14- Benign Diseases Of The Vulva And Cervix

Question 1

What are the differents conditions of the vulva?

Answer 1

Vulvovaginitis- common , affect women of all ages
Condylomata acuminata
Bartholin cysts
Vulvar dystrophies

Question 2

What are the causes of vulvovaginitis?

Answer 2

Bacteria
Viruses
Yeasts
Other parasites
STI
Environmental factors (poor hygiene, allergens, chemicals)

Question 3

What are the diagnostics tools for vulvovaginitis?

Answer 3

Inspection
Vaginal pH ( normal 3.8-4.2)
Whiff test (KOH)
Culture in selected cases only

Question 4

What are other contributing factors?

Answer 4

Irriated tissue is more susceptible to infection than normal tissue
Lack of estrogen in postmenopausal women resulting in vaginal dryness
Foreign bodies such as lost tampons

Question 5

What is a non specific vulvovaginitis?

Answer 5

Specific cause cannot be identified
Can be seen in all age groups
Occurs most commonly in young girls before puberty
Can occurs in girls with poor genital hygiene

Question 6

What are the characteristics of unusual/ recurrent infections in children?

Answer 6

Sexual abuse should be considered in children with unusual infections and recurrent episodes of unexplained vulvovaginitis
N. Gonorrhea produces gonococcal vulvovaginitis in young girls who have sexual exposure

Question 7

What is vulvovaginal candidiasis?

Answer 7

Caused by candid albicans
75% of females have at least one episode of VVC
Attachment of the organism to vaginal epithelium necessary for infection ( crab grass effect)

Question 8

What are the predisposing factors for VVC?

Answer 8

Pregnancy 
Oral contraceptives 
Systemic antibiotics therapy
Diabetes mellitus
AIDS

Question 9

What are the clinical features of VVC?

Answer 9

Vestibular pruritus
White curd like discharge
Vaginal erythema

Question 10

How is VVC diagnosed?

Answer 10

Vaginal pH<4.7
Wet mount showing spores and hyphae, lactobacilli
KOH- accentuation of spores and hyphae which are alkali resistant

Question 11

How to treat VVC?

Answer 11

Azole compounds as creams and suppositories
Oral fluconazole
Gentian violet suppositories
Boric acid suppositories

Question 12

What is trichomoniasis?

Answer 12

Generally transmitted by sexual conduct but not exclusively an STD
Caused by Trichomonas vaginalis

Question 13

What are the clinical features of trichomoniasis?

Answer 13

Profuse, frothy leukorrhea
Vestibular pruritus common
Swollen vaginal papillae- strawberry spots
Vaginal erythema
Dysuria
Premenstrual recurrences

Question 14

How is trichomoniasis diagnosed?

Answer 14

Vaginal pH>4.7
Wet mount showing mobile flagellated organisms
Culture- more sensitive than wet mount reserved for patients with symptoms but no trichomonas

Question 15

How is trichomoniasis treated?

Answer 15

Metronidazole( flagyl)  for patient and partner
Acidify vagina ( boric acid suppositories) 
Avoid betadine douches due to delaying re establishment of lactobacilli
Avoid flagyl in first trimester of pregnancy

Question 16

What is bacterial vaginosis?

Answer 16

Poly microbial syndrome dependent for its occurrence on synergism between gardnerella vaginalis and anaerobic bacteria particularly mobiluncus and bacteroids
Generally sexually transmitted but not exclusively
Inverse relationship between presence of lactobacillus and BB

Question 17

What are the clinical features of BV?

Answer 17

Vaginal odor
No vaginal inflammation
Thin, grayish, homogeneous discharge

Question 18

How is BV diagnosed?

Answer 18

Vaginal pH>4.7
Whiff test
Wet mount showing clue cells= bacterial studded epithelial cells

Question 19

How is BV treated?

Answer 19

Metronidazole
2% clindamycin vaginal cream
Boric acid suppositories
Treatment of partner is not necessary

Question 20

How does BV affects pregnancy?

Answer 20

Significantly associated with premature rupture of membranes

BV organisms increases phospholipase increasing arachidonic acid and prostaglandins