Clinical Review of Urethral and Vaginal Discharge Syndrome: A Comprehensive Case Series from Primary Care Centers in Bahrain

Case Series

Austin J Clin Case Rep. 2023; 10(8): 1305.

Clinical Review of Urethral and Vaginal Discharge Syndrome: A Comprehensive Case Series from Primary Care Centers in Bahrain

Basem Abbas Ahmed Al Ubaidi¹*; Mohammed Al Sheikh²

¹Assistant Professor, Consultant Family Physician, Arabian Gulf University, Bahrain

²Consultant Family Physician, Sexiology, Primary Care, Bahrain

*Corresponding author: Basem Abbas Ahmed Al Ubaidi Assistant Professor, Consultant Family Physician, Arabian Gulf University, Bahrain. Email: alubaidibasem@gmail.com

Received: September 11, 2023 Accepted: October 09, 2023 Published: October 16, 2023

Abstract

Background: This case series presents a comprehensive clinical review of twelve cases exhibiting symptoms of urethral and vaginal discharge syndrome in men and women attending primary care centers in Bahrain. The cases encompassed a diverse range of clinical manifestations, including dysuria, frequency, pyuria, urethral pruritus, malodorous urine, vulval itching, purulent vaginal discharge, abnormal vaginal bleeding, dyspareunia, lower abdominal pain, anorectal pain, and anal skin lesions. The individuals included in the case series engaged in various types of sexual activities, ranging from heterosexual intercourse, unsafe sexual behavior, a history of sexual abuse, to homosexual activity. This study aims to provide a scientifically rigorous analysis of these cases, highlighting the clinical presentation, potential risk factors, and implications for diagnosis and management of urethral and vaginal discharge syndrome in the primary care setting in Bahrain.

Methods: The clinical evaluation of the patients encompassed a comprehensive assessment of their medical history, physical examination, and laboratory investigations. Urethral and vaginal swabs were collected for culture and sensitivity testing, urine analysis, microscopy, and imaging studies were performed. The most frequently identified etiological agents in this study were Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida yeasts infection. This study provides valuable insights into the clinical management of urethral and vaginal discharge syndrome, aiding in accurate identification and appropriate treatment of patients with similar symptoms.

Results: Management of the patients involved a combination of antibiotic therapy, antifungal medications, and symptomatic relief measures. Safe sexual behaviors were highlighted as a preventive measure against sexually transmitted infections, which were identified as the primary causative agents of urethral and vaginal discharge syndrome. These findings have significant implications for primary care providers, offering valuable insights into the clinical presentation, diagnosis, and management of these conditions, particularly in primary care.

Introduction

Urethral and Vaginal Discharge Syndrome (UVDS) is a prevalent condition that commonly affects individuals of reproductive age. It is characterized by the manifestation of abnormal vaginal and urethral discharge, and its etiology can stem from various factors such as infections, hormonal imbalances, and anatomical abnormalities. Epidemiological studies have reported a prevalence range of 5% to 35% in developed countries [1,2], while developing countries generally exhibit higher prevalence rates, ranging from 60% to 80% [3,4].

Investigating case series related to UVDS is of utmost importance due to its potential implications for reproductive health and overall well-being among adults. In addition to the associated physical symptoms, UVDS may contribute to psychological distress and sexual dysfunction [5]. Despite its high prevalence and significant impact, UVDS is often underdiagnosed and undertreated, potentially due to limited awareness among healthcare providers and patients, as well as a lack of clear diagnostic criteria and evidence-based management guidelines [6].

Syndromic diagnosis and management of UVDS in primary care play a crucial role in reducing disease morbidity and mortality. Syndromic management allows for timely and effective treatment of the most common causes of the syndrome by addressing the clinical syndrome as a whole, rather than targeting specific pathogens. This approach is particularly relevant in resource-limited settings where laboratory testing and microbiological culture may be limited [7]. Furthermore, effective syndromic management of UVDS in primary care can significantly improve quality of life, reduce psychological distress, and alleviate sexual dysfunction [8].

The objective of this case series is to provide a comprehensive and updated overview of the various etiologies, diagnostic approaches, and management strategies for UVDS, based on the analysis of case series [9]. The aim is to enhance healthcare providers' awareness and knowledge regarding the clinical and epidemiological aspects of UVDS, ultimately improving the quality of care provided to patients presenting with this condition [10].

Case 1

A 25-year-old male presented for a follow-up of urine routine microscopy, with complaints of dysuria, frequency, urethral pruritus, and malodorous urine. The urine analysis revealed the presence of pyuria (100 white blood cells per high-power field) and positive results for leucocyte esterase and nitrate.

Common Pitfall in Assessment

A common pitfall in evaluating dysuria in male patients is the failure of physicians to obtain a thorough medical and sexual history and to screen for Sexually Transmitted Infections (STIs). This oversight may stem from patients' hesitancy to disclose urethral discharge due to associated societal stigma. Additionally, physicians may neglect to examine the genitalia for the presence of urethral discharge. Consequently, they may prematurely order urine routine microscopy, leading to the identification of signs of infection. As a result, patients may receive a misdiagnosis of Urinary Tract Infection (UTI) and be prescribed antibiotics typically used for UTIs, which may prove ineffective in the presence of STIs [11,12].

Evidence-Based Practice in the Presence of Urethral Discharge

The best evidence-based practice in cases of male urethritis involves a comprehensive approach encompassing diagnosis, treatment, and management. This includes obtaining a comprehensive medical and sexual history, conducting a thorough physical examination [11], and adhering to established guidelines for diagnosing and treating urethritis [Flow chart 1 (32)].