Leucorrhea (Leukorrhea)

"""
Clinical Decision Tree PDF - Vaginal Discharge Diagnosis & Management
Uses ReportLab to draw a full A3-landscape flowchart with colour-coded boxes.
"""

from reportlab.lib.pagesizes import A3, landscape
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.pdfgen import canvas
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import Paragraph
from reportlab.lib.enums import TA_CENTER, TA_LEFT

# ── colour palette ────────────────────────────────────────────────
C_START      = colors.HexColor("#1A237E")   # dark navy  – start node
C_DECISION   = colors.HexColor("#0277BD")   # blue       – decision diamond
C_PHYSIO     = colors.HexColor("#2E7D32")   # dark green – physiological
C_BV         = colors.HexColor("#6A1B9A")   # purple     – BV
C_CANDIDA    = colors.HexColor("#E65100")   # orange     – candida
C_TRICH      = colors.HexColor("#C62828")   # red        – trichomoniasis
C_CERVICITIS = colors.HexColor("#00695C")   # teal       – cervicitis
C_TREATMENT  = colors.HexColor("#1565C0")   # mid-blue   – treatment boxes
C_INVESTIGATE= colors.HexColor("#4527A0")   # indigo     – investigation
C_NOTE       = colors.HexColor("#F9A825")   # amber      – note/warning
C_TEXT_LIGHT = colors.white
C_TEXT_DARK  = colors.HexColor("#212121")
C_LINE       = colors.HexColor("#455A64")
C_BG         = colors.HexColor("#F5F5F5")

PAGE = landscape(A3)
W, H = PAGE

out_path = "/home/daytona/workspace/vaginal-discharge-pdf/Vaginal_Discharge_Decision_Tree.pdf"
c = canvas.Canvas(out_path, pagesize=PAGE)


# ── helper: wrapped text in a box ────────────────────────────────
def draw_box(c, x, y, w, h, text, fill_color, text_color=colors.white,
             font="Helvetica-Bold", font_size=7.5, radius=4, border_color=None):
    """Draw a rounded-rect box with centred wrapped text."""
    if border_color is None:
        border_color = fill_color.clone() if hasattr(fill_color, 'clone') else fill_color

    c.saveState()
    c.setFillColor(fill_color)
    c.setStrokeColor(C_LINE)
    c.setLineWidth(0.6)
    c.roundRect(x, y, w, h, radius, fill=1, stroke=1)

    # text
    c.setFillColor(text_color)
    c.setFont(font, font_size)
    lines = text.split("\n")
    total_h = len(lines) * (font_size + 1.5)
    start_y = y + h/2 + total_h/2 - font_size
    for line in lines:
        c.drawCentredString(x + w/2, start_y, line)
        start_y -= (font_size + 1.5)
    c.restoreState()


def draw_diamond(c, cx, cy, hw, hh, text, fill_color, font_size=7.5):
    """Draw a diamond shape for decision nodes."""
    c.saveState()
    c.setFillColor(fill_color)
    c.setStrokeColor(C_LINE)
    c.setLineWidth(0.6)
    p = c.beginPath()
    p.moveTo(cx, cy + hh)
    p.lineTo(cx + hw, cy)
    p.lineTo(cx, cy - hh)
    p.lineTo(cx - hw, cy)
    p.closePath()
    c.drawPath(p, fill=1, stroke=1)

    c.setFillColor(colors.white)
    c.setFont("Helvetica-Bold", font_size)
    lines = text.split("\n")
    total_h = len(lines) * (font_size + 1.5)
    start_y = cy + total_h/2 - font_size
    for line in lines:
        c.drawCentredString(cx, start_y, line)
        start_y -= (font_size + 1.5)
    c.restoreState()


def arrow(c, x1, y1, x2, y2, label="", color=C_LINE, label_color=C_TEXT_DARK):
    """Draw an arrow between two points with optional label."""
    c.saveState()
    c.setStrokeColor(color)
    c.setLineWidth(1.0)
    c.line(x1, y1, x2, y2)

