Abnormal Vaginal Discharge and Vaginal Health Flashcards

Question

BV Links

Answer 1

- Premature rupture of membranes - Premature delivery - Low birth weight - Acquisition of HIV - Development of PID - Post-op infections after GYN procedures

Answer 2

- African-Americans - 2+ sex partners in previous 6mo/new sex partner - Douching - Lack of barrier protection - Absence or decrease of lactobacilli - Lack of H2O2 producing lactobacilli

Answer 3

- All lactobacilli produce lactic acid - Some also produce H2O2, which is a natural microbicide - Present in 42-74% - In vitro, H2O2 is toxic to viruses such as HIV as well as bacteria

Answer 4

- Visualized as slime - Vagina is optimal environment for biofilms - Prevents ABX from getting to organisms

Answer 5

Amsel Criteria: Must have 3+ of the following - pH >4.5 - Presence of >20% per HPF of "clue cells" on wet mount examination - (+) amine "Whiff"test - Homogenous, non-viscous, milky-white D/C adherent to the vaginal walls

Answer 6

- Vaginal Gram stain (Nugent or Speigel criteria) - Culture - DNA probe - PIP Activity - Sialidase tests

Answer 7

- 1st Line * * Metronidazole 500mg PO BID x 7d * * Metronidazole 0.75% gel intravaginally q day x 5d * * Clindamycin 2% cream intravaginally qhs x7d - 2nd Line * * Clindamycin 300mg PO BID x7d * * Clindamycin Ovules 100g intravaginally qhs x3d - Chronic * * Metronidazole gel twice weekly for 6mo

Answer 8

``` Symptomatic - Metronidazole 500mg BID for 7d - Metronidazole 250mg TID for 7d - Clindamycin 300mg BID for 7d Asymptomatic high-risk women (those who have had previous pre-term birth) - Screening and treatment at NOB visit - F/U 1mo after treatment ```

Answer 9

- Male partners of women with BV do NOT need to be treated - Female partners of women with BV SHOULD be examined and treated - Screen and treat prior to hysterectomy or surgical abortion

Answer 10

- Rate is ~20-40% 1mo after therapy - may be r/t persistence of BV-associated organisms and failure of lactobacillus flora to recolonize - Yogurt and exogenous lactobacillus supplements NOT proven to be helpful - Vaginal suppositories w/human lactobacillus strains being investigated - Twice weekly metronidazole gel for 6mo may reduce recurrence

Answer 11

- Association w/sexual activity - High concordance in lesbian partnerships - Correct and consistent condom use - Avoid douching - Limit number of sex partners

Answer 12

- Affects most females during their life - Most caused by C. albicans - 2nd most common cause of vaginitis - NOT sexually transmitted pathogens - Yeast can grow as oval budding cells of chains of cells (pseudohyphae)

Answer 13

- Vulvar pruritus is most common symptom - Thick, white, curd-like vaginal discharge - Erythema, irritaion, occasional erythematous satellite lesion - External dysuria and dyspareunia

Answer 14

- Hx of recent ABX, S/S - Visualization of pseudohyphae (mycelia) and/or budding yeast (conida) on KOH or saline wet prep - pH NL (4-4.5) * * If pH >4.5, consider concurrent BV or trich - Cultures NOT useful

Answer 15

``` - Sporadic/infrequent VVC OR - Mild-to-moderate VVC OR - Likely to be C. albicans OR - Non-immunocompromised women ```

Answer 16

``` - Recurrent VVC (4+/yr OR - Severe VVC (edema/excoriation) OR - Non-albicans candidiasis OR - Women with uncontrolled DM, debilitation, or immunosuppression OR - Pregnancy ```

Answer 17

Intravaginal agents: Butoconazole 2% cream, 5 g intravaginally for 3 days† Butoconazole 2% sustained release cream, 5 g single intravaginally application Clotrimazole 1% cream 5 g intravaginally for 7-14 days† Clotrimazole 100 mg vaginal tablet for 7 days Clotrimazole 100 mg vaginal tablet, 2 tablets for 3 days Miconazole 2% cream 5 g intravaginally for 7 days† Miconazole 100 mg vaginal suppository, 1 suppository for 7 days† Miconazole 200 mg vaginal suppository, 1 suppository for 3 days† Miconazole 1,200 mg vaginal suppository, one suppository for 1 day Nystatin 100,000-unit vaginal tablet, 1 tablet for 14 days † Tioconazole 6.5% ointment 5 g intravaginally in a single application† Terconazole 0.4% cream 5 g intravaginally for 7 days Terconazole 0.8% cream 5 g intravaginally for 3 days Terconazole 80 mg vaginal suppository, 1 suppository for 3 days Oral agent: Fluconazole 150 mg oral tablet, 1 tablet in a single dose

Answer 18

``` Recurrent VVC - 7-14d of topical therapy, OR - 100, 150, 0r 200mg oral dose of fluconazole (repeated 3d later) AND - Maintenance regimens Severe VVC - 7-14d of topical therapy - 150mg oral dose fluconazole (repeat 3d later Non-albicans - 7-14d non-fluconazole therapy - 600mg boric acid in gel capsule vaginally qd x14d Compromised Host - 7-14d topical therapy Pregnancy - Fluconazole is CONTRAINDICATED - 7d topical agents receommended ```

Answer 19

- Most common treatable STD - Risks: Multiple sex partners; Lower socioeconomic status; Hx of STD; Lack of condom use - Sexually transmitted - Females and males may be asymptomatic - Caused by trichomonas vaginalis (flagellated anaerobic protozoa) - Associated w/pre-term rupture of membranes/delivery; increased risk of HIV

Answer 20

- May be asymptomatic or vagintitis - Frothy gray or yellow-green vaginal D/C - Pruritus - Cervical petechiae ("Strawberry cervix") - May also infect Skene's glands or urethra (not susceptible to topical therapy in these locations)

Answer 21

- May cause non-gonococcal urethritis | - Associated with increased shedding of HIV virus

Answer 22

- Motile trichomonads seen on wet mount - Vaginal pH often >4.5 - Culture is the gold standard - Pap smear has low S&S - DNA probe - Rapid test

Answer 23

- 1st void urine concentrated * * Examine for motile trichomonads * * Culture - Urethral swab culture

Answer 24

``` 1st Line - Metronidazole 2g PO x 1 dose OR - Tinidazole 2g PO x 1 dose 2nd Line - Metronidazole 500mg BID PO x 7d Pregnancy - Metronidazole 2g PO x 1dose ```

Answer 25

- Reinfection is most common reason for failure * * Treat partners and avoid intercourse until both Tx are completed - If failure occurs w/single dose of metronidazole, use single dose tinidazole or metronidazole x7d - If failure occurs with either of these regimens, use tinidazole of metronidazole 2g PO x5d - If repeated Tx fails call CDC (Division of STD prevention)