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Clinical - Winter > 5 - Vaginal Conditions > Flashcards

5 - Vaginal Conditions Flashcards

1
Q

What is the vagina?

A

Fibromuscular structure that connects vulva w/ cervix and uterus

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2
Q

What happens to the vagina during puberty?

A

Estrogen causes vaginal lining to change to stratified squamous epithelium, which contains glycogen

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3
Q

What is important about the glycogen in the vagina?

A
  • Lactobacillus use glycogen to form lactic acid, which makes the pH 3.5-5.5
  • Acidic environment maintains normal vaginal flora and inhibits growth of pathogenic organisms
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4
Q

What occurs after menopause?

A

Vaginal lining thins, lactobacilli decline, and pH rises

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5
Q

What are some factors that influence vaginal flora, pH, and glycogen concentration?

A
  • Aging
  • Menstrual cycle hormonal fluctuations
  • Certain diseases (ex: diabetes)
  • Various medications (oral or parenteral)
  • Douching
  • Number of sexual partners
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6
Q

How does diabetes mellitus affect the vagina?

A

When the body is experiencing hyperglycemia, the body will try to get rid of extra sugar through the urine, which introduces more glucose to the area, providing a food source for microorganisms

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7
Q

Increase in vaginal secretions is normal during _______

A
  • Ovulation
  • Pregnancy
  • Following menses
  • Sexual excitement
  • Emotional flares
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8
Q

What is douching?

A

Using liquid to flush the vaginal cavity

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9
Q

What are disadvantages to douching?

A
  • No sustained benefit
  • Upsets natural acidic balance
  • Disrupts normal vaginal flora, increasing risk of irritation or infection
  • Increases risk of genital tract infections, ectopic pregnancy, potential cervical cancer risk
  • Prevent detection of infection
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10
Q

When should douching not be done?

A
  • Pregnancy
  • As a contraceptive or self-tx of vaginal infection
  • 24-48 hours prior to gynecologic exam
  • At least 3 days after last dose of vaginal antifungal medication
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11
Q

What is preferred over the use of genital towelettes?

A

Daily cleansing w/ mild soap and water

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12
Q

Are cleansers recommended?

A

As long as only using on external genitalia, no significant risk, but also no proven benefit over mild soap and water

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13
Q

What are disadvantages to feminine deodorant sprays?

A
  • May mask an infection

- May cause irritation and allergic reactions

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14
Q

What is a disadvantage to genital towelettes?

A

May lead to irritation or allergic reactions

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15
Q

What are some non-pharms to prevent vaginal irritation?

A
  • Wear cotton underwear to allow moisture to escape
  • Avoid tight fitting clothing and synthetic materials
  • Change pads and tampons regularly; use only unscented products
  • Avoid vaginal sprays and deodorants
  • Avoid long exposure to conditions that are hot and cause sweating
  • Wipe front to back after using the toilet
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16
Q

What is bacterial vaginosis?

A
  • Increased growth in organisms normally found in genital tract
  • Decrease in lactobacilli
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17
Q

What is the difference between vaginitis and vaginosis?

A
  • Vaginitis = inflammation and swelling

- Vaginosis doesn’t cause inflammation, so painful urination/intercourse should not be a sx

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18
Q

What are some complications associated w/ bacterial vaginosis?

A
  • 2nd trimester miscarriage
  • Pre-term birth
  • Pelvic inflammatory disease
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19
Q

What are risk factors for bacterial vaginosis?

A
  • More common if sexually active
  • New sexual partner
  • IUD
  • Douching
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20
Q

Is bacterial vaginosis sexually transmitted?

A

Not usually

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21
Q

Can bacterial vaginosis be asymptomatic?

A

Yes

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22
Q

What are signs and sx of bacterial vaginosis?

A
  • Thin, off-white/yellow or grey discoloured discharge
  • Vaginal pH 5-6
  • Unpleasant “fishy” odour
  • Minimal itching
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23
Q

What should be done if a px is suspected to have bacterial vaginosis or trichomoniasis?

A

Referred

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24
Q

What is involved in diagnosing bacterial vaginosis or trichomoniasis?

