Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Practice bulletins > #215 Vaginitis in Nonpregnant Patients > Flashcards

#215 Vaginitis in Nonpregnant Patients Flashcards

1
Q

Among patients with vaginal symptoms, what % are diagnosed with vaginal candidiasis?

A

17-39%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Among patients with vaginal symptoms, what % are diagnosed with bacterial vaginosis?

A

22-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Among patients with vaginal symptoms, what % are diagnosed with trichomoniasis?

A

4-35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does the presence of estrogen affect vaginal epithelial cells on the molecular level?

A

Increase glycogen content (encourages colonization of vagina by lactobacilia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the normal vaginal pH of a reproductive-aged woman?

A

<4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is gardnerella vaginalis among the normal vaginal flora?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is Escherichia coli among normal vaginal flora?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is group B streptococci among normal vaginal flora?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is candida albicans among normal vaginal flora?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are any mycoplasma species among normal vaginal flora?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the vaginal pH in prepubertal girls? In postmenopausal women?

A

Both >4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is bacterial vaginosis common among prepubertal girls? Postmenopausal women? Why?

A

Uncommon in both d/t estrogen-depleted environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is vaginal candidiasis common among prepubertal girls? Postmenopausal women? Why?

A

Uncommon in both d/t estrogen-depleted environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Overgrowth of what type of bacteria cause bacterial vaginosis?

A

Facultative anaerobes (eg. G vaginalis, bacteroides species, peptostreptococcus, fusobacterium, prevotella, atopobium vaginae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common cause of abnormal vaginal discharge in reproductive aged patients?

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Are certain race/ethnicities at higher risk for bacterial vaginosis?

A

Yes. higher prevalence in black, Hispanic, and Mexican American women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are risk factors for bacterial vaginosis?

A

Race and ethnicity (black, hispanic), age, douching, and sexual activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Does bacterial vaginosis occur in women who have not been sexually active?

A

Rarely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is bacterial vaginosis associated with sexual activity for heterosexual or lesbian couples?

A

Both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does bacterial vaginosis put nonpregnant patients at risk for?

A

Increased risk of various infections including PID, postprocedural gyn infections, increased susceptibility to STIs such as HIV and HSV2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What symptoms present with bacterial vaginosis?

A

Many are asymptomatic. Abnormal vaginal discharge and a fishy odor, particularly after vaginal intercourse and menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What causes trichomoniasis?

A

Infection with protozoan parasite Trichomonas vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common nonviral STI in the US?

A

Trichomoniasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are risk factors for trichomoniasis?

A

African american, increased # sex partners, low socioeconomic status, douching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Has trichomoniasis been associated with PID?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Has trichomoniasis been associated with posthysterectomy cuff cellulitis?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Is trichomoniasis associated with HIV and other STIs?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Is trichomonas typically symptomatic or asymptomatic?

A

More than 50% of patients are asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the symptoms of trichomoniasis?

A

abnormal vaginal discharge, itching, burning, postcoital bleeding. (most commonly asymptomatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the most common cause of vaginitis?

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the second most common cause of vaginitis?

A

Vulvovaginal candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the symptoms of vulvovaginal candidiasis?

A

Asymptomatic colonization to severe vulvovaginal symptoms such as burning, itching, edema, dysuria, dyspareunia, and an abnormal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In the workup of vaginitis, where should a swab for pH evaluation be collected?

A

From mid-portion of the vaginal side wall to avoid false elevations caused by cervical mucus, blood, semen, lubricants, or other substances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the pH level of normal physiologic discharge?

A

3.5-4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the pH level of bacterial vaginosis discharge?

A

> 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the pH level of trichomoniasis discharge?

A

> 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the pH level of vulvovaginal candidiasis discharge?

A

3.5-4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are symptoms/discharge associated with normal physiologic discharge?

A

White and creamy or clear discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are symptoms/discharge associated with bacterial vaginosis?

