15- Benign Diseases Of The Vulva/cervix 2 Flashcards
What is condylomata acuminata (venereal warts)?
Caused by HPV (42 serotypes)
Transmitted by sexual contact
Types 6;11- benign disease
Types 16,18,31,33,35- 80% of cervical cancers contains HPV DNA
Koilocytosis are pathognomonic cytologic feature
What are the clinical features of condylomata acuminata?
Raised warty lesions over vulva and vagina usually visible to naked eye
Flat lesions on vaginal epithelium and cervix- acetowhite: visible as white areas only after application of acetic acid
How is condylomata acuminata diagnosed?
Visual inspection Acetic acid test Biopsy Southern blot hybridization Rule out other STDs
How is condylomata acuminata treated?
TCA- trichloroacetic acid
Cryosurgery
Laser vaporization- risk of contagion from HPV in smoke
Cure may not be possible
What are Bartholin cysts/ abscesses?
Cysts arise from duct of gland when there is occlusion and continued secretory activity
Glands located between superficial and deep perineal compartments of posterior third of labia
Most common cause of duct obstruction, infection
What are the clinical features of Bartholin cysts?
Cystic unilateral mass on posterior third of vulva
Infection showing exquisite tenderness with dyspareunia, pain on walking
How are Bartholin cysts treated?
Marsupialization- creation of a new opening for gland
Simple incision and drain- high recurrence rate
What are are the vulvar dystrophies?
Hypertrophic dystrophy
Lichen sclerosus atrophicus
What are the characteristics of hypertrophic dystrophy?
Thickening of vulva skin secondary to external irritants
Biopsy critical to rule out carcinoma
Toluidine blue can show nuclear strain
Treated with 1% hydrocortisone cream
What are the characteristics of lichen sclerosus?
Skin atrophic and thinned Biopsy critical to rule out carcinoma Vulvar pruritus is a key symptom Treated with vasoline and eurax cream Long term treatment necessary
What are the conditions of the cervix?
Acute cervicitis
Chronic cervicitis
Endocervical polyps
What are the general aspects of acute cervicitis?
Not the same as cervical ectopy
Etiologic agents are chlamydia and gonorrhea
Culture critical for diagnosis to rule out vaginitis
What Hat are the clinical features of acute cervicitis?
Contact bleeding is key symptom
Purulent discharge- yellow pus like discharge
May lead to dyspareunia, pelvic pain with ascending infection
How is acute cervicitis diagnosed?
Vaginal pH>4.7 Cervix friable to touch Wet mount shows multiple PMNs Gram stain Obtain Pap to rule out CIN
What are the conditions of the chronic cervicitis?
Presence of endocervical mucosa on portion vaginalis of cervix
Usually normal findings @ times of high estrogen levels ( menarche, pregnancy)
May lead to leukorrhea with increased vaginal pH and recurrent vaginitis
Treated by acidifying vagina, eliminate ectopy via cryosurgery or electrocautery
