Page 2092 - Cote clinical veterinary advisor dogs and cats 4th

1046 Vulvar Discharge

pregnancy loss. Mild hemorrhagic discharge • Primary bacterial vaginitis (uncommon) • Canine brucellosis is reportable in some
is normal during proestrus in the bitch. • Urinary tract infection/urethritis (p. 232) jurisdictions, and consultation with local
VetBooks.ir often associated with secondary bacterial noted from the vulvar area; discharge may Acute and Chronic Treatment
public health authorities is advised for
• Perivulvar pyoderma: malodor is typically
• Spayed adult: clear or purulent discharge
confirmed cases.
be mild to moderate in volume; mucoid and
vaginitis due to anatomic abnormalities
occasionally blood tinged
(lateral/dorsal vulvar fold dermatitis, vaginal
stricture, septum), foreign body, or urinary • Transmissible venereal tumor: vulvar mass The nature and extent of treatment is
tract infection with urethritis/vestibulitis. typically noted; associated discharge is typi- determined by the underlying cause; vaginal
Neoplasia is more frequently associated with cally serosanguineous (p. 993). discharge is simply a clue to underlying disease.
a hemorrhagic vaginal discharge (leiomyoma,
leiomyosarcoma). Initial Database Behavior/Exercise
• Prepubertal dogs: lymphoplasmacytic vagi- • Physical exam, including evaluation of vulvar If discharge is associated with an infectious
nitis and juvenile-onset (puppy) vaginitis: lip conformation, mucosa, and digital rectal disease (e.g., B. canis, transmissible venereal
unknown cause and vaginal exams tumor), bitch should be quarantined from other
• Vaginal cytologic exam (p. 1183) dogs to prevent transmission.
DIAGNOSIS • CBC: leukocytosis with left shift, toxic
changes common with pyometra; leukopenia Possible Complications
Diagnostic Overview possible with endometritis; anemia may be Chronic estrogen exposure may cause
• Purulent vaginal discharge in an intact patient noted postpartum or associated with SIPS myelotoxicosis.
should prompt an evaluation for pyometra • Serum biochemical analysis: generally un-
during diestrous or metritis/endometritis in remarkable unless systemic illness Recommended Monitoring
the periparturient period. • Urinalysis, sediment exam, and culture: • When diethylstilbestrol (DES) is used in
• Hemorrhagic vaginal discharge (with the assess for concurrent cystitis. Avoid cysto- high doses or for chronic therapy, regular
exception of scant discharge during proestrus) centesis if there is a possibility of pyometra evaluation of patient’s CBC is advised
warrants evaluation for systemic bleeding or coagulopathy. (myelotoxicity).
disorders (p. 433), SIPS in the postpartum • Ultrasonographic evaluation of genitourinary • Clinical response for uncomplicated bacterial
bitch, and neoplasia. tract: diagnostic test of choice for pyometra vaginitis
• Chronic discharges should be evaluated with • Brucella screening (p. 1319) • Repeat exam and evaluation if complete
a thorough physical exam, including digital resolution is not achieved after 14 days of
rectal and vaginal palpation, cytologic exam Advanced or Confirmatory Testing therapy
of the discharge, video vaginoscopy, and a • Guarded cranial vaginal aerobic/mycoplasma
routine database for detection of urinary tract bacterial culture to evaluate bacterial PROGNOSIS & OUTCOME
infection, vulvar abnormalities, vaginal stric- population
tures, foreign body, and neoplastic change. • Retrograde double-contrast vaginocystoure- • Good prognosis for secondary bacterial
throgram vaginitis if underlying cause is identified
Differential Diagnosis • Cystoscopy (p. 1085) and video vaginoscopy and corrected
• Normal vaginal discharge; none should be (p. 1184), including exam of cervix: foreign • Idiopathic lymphoplasmacytic vaginitis is
malodorous body, congenital malformation, mass often recurrent but responsive to steroid
○ Estrus: hemorrhagic, low volume • Vaginal biopsy ± mass biopsy therapy.
○ Parturition: moderate to large volume, • Coagulation profile (if hemorrhagic discharge)
hemorrhagic, green or brown • Urethral pressure profile PEARLS & CONSIDERATIONS
○ Postpartum: low to moderate volume for
up to 4-6 weeks, green initially then brown TREATMENT Comments
• Endometritis/metritis: purulent, mucosan- • Always rule out pyometra in an intact animal
guineous, malodorous, moderate volume in Treatment Overview with vaginal discharge.
association with a febrile postpartum bitch • Treatment goals are to restore patient’s • Always perform digital vaginal and rectal
• Subinvolution of placental sites (p. 950): comfort, correct underlying cause, and palpation when initially evaluating a patient
hemorrhagic, moderate volume in association prevent recurrence. with vaginal discharge.
with periparturient period
• Juvenile-onset vaginitis: white, mucoid, and
moderate volume
• Secondary bacterial vaginitis due to stric-
ture, foreign body: mucoid, blood-tinged
discharge; may be malodorous and scant to
moderate volume
• Herpesvirus, B. canis infection (abortion),
C. jejuni: abortion-associated discharge is
typically brown, moderate volume.
• Urogenital neoplasia: varies; may be hemor-
rhagic, serous, or mucoid; scant to moderate
volume
• Bleeding disorder: hemorrhagic; volume
depends on degree of coagulation impairment
• Lymphoplasmacytic vaginitis: typically low
volume, scant, and serous initially; may A B
become mucoid with secondary bacterial
infection; occasionally serosanguineous (p. VULVAR DISCHARGE Normal postpartum vaginal discharge from a bitch 1 day (A, green discharge) and
1030) 1 week (B, brown discharge) after whelping.

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