A

Increased thin, watery, white-gray vaginal discharge often with fishy odor. Most are asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are symptoms/discharge associated with trichomoniasis?

A

Yellow-to-green frothy vaginal discharge, abnormal vaginal odor, pruritus, irritation, and dysuria. More than half are asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are symptoms/discharge associated with vulvovaginal candidiasis?

A

Normal-appearing discharge or thick, white vaginal discharge, pruritus, burning, dyspareunia and dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the gross examination findings with normal physiologic discharge?

A

White discharge in vaginal fornix and adherent to vaginal walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the gross examination findings with bacterial vaginosis?

A

Thin, white-gray homogenous discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the gross examination findings with trichomoniasis?

A

Yellow, frothy vaginal discharge; vaginal or cervical-vaginal erythema with petechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the gross examination findings with vulvovaginal candidiasis?

A

Thick, white, curd-like vaginal discharge. In severe vulvovaginal candidiasis, erythema, edema, excoriations, and fissures may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the microscopy/KOH test results with normal physiologic discharge?

A

Mature squamous cells, rare PMH, background bacteria dominated by lactobacillus

47
Q

What are the microscopy/KOH test results with bacterial vaginosis?

A

Clue cells (more than 20%), no PMNs, a positive KOH “whiff” test. Decreased or absent lactobacilli and increased cocci, and small curved rods

48
Q

What are the microscopy/KOH test results with trichomoniasis?

A

Motile trichomonads, abundant PMNs, bacteria with both bacilus and cocci, variable KOH “whiff” test

49
Q

What are the microscopy/KOH test results with vulvovaginal candidiasis?

A

Branching pseudohyphae, budding pseudohyphae (10x), or spores (40x) with 10% KOH. Mature squamous cells, rare PMNs, bacteria dominated by lactobacilus.

50
Q

What diagnostic tests are recommended for bacterial vaginosis?

A

Recommended: Amsel criteria, Gram stain with Nugent scoring.
Alternative: FDA-approved commercial tests

51
Q

What diagnostic tests are recommended for trichomoniasis?

A

Recommended: NAAT
Alternative: FDA-approved commercial tests, culture

52
Q

What diagnostic tests are recommended for vulvovaginal candidiasis?

A

Recommended: microscopy, yeast culture
Alternative: FDA-approved commercial tests

53
Q

Is bacterial culture recommended for the diagnosis of bacterial vaginosis?

A

No, because normal vaginal flora is heterogeneous, culture not specific for BV

54
Q

What is Amsel Criteria? What is it used to diagnose? When is it positive?

A

BV can be diagnosed with 3/4:

  1. homogenous thin white-gray discharge that smoothly coats vaginal walls
  2. More than 20% clue cells
  3. pH of vaginal fluid < 4.5
  4. Positive KOH whiff test
55
Q

What is the sensitivity and specificity of Amsel criteria for diagnosis of BV?

A

Sensitivity: 92%
Specificity: 77%

56
Q

What is the reference standard for diagnosis of bacterial vaginosis?

A

Gram stain with Nugent scoring

57
Q

How is a Nugent score performed (for bacterial vaginosis)?

A

Assigns a value to different bacterial morphotypes seen on gram stain of vaginal secretions

58
Q

How is a Nugent score interpreted?

A

For diagnosis of BV:
0-3: normal flora
4-6: intermediate flora
7-10: BV flora

59
Q

How do you diagnose BV is Nugent score is intermediate (4-6)?

A

Apply Amsel criteria

60
Q

How does treatment of BV work?

A

Reduce the overgrowth of the patient’s endogenous faculatative and anaerobic bacteria and enabling the lactobacilli to become dominant

61
Q

True or false: people with BV should also be tested for other STIs?

A

Yes, per CDC recommendation

62
Q

What treatment regimens are available for BV (drug name and route)?

A

Recommended: metronidazole PO or PV, Clindamycin cream PV
Alternative: Secnidazole PO, tinidazole PO, clindamycin PO, clindamycin ovules PV

63
Q

What is the dosing of metronidazole to treat BV?