A
  • Physical exam

- Lab testing of sample of vaginal fluid

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25
Q

Are there any OTC products to treat bacterial vaginosis?

A

No

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26
Q

Do asymptomatic px w/ bacterial vaginosis require tx?

A

No, unless the woman has a high risk pregnancy or it is prior to IUD insertion or gynecological procedures

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27
Q

What is the preferred tx for a px w/ symptomatic bacterial vaginosis?

A
  • Metronidazole 500 mg PO BID for 7 days
  • Metronidazole 0.75% gel, 5g intravaginally hs for 5 days
  • Clindamycin 2%, 5g intravaginally hs for 7 days
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28
Q

Do sexual partners of a px w/ bacterial vaginosis need tx if they are asymptomatic?

A

No

29
Q

Can lactic acid be used to treat bacterial vaginosis?

A

No, considered significantly less effective than Rx therapies

30
Q

What is the theory behind using lactic acid for tx of bacterial vaginosis?

A

Lactic acid thought to return vaginal pH to an acidic environment, allowing healthy vaginal flora to be restored

31
Q

When is bacterial vaginosis considered recurrent?

A

If occurs w/in 1-3 months of previous tx

32
Q

What must be done if bacterial vaginosis if recurrent? What is the tx

A
  • Diagnosis must be reconfirmed by physician
  • Tx = metronidazole 500 mg PO BID for 10-14 days
  • If 1st tx not effective, 0.75% metronidazole gel, 5g intravaginally hs for 10 days followed by suppressive therapy of metronidazole gel twice a week for 3-6 months
33
Q

What is the tx for bacterial vaginosis during pregnancy?

A
  • Oral tx preferred

- Metronidazole 500 mg or clindamycin 300 mg PO BID for 7 days

34
Q

What is trichomoniasis?

A

Sexually transmitted infection caused by Trichomonas vaginalis

35
Q

What may happen if trichomoniasis is left untreated?

A
  • Progress to urethritis or cystitis
  • Associated w/ reproductive issues
  • During pregnancy - preterm delivery, low birth weight
36
Q

What are risk factors for trichomoniasis?

A
  • Multiple or now sexual partners
  • Nonuse of barrier contraception
  • Presence of other STI’s
37
Q

What are the signs and sx of trichomoniasis?

A
  • Large amounts of white or yellow frothy discharge
  • Redness of vulva and cervix
  • Vaginal pH 6 or higher
  • Itching, dysuria (painful urination), no odour
38
Q

Can trichomoniasis be asymptomatic?

A

Yes

39
Q

What is the tx for trichomoniasis?

A

Oral metronidazole, 2g single dose or 500 mg BID for 7 days

40
Q

Do sexual partners of a px w/ trichomoniasis need to be treated?

A

Yes

41
Q

What is the tx for trichomoniasis in pregnancy?

A

Same as other tx (2g single dose preferred)

42
Q

What is another name for vulvovaginal candidiasis?

A

Yeast infection

43
Q

What commonly causes vulvovaginal candidiasis?

A

Candida albicans

44
Q

Is vulvovaginal candidiasis sexually transmitted?

A

No

45
Q

When is vulvovaginal candidiasis considered self-treatable?

A

If the woman has had a previous diagnosis of candidiasis

46
Q

What are the signs and symptoms of vulvovaginal candidiasis?

A
  • White, clumpy, curd-like discharge
  • Inflammation/redness of vaginal area
  • Severe itching
  • Pain during sexual intercourse (dyspareunia)
  • Stinging/burning
  • External dysuria
47
Q

Can vulvovaginal candidiasis be asymptomatic?

A

Yes

48
Q

What are risk factors for vulvovaginal candidiasis?

A
  • Medications (antibiotics, hormones, chemo)
  • Menses
  • Pregnancy
  • Stress
  • Immunocompromised
  • Poorly controlled diabetes
  • Tight fitting clothing
  • Irritants (scented products, douches)
  • Diet
49
Q

What are the goals of treatment for vulvovaginal candidiasis?

A
  • Relieve signs and symptoms of infection
  • Eradicate infection
  • Prevent recurrence
  • Prevent misdiagnosis, which causes a delay in treatment
50
Q

What are the guidelines for self-treatment of vulvovaginal candidiasis?

