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Diferentierea secretiei vaginale normale de secretia vaginala patologica

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Vulvovaginita / colpita / modificarea secretiei vaginale este unul dintre cele mai fecvente motive pentru care femeia se prezinta la consultul ginecologic.

Ce inseamna secretie vaginala normala?

Secretia fiziologica a vaginului este transparenta sau albicioasa, vascoasa, in cantitate mica (exista modificari cantitative functie de faza ciclului menstrual; cea mai mare cantitate de secretie se inregistreaza in perioada ovulatiei; in faza premenstruala/ dupa ovulatie, cantitatea scade si devine mai vascoasa).

Secretia vaginala normala nu miroase si nu se asociaza cu simptome ca arsuri, eritem, edem, papule, pustule, vezicule.

Secretia vaginala este produsa de glandele de la nivelul vaginului si colului uterin; se elimina zilnic prin vagin impreuna cu celulele imbatranite care tapeteaza vaginul. Secretia vaginala normala ajuta la curatirea vaginului, lubrefierea sa si prevenirea infectiilor. Flora microbiana vaginala este formata din bacili gram negativi, gram pozitivi, anaerobi si predominant Lactobacillus (bacili Doderline).

Ph-ul normal al vaginului este usor acid (3,8- 4,5).


Ce este secretia vaginala patologica?

Orice modificare de aspect, miros sau cantitate a secretiei vaginale.

 

Cauzele

Cele mai frecvente cauze ale unei secretii modificate sunt infectiile. Candida, Trichomonas si vaginoza multibacteriana sunt cele mai frecvente etiologii; exista si infectiile virale care pot modifica secretia vaginala: herpes virus sau papilloma virusuri).

Cauze mai putin frecvente: vaginita atrofica (din menopauza), vaginita de contact (secundara unui allergen)

 

Factori care modifica secretia vaginala

  • dieta/suplimentele alimentare
  • sarcina
  • contraceptivele orale/alti hormone
  • stresul
  • medicamentele
  • diabetul zaharat sau boli care scad imunitatea organismului (tratament cu citostatice/ corticoterapie)
  • cancerele organelor genitale (uter, ovar, col).

 

Acuze subiective - de ce se prezinta pacientele la ginecolog?

  • modificare de cantitate (secretia devine abundenta)
  • modificare de culoare (ex: alba-grunjoasa = Candida , gri-verzuie-aerata = Trichomonas)
  • modificare de miros (ex: miros de peste = Garnerella)
  • simptome associate: prurit vulvar sau vaginal, arsura, dureri pelvine, modificari urinare (usturimi, urinat des).

 

recoltare secretie vaginala

 

Ce constata medicul in urma consultului?

la examenul cu valve: medicul vizualizeaza modificarile de culoare sau cantitate ale secretiei, leziuni, eritem, papule/vezicule daca se asociaza si cu alta simptomatologie

la tuseul vaginal: se pot decela inflamatiile tractului genital superior (inflamatia trompei / ovarului / uterului) -  acestea pot apare ca si complicatii ale unei vulvovaginite sau pot fi cauza care a determinat vulvovaginita.

 

Investigatii / Cum este pus un diagnostic de infectie?

In momentul examenului cu valvele se recolteaza secretia vaginala sau / si cultura din col. Secretia vaginala este examinata la microscop pentru a se vizualiza eventuale bacterii / protozoare / fungi (gonococci, Trichomonas, Candida). Cultura din col se insemanteaza pe anumite medii pt a vedea daca vor creste colonii de agenti infectiosi (streptococci, Chlamydia, Mycoplasma, Ureaplasma) Pentru depistarea infectiilor virale se dozeaza anticorpii specifici din sange (herpes virus, citomegalovirus) sau se face analiza genetica a secretiei vaginale pentru papilloma virus.

 

Tratament

Tratamentul vaginitei se va face functie de rezultatul investigatiilor (secretia vaginala / cultura din col) - va fi administrat pe cale sistemica sau locala numai la sfatul medicului! Daca este vorba de o boala cu transmitere sexuala, se va trata obligatoriu si partenerul!

Durata tratamentului

5-7-10 zile, in functie de agentul cauzal.

 


Dr. Catalina Andrei – Clinica Medicala Fertilia-Sapiens
Centrul medical ultraspecializat in infertilitate, medicina materno-fetala si ginecologie complexa
www.fertilia.ro





Cuvinte cheie: Infectie vaginala , Scurgeri vaginale , Afectiuni ginecologice


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