2 - Vaginal Infections

Question 1

What are the 3 basic vaginal infections, in order from most common to least common?

Answer 1

Bacterial Vaginosis, Candidiasis, Trichamonas

Question 2

For Candidiasis infections, what is the most common organism?

Answer 2

Albicans

patients who do not respond to tx for Candida Albicans may have a different organism like tropicalis, glabrata, etc

Question 3

What are the 7 risk factors that predispose women for developing candidiasis?

Answer 3

1) antibiotics
2) corticosteroids
3) diabetes
4) oral BC
5) pregnancy
6) immunocompromised
7) lubes

Question 4

What is the normal range for vaginal pH?

Answer 4

3.8-4.2

Question 5

If your patient has a complaint of vaginal discharge, what is the first thing you should do?

Answer 5

Test pH.
Normal = normal secretion or candidiasis
Abnormal = BV or trich

Question 6

If your pH is normal, what could you do to make a definitive dx?

Answer 6

KOH prep, look for the little buds on the squiggly mycelia. (HYPHE)

Question 7

What are the topical OTC recommendations for yeast infection?

Answer 7

Miconazole, Clotrimazole

Question 8

Your patient comes in complaining of severe vaginal itching. Upon exam, you note erythema, satellite pustules, and white curd-like discharge. What is the most likely dx?

Answer 8

Candidiasis

Question 9

What is the prescription strength topical recommendation for yeast infection?

Answer 9

Terconazole

Question 10

What is the oral script for yeast infection?

Answer 10

Fluconazole

Question 11

What are some things your patient should avoid if they are prone to candidiasis?

Answer 11

bubble baths, douching, oils, synthetic underwear (use cotton), dampness (careful hygiene)

Question 12

Which of the 3 major vaginal infections is caused by an STD?

Answer 12

trichomoniasis

Question 13

Where do patients experience pain during sex (dyspareunia) if they have trich?

Answer 13

superficial vaginal pain

Question 14

What does trich discharge look like?

Answer 14

yellow-green, frothy

Question 15

What is the pH for trich dx?

Answer 15

> 4.5

Question 16

Trich is a/w punctate cervical hemorrhages, what is that?

Answer 16

strawberry vagina

Question 17

What is the tx for trich?

Answer 17

Metronidazole 2grams, single dose

Question 18

Do you need to get a culture to confirm trich?

Answer 18

Not usually, you can see trich in a saline prep under the microscope

Question 19

What is the “police force” responsible for maintaining a normal vaginal pH?

Answer 19

Lactobacilli

Question 20

What are some things that can disrupt the normal levels of lactobacilli, leading to an overgrowth of anaerobes?

Answer 20

menses, douching, lubes, intercourse, abx

Question 21

Vaginal epithelial cell that is studded with hundreds of microorganisms that create an uneven cell border. They indicate BV and are seen on saline microscopy

Answer 21

Clue cells

Question 22

When vaginal pH is elevated due to the overgrowth of anaerobes, what is the diagnosis?

Answer 22

Bacterial Vaginosis

Question 23

What is the vaginal discharge like for BV?

Answer 23

thin, gray, fishy

Question 24

What is the pH for BV?

Answer 24

> 4.5

Question 25

What are some complications from BV?

Answer 25

1) PID
2) Post op infection
3) PPROM
4) preterm delivery
5) chorioamnionitis
6) endometritis

Question 26

What is the tx for BV?

Answer 26

ORAL metronidazole 500mg one po BID x 7 days

better than topical b/c it will handle systemic complications

Question 27

The bartholin’s gland has 3 major problems associated with it. What are they?

Answer 27

cyst, abscess, tumor

Question 28

How do you tx problem with Bartholin’s Gland?

Answer 28

I&D,
clear serous drainage = cyst,
purulent = abscess (then culture and tx).
hard tumor = excise and bx

Question 29

What abx course is best for Bartholin’s abscess?

Answer 29

Doxy + Metronidazole

or Augmentin