A
  • Uncomplicated (not recurrent)
  • Previously diagnosed
  • Mild to moderate sx
  • *Not pregnant
  • Older than 12 y/o (post puberty)
  • Had less than 3 episodes in past year and no signs w/in past 2 months
51
Q

What are red flags for vulvovaginal candidiasis?

A
  • First episode
  • Less than 12 y/o
  • Pregnant
  • Sx of fever, pain in lower abdomen, back, or shoulder
  • Medication - corticosteroids, immunosuppressive drugs
  • Medical conditions - diabetes, HIV
  • Recurrent infection (less than 2 months since previous episode)
52
Q

What are some non-pharms for vulvovaginal candidiasis?

A
  • Genital hygiene (avoid vaginal deodorants, douching, harsh soaps, perfumed products)
  • Avoid tight clothing and synthetic underwear (use cotton underwear and loose fitting undergarments and pants)
53
Q

Which type of antibiotic is used for vulvovaginal candidiasis?

A

Imidazoles/azoles

54
Q

What are side effects of clotrimazole?

A
  • Itching
  • Burning
  • Bloating
  • Irritation
55
Q

Do one day treatments for vulvovaginal candidiasis provide any further benefits?

A
  • No b/c symptom relief takes 2-3 days

- Does have a greater chance of adverse effects

56
Q

What are side effects of miconazole nitrate?

A
  • Itching
  • Burning
  • Headache
  • Allergic contact dermatitis
  • Skin rash
57
Q

What are some counselling tips for tx of vulvovaginal candidiasis?

A
  • Use once daily at bedtime
  • Use according to product instructions
  • Some relief w/in 24-48 h
  • May take 1 week for complete relief
  • Do not use tampons/douche for 3 days after tx
  • Don’t use condoms or diaphragms during or for 3 days after tx b/c products are oil based and may cause either to fail
58
Q

What are contraindications for fluconazole?

A
  • Pregnancy

- Not recommended in px under 12 y/o unless physician advice

59
Q

What are side effects of fluconazole?

A
  • Headache
  • Nausea
  • Abdominal pain
  • Dyspepsia
  • Dizziness
60
Q

What are side effects of terconazole?

A
  • Headache
  • Abdominal pain
  • Vaginal burning and itching
  • Fever, chills
61
Q

What is a contraindication for terconazole?

A

1st trimester of pregnancy

62
Q

What is the monitoring for vulvovaginal candidiasis?

A
  • Improvement of sx w/in 48-72 h
  • Resolution of sx in 7 days
  • Refer if sx don’t resolve in 7 days or sx worsen
  • Recurrence of sx w/in 2 months
63
Q

What is considered recurrent candidiasis?

A

4 or more episodes in 1 year

64
Q

What is the initial tx for recurrent vulvovaginal candidiasis?

A
  • Fluconazole 150 mg every 72 h (3 doses)
  • Topical azoles for 10-14 days
  • Boric acid intravaginally for 14 days
65
Q

What is the maintenance tx for recurrent vulvovaginal candidiasis?

A
  • Minimum of 6 months tx
  • Fluconazole 150 mg weekly
  • Ketoconazole 100 mg once daily
  • Clotrimazole 500 mg once per month
  • Boric acid 300 mg intravaginally for 5 days each month, beginning on first day of menstrual cycle
66
Q

What is the recommended therapy for vulvovaginal candidiasis of a pregnant woman?

A

Topical azole, 7 day tx

67
Q

What is toxic shock syndrome?

A

Acute illness caused by a toxin produced by Staph aureus

68
Q

Who is at risk of getting toxic shock syndrome?

A
  • Menstruating women using tampons
  • Women using contraceptive sponges, diaphragm, or cervical cap
  • Anyone w/ surgical wound infection
69
Q

What are the sx of toxic shock syndrome?

A
  • Sudden high fever
  • Diarrhea
  • Vomiting
  • Dizziness
  • Muscle aches
  • Fainting
  • Sunburn-like rash on palms of hands and soles of feet

Clinical - Winter (24 decks)

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