Flour Albus

Penyebab Utama
Bakteri ( Gardnerella vaginosis, Neiserria
gonorrhea)
Virus ( HIV, herpes)
Jamur (Kandidiasis)

Gardnerella vaginalis
flora normal yang berada di vagina, yang
bisa menyebabkan bakterial vaginosis
karena terjadinya perubahan pH di vagina,
aktivitas seks yang tinggi, dan berganti
ganti pasangan

G vaginalis is found in nearly 100% of women

with symptomatic BV. In fact, G vaginalis may
be the organism primarily responsible for the
premature rupture of membranes in women
with BV. The organism has phospholipase A2
activity, which initiates labor. Other factors
may also play a role in early labor, however,
as G vaginalis is also found in many normal
women with uncomplicated pregnancies.

Manifestasi
Women often report that the odor is particularly
embarrassing after sexual intercourse. When semen
mixes with vaginal secretions, it lowers the acidity
level to make the odor particularly strong. Odor may
also be more noticeable around the time of menses.
Vaginal itching or burning is also sometimes present.
Up to 40% of women with BV may experience no
outward symptoms. BV has been associated with
pelvic inflammatory disease, which can result in
infertility, as well as increased risk of endometritis,
cervicitis, pregnancy complications, and post-operative
infections. Pregnant women with BV in the 23rd to
26th weeks of pregnancy were 40% more likely to
deliver a low birth-weight baby (i.e., less than 5.5 lbs)

Abu-abu keputihan, berair, dan berbau amis

Diagnosis

The diagnosis of BV requires the presence of

at least 3 of the following 4 criteria
A homogenous noninflammatory discharge
(not many WBCs).
Vaginal pH >4.5.
Clue cells (bacteria attached to the borders of
epithelial cells, >20 % of epithelial cells;
Whiff test positive for fishy or musty odor
when alkaline KOH solution added to smear.

Candidiasis
Candida, a commensal organism, is found in
small population densities in the vaginal
ecosystems of nearly one third of healthy
women. Symptomatic infection arises,
however, when proliferation causes a shift
from colonization to frank adherence and
infection. The most common offender
is Calbicans; however, other species
of Candida, such as tropicalisand glabrata,
have become increasingly prevalent,
currently representing one third of isolates

Manifestasi
The patient typically presents with a thick,
"curdled" white discharge or vulvar pruritus
(Table I). The vagina has no "itch"
receptors, hence, pruritus ensues only
after the fungus has spread distally onto
the vulva (Fig. 5). The discharge is usually
neither malodorous nor off-white unless a
mixed infection is present. The vagina
often appears hyperemic; the vulva can be
erythematous and/or excoriated

Diagnosis
Diagnosis is frequently made based on the
character of the vaginal discharge (i.e.,
curd-like discharge) and on other patient
signs and symptoms. Grams stains and
KOH treatment of the discharge can be
performed to look for yeast cells and
pseudohyphae.

Pseudohypha dan blastoconidia di pengecatan gram

Differential Diagnosis of Vaginal Infections

Vaginal pH

3.8 - 4.2

> 4.5

4.5

< 4.5 (usually)

Discharge

White,thin,
flocculent

Thin, white
(milky), gray

Yellow, green,
frothy

White, curdy,
"cottage cheese"

Amine odor
"whiff" test

Absent

fishy

fishy

Absent

Microscopic

Lactobacilli,
epithelial cells

Clue cells,
adherent cocci,
no WBC's

Trichomonads,
WBC's >10/hpf

Budding yeast,
hyphae,
pseudohyphae

Daftar Pustaka
http://www.medscape.com/viewarticle/719
240_5
http://www.atsu.edu/faculty/chamberlain/W
ebsite/lectures/lecture/stdd.htm