    # arrowhead
    import math
    angle = math.atan2(y2 - y1, x2 - x1)
    size = 5
    c.setFillColor(color)
    p = c.beginPath()
    p.moveTo(x2, y2)
    p.lineTo(x2 - size * math.cos(angle - 0.35),
             y2 - size * math.sin(angle - 0.35))
    p.lineTo(x2 - size * math.cos(angle + 0.35),
             y2 - size * math.sin(angle + 0.35))
    p.closePath()
    c.drawPath(p, fill=1, stroke=0)

    if label:
        mx, my = (x1 + x2) / 2, (y1 + y2) / 2
        c.setFillColor(label_color)
        c.setFont("Helvetica-Bold", 6.5)
        c.drawCentredString(mx, my + 3, label)
    c.restoreState()


def bent_arrow(c, x1, y1, xmid, ymid, x2, y2, label="", color=C_LINE):
    """L-shaped arrow via a midpoint."""
    arrow(c, x1, y1, xmid, ymid, color=color)
    arrow(c, xmid, ymid, x2, y2, label=label, color=color)


# ═══════════════════════════════════════════════════════════════════
#  PAGE 1  –  OVERVIEW DECISION TREE
# ═══════════════════════════════════════════════════════════════════
def page1(c):
    # Background
    c.setFillColor(C_BG)
    c.rect(0, 0, W, H, fill=1, stroke=0)

    # Header bar
    c.setFillColor(C_START)
    c.rect(0, H - 22*mm, W, 22*mm, fill=1, stroke=0)
    c.setFillColor(colors.white)
    c.setFont("Helvetica-Bold", 16)
    c.drawCentredString(W/2, H - 14*mm, "CLINICAL DECISION TREE: Vaginal Discharge – Diagnosis & Management")
    c.setFont("Helvetica", 8)
    c.drawCentredString(W/2, H - 20*mm,
        "Based on Harrison's Principles of Internal Medicine 22E | Rosen's Emergency Medicine | "
        "Park's Textbook of PSM | Harriet Lane Handbook 23E | Berek & Novak's Gynecology")

    # Footer
    c.setFillColor(C_START)
    c.rect(0, 0, W, 7*mm, fill=1, stroke=0)
    c.setFillColor(colors.white)
    c.setFont("Helvetica", 7)
    c.drawCentredString(W/2, 2*mm, "Page 1 of 2  |  For educational use only  |  Always apply clinical judgment")

    bw = 52*mm   # standard box width
    bh = 12*mm   # standard box height
    dw = 38*mm   # diamond half-width
    dh = 10*mm   # diamond half-height

    # ── ROW 1: START ─────────────────────────────────────────
    sx = W/2 - bw/2
    sy = H - 44*mm
    draw_box(c, sx, sy, bw, bh,
             "PATIENT WITH VAGINAL DISCHARGE", C_START, font_size=8.5)

    # ── ROW 2: HISTORY diamond ──────────────────────────────
    d1cx = W/2
    d1cy = sy - 26*mm
    draw_diamond(c, d1cx, d1cy, dw, dh,
                 "ASSESS CHARACTER\nOF DISCHARGE", C_DECISION, font_size=8)
    arrow(c, sx + bw/2, sy, d1cx, d1cy + dh)

    # Five branches from diamond
    # Branch labels & positions
    branches = [
        # (label, cx_offset, colour, name)
        ("Physiological\n(clear/white,\nscant, no sx)", -2.05*bw, C_PHYSIO),
        ("White curdy,\npruritus\n(Candida?)",          -0.95*bw, C_CANDIDA),
        ("Thin gray,\nfishy odour\n(BV?)",               0.05*bw, C_BV),
        ("Yellow-green\nfrothy, profuse\n(Trich?)",       1.10*bw, C_TRICH),
        ("Mucopurulent\ncervical dc\n(Cervicitis?)",      2.15*bw, C_CERVICITIS),
    ]

    branch_y = d1cy - 26*mm
    branch_centres = []
    for label, xoff, col in branches:
        bx = W/2 + xoff - bw/2
        draw_box(c, bx, branch_y, bw, bh + 2*mm, label, col, font_size=7.5)
        bxc = bx + bw/2
        branch_centres.append((bxc, branch_y + bh + 2*mm, col))
        # arrow from diamond
        bent_arrow(c, d1cx, d1cy - dh, d1cx, branch_y + bh + 2*mm + 3*mm, bxc, branch_y + bh + 2*mm, color=col)

