What is the treatment for leukorrhoea?

Treatment for Leukorrhea

The treatment for leukorrhea should target the underlying cause, with empiric therapy for Candida, bacterial vaginosis, or sexually transmitted infections based on clinical findings and risk factors. 1, 2

Understanding Leukorrhea

• Leukorrhea is characterized by an increased number of polymorphonuclear leukocytes (>10 WBC per high power field) on microscopic examination of vaginal fluid and is associated with cervical inflammation 1
• It has a high negative predictive value (98-100%) for cervical infections, making it a useful screening tool in clinical settings 2
• Leukorrhea is not specific to one condition and can be caused by various infections or non-infectious causes 3

Diagnostic Approach

• Perform microscopic examination of vaginal discharge to identify leukorrhea (>10 WBC per high power field) 2
• Check for bacterial vaginosis using Amsel criteria (clue cells >20% of epithelial cells, positive whiff test, vaginal pH >4.5, homogeneous discharge) 2, 4
• Test for Chlamydia trachomatis and Neisseria gonorrhoeae using nucleic acid amplification tests (NAAT) 1, 2
• Evaluate for Trichomonas vaginalis and Candida species 3
• The combination of bacterial vaginosis and leukorrhea significantly increases the risk of cervical infection (odds ratio 3.8) 4

Treatment Recommendations

For Bacterial Vaginosis:

• Metronidazole 500 mg orally twice daily for 7 days 1
• OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once daily for 5 days 1
• OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days 1

For Candida Vaginitis:

• Fluconazole 150 mg oral tablet as a single dose 5
• OR Topical azole therapies (clotrimazole, miconazole, etc.) for 3-7 days 5

For Cervicitis/Mucopurulent Cervicitis:

• If high prevalence of both gonorrhea and chlamydia or high-risk population:
  • Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice daily for 10 days 1
• If low gonorrhea prevalence but substantial chlamydia risk:
  • Doxycycline 100 mg orally twice daily for 10 days 1
• If low prevalence of both infections and patient likely to return for follow-up:
  • Await test results before initiating treatment 1

For Trichomoniasis:

• Metronidazole 2 g orally in a single dose 1
• OR Tinidazole 2 g orally in a single dose 1

Management of Sexual Partners

• Sexual partners of patients with STI-related leukorrhea should be referred for evaluation and treatment 1
• For partners of patients with chlamydia or gonorrhea, treatment is recommended if sexual contact occurred within 60 days preceding symptom onset 1
• Patients should abstain from sexual intercourse until both they and their partners complete treatment and are symptom-free 1

Follow-Up

• If symptoms persist despite appropriate treatment, reevaluation is necessary 1
• Consider alternative diagnoses or resistant organisms if no improvement occurs 1
• For persistent or recurrent symptoms, culture for resistant organisms or consider other causes of vaginal discharge 1

Special Considerations

• HIV-positive patients with cervicitis should receive the same treatment as HIV-negative patients 1
• Pregnant women with leukorrhea should be evaluated and treated promptly to prevent complications 2
• In settings where patient follow-up is uncertain, empiric antibiotic therapy may be appropriate based on microscopic findings of leukorrhea 2

Common Pitfalls and Caveats

• Relying solely on patient-reported symptoms without microscopic confirmation can lead to misdiagnosis 1
• Failure to test for multiple potential pathogens may result in incomplete treatment 3
• Not evaluating sexual partners can lead to reinfection 1
• Overuse of corticosteroid preparations for symptomatic relief should be avoided as prolonged use may be harmful 1