to consider neoplasia in this group).” [2-4]

 

The PatientPlus (Mentor) website contains an article on atrophic vaginitis and this gives the following information on differential diagnosis:

 

• “The differential diagnosis should include vaginal infections e.g. bacterial vaginosis, trichomonas. Atrophic vaginitis predisposes the vagina to bacterial infection.
• Candidal infections may occur for other reasons e.g. diabetes.
• Local irritation from other sources e.g. soap, panty liners, spermicides, condoms etc.
• The use of biological washing powder and tight fitting clothes such as jeans may produce similar symptoms.
• Women with unexplained, persistent vaginal discharge need investigation to exclude gynaecological neoplasms.”

 

This is followed by sections on assessment, investigations and management. [5]

 

References
1. Shaw C, Mason M and Scoular A et al. Group B streptococcus carriage and vulvovaginal symptoms: causal or casual? A case-control study in a GUM clinic population. Sex Transm Infect. 2003 Jun;79(3):246-8. (http://www.hubmed.org/display.cgi?uids=12794214)
2. CKS. Candida – female genital. September 2007. (http://www.cks.library.nhs.uk/candida_female_genital/view_whole_topic#283995001)
3. CKS. Bacterial vaginosis. May 2006. (http://www.cks.library.nhs.uk/bacterial_vaginosis/view_whole_topic)
4. CKS. Trichomoniasis May 2006. (http://www.cks.library.nhs.uk/trichomoniasis/view_whole_topic#223311001)
5. PatientPlus. Atrophic vaginitis. September 2007. (http://www.patient.co.uk/showdoc/40024656 )

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