A

PO: 500mg PO BID for 7d.
PV: One applicator 0.75% gel (5g), qD for 5d

64
Q

What is the dosing of clindamycin for treatment of BV?

A

PV#1: one applicator 2% cream (5g) qHS 7d
PO: 300mg BID for 7d
PV#2: 100mg ovules qHS for 3d

65
Q

What is the dosing of Secnidazole for BV?

A

2g PO in a single dose

66
Q

What is the dosing of tinidazole for treatment of BV?

A

2g PO daily for 2d OR 1g PO daily for 5d

67
Q

What is the dosing of metronidazole for the treatment of uncomplicated trichomoniasis?

A

500mg BID for 7d (single dose has been preferred, but recent data from RCT show 7d course more effective)

68
Q

What treatment options are available for trichomonas (drug name and route)?

A

Metronidazole PO

Tinidazole PO

69
Q

What is the dosing of tinidazole for treatment of trichomoniasis?

A

2g PO once

70
Q

What over the counter agents are available to treat uncomplicated vulvovaginal candidiasis?

A

All intravaginal:

Clotrimazole, miconazole, tioconazole

71
Q

What prescription-only intravaginal and oral agents are available to treat uncomplicated vulvovaginal candidiasis?

A

Intravaginal: Butoconazole, terconazole
Oral: fluconazole

72
Q

What is the dosing of fluconazole for uncomplicated vulvovaginal candidiasis?

A

150mg PO once

73
Q

For how long after completion of oral metronidazole treatment should you avoid alcohol?

A

24 hours

74
Q

For how long after completion of oral tinidazole should you avoid alcohol?

A

72 hours

75
Q

True or false: Clindamycin ovules affect efficacy of condoms or diaphragms?

A

True. May weaken latex or rubber products up to 72 hours after treatment

76
Q

True or false: patients should completely abstain from sexual activity during BV treatment?

A

False, they can if they use condoms

77
Q

True or false: patients should use condoms for all sexual activity during BV treatment?

A

True

78
Q

True or false: patients who are using intravaginal product to treat a vaginal infection should avoid use of tampons

A

True, generally recommended to ensure adequate dispersion of the medication

79
Q

Do you need to perform a test of cure after BV treatment?

A

No, as long as symptoms have resolved

80
Q

What % of patients will have BV recur within 3 months? Within 12 months?

A

30% within 3. 58% within 12.

81
Q

What potential factors are associated with recurrent BV?

A

Douching, frequent sexual activity, previous hx of BV, persistence of pathogenic bacteria, or failure to reestablish a lactobacillus-predominant vaginal flora

82
Q

What is the criteria for recurrent bacterial vaginosis?

A

At least three documented, separate episodes in 1 year

83
Q

Do you offer some type of suppression to people with recurrent bacterial vaginosis?

A

Yes. Twice weekly suppressive metronidazole gel for 16 wks after treatment for the acute episode

84
Q

What is the sensitivity of microscopy for diagnosis of trichomoniasis?

A

50-60%

85
Q

How does the sensitivity of NAAT for trichomoniasis compare between urine and vaginal or cervical samples?

A

Equal sensitivity and specificity.
Sensitivity 95.3-100%
Specificity 95.2-100%

86
Q

How long does a culture of trichomonas take to result?

A

At least 5 days

87
Q

Does metronidazole or tinidazole have more gastrointestinal adverse effects?

A

Metronidazole

88
Q

Is metronidazole gel or PO more effective in treating T vaginalis infections?

A

Oral. Metro gel is not effective.

89
Q

Should patients with T vaginalis be retested after infection?

A

Yes, within 3 months because of high rates of infection recurrence

90
Q

Can vulvovaginal candidiasis be reliable diagnosed based on clinical symptoms alone?

A

No

91
Q

In a symptomatic patient, diagnosis of vulvovaginal candidiasis requires one of the follow two findings:

A
  1. visualization of spores, pseudohyphae, or hyphae on wet-mount
  2. vaginal fungal culture or commercial diagnostic test results positive for Candida species
92
Q

What is the sensitivity of microscopy to detect yeast on a wet prep?