    # ── ROW 3: INVESTIGATIONS ─────────────────────────────────
    inv_y = branch_y - 25*mm

    inv_data = [
        ("PHYSIOLOGICAL\nLEUKORRHEA\n\npH <4.5\nLactobacillus on smear\nNo inflammation", C_PHYSIO),
        ("VVC WORKUP\n\npH <4.5\n10% KOH → pseudohyphae\nWet mount: budding yeast", C_CANDIDA),
        ("BV WORKUP\n\npH >4.5 | Whiff test +ve\nClue cells on wet mount\n≥3 Amsel criteria", C_BV),
        ("TRICHOMONIASIS\nWORKUP\n\npH >5 | Frothy dc\nMotile trichomonads\n(NAAT preferred)", C_TRICH),
        ("CERVICITIS\nWORKUP\n\nEndocervical swab\nGram stain / NAAT\nfor GC + Chlamydia", C_CERVICITIS),
    ]

    inv_centres = []
    for i, ((bxc, byc, col), (itxt, icol)) in enumerate(zip(branch_centres, inv_data)):
        bx = bxc - bw/2
        draw_box(c, bx, inv_y, bw, 18*mm, itxt, icol, font_size=6.8, radius=3)
        arrow(c, bxc, branch_y, bxc, inv_y + 18*mm)
        inv_centres.append((bxc, inv_y, icol))

    # ── ROW 4: MANAGEMENT ─────────────────────────────────────
    mgmt_y = inv_y - 34*mm

    mgmt_data = [
        ("NO TREATMENT\nNEEDED\n\nReassure patient\nHygiene counselling\nReview if symptoms\nappear", C_PHYSIO),
        ("TREAT VVC\n\nFluconazole 150 mg PO\nsingle dose\n(non-pregnant)\n\nOR topical azole\n(clotrimazole/miconazole)\n\nPregnancy: topical\n7-day azole ONLY\n(no oral fluconazole)", C_CANDIDA),
        ("TREAT BV\n\nMetronidazole 500 mg\nPO BD × 7 days\n\nOR Metro gel 0.75%\n5 g intravag × 5 days\n\nOR Clindamycin cream 2%\n5 g intravag × 7 days\n\nNo partner treatment", C_BV),
        ("TREAT TRICHOMONIASIS\n\nMetronidazole 500 mg\nPO BD × 7 days\n(preferred)\n\nOR Tinidazole\n(metronidazole-resistant)\n\nTREAT PARTNER\n(mandatory)\n\nNo intravag metro", C_TRICH),
        ("TREAT CERVICITIS\n(GC + Chlamydia)\n\nCefixime 400 mg PO\nsingle dose\n+\nAzithromycin 1 g PO\nsingle dose\n\nPartner notification\nmandatory", C_CERVICITIS),
    ]

    for i, ((bxc, byc, col), (mtxt, mcol)) in enumerate(zip(inv_centres, mgmt_data)):
        bx = bxc - bw/2
        draw_box(c, bx, mgmt_y, bw, 28*mm, mtxt, mcol, font_size=6.5, radius=3)
        arrow(c, bxc, byc, bxc, mgmt_y + 28*mm)

    # ── FOLLOW-UP note bar ─────────────────────────────────────
    note_y = mgmt_y - 12*mm
    draw_box(c, 18*mm, note_y, W - 36*mm, 9*mm,
             "FOLLOW-UP: Review all cases in 1 week  |  "
             "BV / Trich: screen for HIV, other STIs  |  "
             "Recurrent VVC: check for DM, HIV, antibiotic use  |  "
             "Persistent symptoms: re-evaluate, consider NAAT / culture",
             C_NOTE, text_color=C_TEXT_DARK, font_size=7.2, radius=3)

    # ── SPECIAL POPULATIONS note ───────────────────────────────
    sp_y = note_y - 10*mm
    draw_box(c, 18*mm, sp_y, (W - 36*mm)/2 - 3*mm, 8*mm,
             "PREGNANCY: Avoid oral fluconazole (all trimesters)  |  "
             "Oral metronidazole generally safe after 1st trimester  |  "
             "Always do per-speculum exam to exclude PPROM",
             C_INVESTIGATE, font_size=6.8, radius=3)
    draw_box(c, W/2 + 3*mm, sp_y, (W - 36*mm)/2 - 3*mm, 8*mm,
             "PREPUBERTAL GIRLS: Consider sexual abuse  |  "
             "Foreign body (toilet paper most common) → remove  |  "
             "Non-specific: hygiene + short-course topical oestrogen",
             C_INVESTIGATE, font_size=6.8, radius=3)


