103. Vaginitis (7%) Flashcards
Chez les patientes qui consultent pour un écoulement vaginal récidivant, mais chez qui l’anamnèse, l’examen physique et les résultats des tests sont négatifs, vous pouvez poser un dx de quoi?
un diagnostic positif d’écoulement physiologique.
Lorsque des prélèvements vaginaux ou le Pap test identifient fortuitement une vaginose bactérienne ou des candidoses, quoi faire ?
informez-vous des symptômes et traitez seulement lorsqu’approprié.
Chez une fillette qui présente un écoulement vaginal, éliminez quoi?
une infection transmissible sexuellement ou un corps étranger.
Chez une fillette qui présente une candidose, recherchez quoi ? (2)
une pathologie sous-jacente (p. ex., immunodépression, diabète).
Name DDX : Infectious vaginal discharge (4)
- Bacterial vaginosis (most common cause of vaginal discharge 30%)
- Candida vulvovaginitis
- Trichomonas vaginalis (STI)
- Cervicitis (Gono/Chlam)
Name DDX : Non-infectious vaginal discharge
(4)
- Physiologic
- Atrophic vaginitis (scant discharge)
- Foreign body
Name DDX : Non-infectious vulvovaginal pruritus without discharge (6)
- Irritant or allergic contact dermatitis (latex, soaps, perfumes)
- Lichen planus
- Lichen sclerosus
- Vulvar cancer
- Psoriasis
- Colovaginal fistula
Describe dx : Bacterial Vaginosis (4)
Clinical (Amsel’s), require 3 of 4
* Adherent and homogenous vaginal discharge (smoothly coats vaginal walls)
* Vaginal pH >4.5
* Clue cells on saline wet mount
* Positive whiff-amine test : Fishy amine odour (before or) after addition of 10% KOH
Describe tx : Bacterial Vaginosis (4)
- Oral: Metronidazole 500mg PO BID or Clindamycin 300mg PO BID x 7-14d
- Preferred in pregnancy as they have been shown to reduce preterm birth
- Topical: Metronidazole gel 0.75% one applicator (5g) PV daily x 5d
- Longer courses if multiple recurrences
Describe dx : Trichomonas vaginalis (3)
- Malodorous, green/yellow frothy discharge
- Pruritus, dyspareunia, petechiae - strawberry cervix
- Motile trichomonads on wet mount microscopy, NAAT PCR vaginal swabs, culture
Describe tx : Trichomonas vaginalis (4)
- Metronidazole PO
- High-dose therapy may be needed for resistance
- Partner treatment enhances cure rates
- Abstain from intercourse until both patients treated and asymptomatic
Describe dx : Candida vulvovaginitis (3)
- Erythema, edema of vulvovaginal tissues with thick, white clumped vaginal discharge, pH<4.5
- Budding yeast and pseudohyphae on wet mount microscopy (negative in 50%)
- Consider culture in negative microscopy or persistent/recurrent symptoms after treatment
Describe tx : Candida vulvovaginitis UNCOMPLICATED (2)
- Uncomplicated (Sporadic, infrequent ≤3/y, healthy, immunocompetent, nonpregannt) : Fluconazole 150mg PO x1 or topical intravaginal/suppository (clotrimazole, miconazole)
- Topical antifungal azoles may require longer courses, but are first-line in pregnancy (Canesten cream)
Describe tx : Candida vulvovaginitis COMPLICATED (3)
- Fluconazole 150mg PO x3 doses 72h apart (day 1, 4, 7)
- Consider maintenance with Fluconazole 150mg PO weekly x 6 months
- Monitor for hepatotoxicity with long-term use and drug interactions
Describe : Prepubescent Vaginal Discharge
Mucoid white vaginal discharge normal in neonates, decreases by 3 months old
Describe investigations : Prepubescent Vaginal Discharge
- Introital (not vaginal) swab if profuse discharge
- Bacterial culture (GAS, Haemophilus influenzae, Gardnerella). If positive bacterial culture, can treat with antibiotics
- Candida unusual, consider if immunosuppression