A

50-70%

93
Q

When a patient with symptoms of yeast infection has a negative wet prep, what is the next step?

A

Culture

94
Q

C albicans constitutes what % of all vulvovaginal Candida infections?

A

90%

95
Q

Cultures may be positive for yeast in as many as what % of asymptomatic patients at any given time?

A

As many as 30%

96
Q

What are pros and cons of using DNA probe test for diagnosis of yeast infection?

A

Pro: Results in hours. High sensitivity and specificity
Cons: cost, not FDA approved. Most tests don’t distinguish between species (apart from newer probe that divides into 3 groups)

97
Q

What is required to classify vulvovaginal candidiasis as uncomplicated?

A

ALL of the following:

  1. sporadic or infrequent episodes
  2. mild-to-mod symptoms or findings
  3. C albicans infection (suspected or proven)
  4. Non-immunocompromised patients
98
Q

What classifies vulvovaginal candidiasis as complicated?

A

ANY of the following:

  1. recurrent episodes (4 or more per year)
  2. Severe symptoms or findings
  3. Non- C albicans candidiasis (suspected or proven)
  4. Diabetes, immunocompromising conditions, debilitation, or immunosuppressive therapy
99
Q

What is recommended for treatment of uncomplicated vulvovaginal candidiasis?

A

Intravaginal azole therapy or oral fluconazole

100
Q

What should you do if patient remains clinically symptomatic after treatment for vulvovaginal candidiasis?

A

Culture and susceptibility testing

101
Q

What alteration should be made to treatment of vulvovaginal candidiasis in recurrent infections?

A

Extended antifungal treatment. Can give suppressive therapy with weekly doses of either an intravaginal or oral azole (eg 150mg weekly fluconazole for 6 months; or clotrimazole 500mg weekly or 200mg twice a week)

102
Q

What are symptoms of severe vulvovaginal candidiasis?

A

Erythema, erosion, fissure, edema

103
Q

What is recommended treatment for severe vulvovaginal candidiasis?

A

Prolonged course with a topical intravaginal azole for 10-14d or 2-3 doses of PO fluconazole q3 days

104
Q

What is the second most common Candida species?

A

C galbrata

105
Q

What is an effective treatment for C galbrata and other atypical Candida species?

A

Intravaginal boric acid (600mg daily for minimum of 14 days). Topical flucytosine 5g nightly for 2wks is another alternative, but it is expensive

106
Q

What should you make sure to counsel patients about boric acid before prescribing it for candida infection?

A

Can be fatal if ingested orally, must be used intravaginally. Keep out of reach of children.

107
Q

What % of users of over the counter treatment for yeast infection will get a contact dermatitis (presenting as localized burning and itching)?

A

Occur in approximately 5% of users

108
Q

What is the appropriate management of findings c/w vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis on a cervical cytology report in an asymptomatic patient?

A

Pap tests are not reliable for diagnosis of vaginitis. Diagnostic confirmation is recommended.

109
Q

Do asymptomatic patients with incidental candida or BV reported on a pap test require additional testing and/or treatment?

A

No and no

110
Q

Do asymptomatic patients with incidentally found trichomonas on pap require additional testing and/or treatment?

A

Yes, should do confirmatory diagnostic testing and treat if confirmed

111
Q

Are probiotics or nonmedical approaches effective for treatment or prevention of vaginitis?

A

Not recommended

112
Q

How long after the last dose of therapy for trichomonas should a patient abstain from sexual activity?

A

Full 7 days since taking last antibiotic dose. As long as asymptomatic

113
Q

Do partners of patients with BV need to be treated?

A

Data do not support that treatment of sex partners affects rates of relapse or remission

114
Q

Do partners of patients with uncomplicated vulvovaginal candidiasis need to be treated?

A

No

Practice bulletins (83 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions