OB-GYN-L Messages for September, 2006: Re: purulent vag discharge

Re: purulent vag discharge

From: ainsron

ainsron@sbcglobal.net

Mon Sep 25 16:52:32 2006

Ronald E. Ainsworth, MD, FACOG

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley Hill Sent: Monday, September 25, 2006 2:00 PM To: Multiple recipients of list OB-GYN-L Subject: Re: purulent vag discharge

Ten bucks says the sonogram shows a pocket of fluid at the fundus. It may be amenable to drainage with a pipelle biopsy or similar if the patient had a Novosure ablation (because those don't always lead to complete ablation of the cavity like the "old" rollerball or wire ablations did). But, in my experience most of these patients end up wanting a vag hyst.

Ashley

At Mon, 25 Sep 2006, ainsron wrote: >
>What's the sonogram show?
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>Bulley, MD
>Sent: Monday, September 25, 2006 7:50 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Gyn: purulent vag discharge
>
>Any help here is welcome. Remind me what I might be missing.
>
>40 yo G3P2012
>Endometrial ablation 4/2003 amenorrheic since then
>
>Several months complaint of copioous vaginal discharge.
>
>Wet prep -- 4+ WBCs but negative for clue cells, pH normal, no trich and
>no candida.
>
>Observed for spontaneous resolution.
>
>Return visit for same 1 month later. Wet prep same: many / sheets of
>WBCs otherwise negative. Culture: mixed urogenital flora.
>
>No other symptoms: no pain, burning, no vulvar complaints, ne sexual
>function issues. Cervix is clean and non tender.
>
>This time I am treating with clindamycin vaginal cream X 2 weeks, no
>vaginal Rx for 1 week then re-exam. Probably with other cultures at
>that time.
>
>Lichen Planus of vuvlo-vaginal-gingival syndrome should have other
>symptoms.
>
>No suspicion of Chron's or other colitis.
>
>Usually I can find what is wrong - but this is one of those conundrums.
>
>Thanks.
>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>

-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Medical Director, Loch Haven Ob/Gyn Group Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando Orlando, Florida

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