# ═══════════════════════════════════════════════════════════════════
#  PAGE 2  –  SYNDROMIC MANAGEMENT + COMPARISON TABLE
# ═══════════════════════════════════════════════════════════════════
def page2(c):
    c.setFillColor(C_BG)
    c.rect(0, 0, W, H, fill=1, stroke=0)

    # Header
    c.setFillColor(C_DECISION)
    c.rect(0, H - 22*mm, W, 22*mm, fill=1, stroke=0)
    c.setFillColor(colors.white)
    c.setFont("Helvetica-Bold", 15)
    c.drawCentredString(W/2, H - 13*mm,
        "Vaginal Discharge: Syndromic Management & Diagnostic Comparison")
    c.setFont("Helvetica", 8)
    c.drawCentredString(W/2, H - 20*mm,
        "WHO Syndromic Approach (Park's PSM) | Amsel Criteria (Harriet Lane) | Harrison's Principles 22E")

    # Footer
    c.setFillColor(C_START)
    c.rect(0, 0, W, 7*mm, fill=1, stroke=0)
    c.setFillColor(colors.white)
    c.setFont("Helvetica", 7)
    c.drawCentredString(W/2, 2*mm, "Page 2 of 2  |  For educational use only  |  Always apply clinical judgment")

    # ── SYNDROMIC FLOWCHART ────────────────────────────────────
    sec_y = H - 28*mm
    c.setFont("Helvetica-Bold", 10)
    c.setFillColor(C_START)
    c.drawString(18*mm, sec_y, "SYNDROMIC MANAGEMENT (Resource-Limited / No Lab)")
    c.setStrokeColor(C_START)
    c.setLineWidth(1.2)
    c.line(18*mm, sec_y - 1.5*mm, W/2, sec_y - 1.5*mm)

    bw2 = 60*mm
    # Step boxes left-to-right
    steps = [
        ("STEP 1\nHistory & Symptoms\n\n• Amount, colour, smell\n• Pruritus / dysuria\n• Partner symptoms\n• LMP / pregnancy", C_DECISION),
        ("STEP 2\nPer Speculum Exam\n\n• Frothy green → Trich\n• Curdy white → Candida\n• Thin adherent → BV\n• Mucopurulent cx → GC/CT", C_INVESTIGATE),
        ("STEP 3\nTreat Vaginitis\n(TV + BV + Candida)\n\nSecnidazole 2 g PO stat\n+ Fluconazole 150 mg PO\n+ Metoclopramide (prophylactic)", C_BV),
        ("STEP 4\nIf Cervicitis Present\nAlso Add:\n\nCefixime 400 mg PO\n+ Azithromycin 1 g PO", C_CERVICITIS),
        ("STEP 5\nCounselling\n\n• Partner notification\n• Avoid douching\n• Condom use\n• Follow-up 1 week", C_PHYSIO),
    ]

    sx_start = 18*mm
    step_y = sec_y - 30*mm
    prev_ex = sx_start + bw2
    for i, (stxt, scol) in enumerate(steps):
        bx = sx_start + i * (bw2 + 8*mm)
        draw_box(c, bx, step_y - 22*mm, bw2, 22*mm, stxt, scol, font_size=7, radius=4)
        if i > 0:
            arrow(c, bx - 8*mm + 3*mm, step_y - 22*mm + 11*mm,
                  bx - 1*mm, step_y - 22*mm + 11*mm, color=C_LINE)

    # Pregnancy note box under steps
    preg_y = step_y - 22*mm - 14*mm
    draw_box(c, 18*mm, preg_y, W/2 - 26*mm, 11*mm,
             "PREGNANCY (Syndromic)\n"
             "1st trimester: Clotrimazole pessary ONLY (no oral fluconazole, no oral metro)\n"
             "2nd/3rd trim: Metronidazole intravag + clotrimazole pessary\n"
             "Cervicitis: Cefixime + Azithromycin safe in pregnancy",
             C_NOTE, text_color=C_TEXT_DARK, font_size=6.8, radius=3)

