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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

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VIA procedure Ė Examination before application of acetic acid Ė Abnormal findings on speculum examination Ė Cervicovaginal inflammation


Infective conditions of the cervix and the vagina are associated with excessive abnormal discharge that can be seen on opening the speculum blades. The characteristics of the discharge (colour, odour, consistency, and quantity) help in detecting the nature of the infection.

  • Excessive grey-white or yellow discharge with a fishy odour is characteristic of bacterial vaginosis, an infective condition caused by bacteria.

  • The presence of thick or thin curdy white discharge indicates candidiasis, an infection caused by a fungus (commonly Candida albicans).

  • Profuse greenish yellow frothy discharge is commonly seen in trichomoniasis, an infection caused by a protozoan known as Trichomonas vaginalis.

Sometimes pus may be seen coming out through the external os. If purulent discharge is seen at the external os, it is indicative of gonococcal infection (caused by the bacteria Neisseria gonorrhoeae) or chlamydial infection (caused by Chlamydia trachomatis). Examination of the urethra may also reveal purulent discharge.

The cervix may appear congested and oedematous as a result of any lower genital tract infection. In trichomoniasis (caused by Trichomonas vaginalis), small red patches are often visible on the ectocervix, giving rise to a strawberry appearance of the cervix. An infected cervix may bleed on contact during the VIA procedure.

Severe infection or inflammation of the cervix may lead to desquamation (superficial peeling off) of the surface epithelium, which on naked-eye examination may appear as red patches on the cervix. The peeling of the epithelium is known as erosion. The raw area on the cervix may bleed on contact.

Click here to download a table of syndromic management of cervicovaginal infections.

The next section describes cervical polyps.


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