    # ── COMPARISON TABLE ───────────────────────────────────────
    # Position: right half of page
    tbl_x = W/2 + 5*mm
    tbl_y_top = H - 28*mm - 3*mm
    tbl_w = W/2 - 23*mm

    c.setFont("Helvetica-Bold", 10)
    c.setFillColor(C_START)
    c.drawString(tbl_x, tbl_y_top, "DIAGNOSTIC COMPARISON TABLE")
    c.setStrokeColor(C_START)
    c.setLineWidth(1.2)
    c.line(tbl_x, tbl_y_top - 1.5*mm, W - 18*mm, tbl_y_top - 1.5*mm)

    col_headers = ["Feature", "Physiological", "BV", "VVC", "Trichomoniasis"]
    col_colors  = [C_START, C_PHYSIO, C_BV, C_CANDIDA, C_TRICH]

    rows = [
        ["Colour",        "Clear/white",         "White/gray",       "White",           "Yellow-green"],
        ["Consistency",   "Heterogeneous",        "Homogeneous thin", "Curdy/adherent",  "Frothy"],
        ["Amount",        "Scant",                "Moderate",         "Scant-moderate",  "Profuse"],
        ["Odour",         "None",                 "Fishy (+whiff)",   "None",            "May be fishy"],
        ["Pruritus",      "No",                   "No",               "Prominent",       "Yes (vulvar)"],
        ["Inflammation",  "No",                   "No",               "Yes (erythema)",  "Yes (strawberry cx)"],
        ["pH",            "<4.5",                 ">4.5",             "<4.5",            ">5.0"],
        ["KOH prep",      "–",                    "+Whiff amine",     "+Pseudohyphae",   "May be +"],
        ["Wet mount",     "Lactobacilli",         "Clue cells",       "Budding yeast",   "Motile trichomonads"],
        ["WBCs",          "Few",                  "Few",              "Many",            "Many"],
        ["Causative org", "Normal flora",         "G.vaginalis +",    "C.albicans",      "T.vaginalis"],
        ["",              "",                     "anaerobes",        "",                ""],
        ["Tx (1st line)", "None",                 "Metro 500mg BD×7d","Fluconazole 150mg","Metro 500mg BD×7d"],
        ["Partner Tx",    "N/A",                  "Not needed",       "Not needed",      "Mandatory"],
        ["Pregnancy Tx",  "N/A",                  "Metro intravag",   "Clotrimazole pess","Metro intravag"],
    ]

    col_w = [tbl_w * f for f in [0.22, 0.165, 0.165, 0.165, 0.185]]
    row_h = 6.2*mm
    tbl_y = tbl_y_top - 8*mm

    # header row
    cx = tbl_x
    for j, (hdr, hcol) in enumerate(zip(col_headers, col_colors)):
        draw_box(c, cx, tbl_y, col_w[j], row_h + 1*mm, hdr, hcol, font_size=7.5, radius=2)
        cx += col_w[j] + 0.3*mm

    # data rows
    alt_colors = [colors.HexColor("#ECEFF1"), colors.white]
    for i, row in enumerate(rows):
        row_y = tbl_y - (i + 1) * (row_h + 0.3*mm)
        cx = tbl_x
        bg = alt_colors[i % 2]
        for j, cell in enumerate(row):
            cell_col = bg if j > 0 else colors.HexColor("#E3F2FD")
            draw_box(c, cx, row_y, col_w[j], row_h, cell,
                     cell_col, text_color=C_TEXT_DARK,
                     font="Helvetica" if j > 0 else "Helvetica-Bold",
                     font_size=6.5, radius=1)
            cx += col_w[j] + 0.3*mm

    # Amsel Criteria box
    amsel_y = tbl_y - (len(rows) + 1) * (row_h + 0.3*mm) - 3*mm
    draw_box(c, tbl_x, amsel_y, tbl_w, 14*mm,
             "AMSEL CRITERIA for BV (≥3 of 4 required)\n"
             "1. Homogeneous thin grayish-white discharge\n"
             "2. Vaginal pH >4.5\n"
             "3. Positive whiff-amine test (10% KOH)\n"
             "4. Clue cells on wet mount",
             C_BV, font_size=7, radius=3)


# ── RENDER BOTH PAGES ─────────────────────────────────────────────
page1(c)
c.showPage()
page2(c)
c.save()

print(f"PDF saved to: {out_path}")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/vaginal-discharge-pdf/build_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/vaginal-discharge-pdf/build_pdf.py'