Benign and Malignant Diseases -Beaton Flashcards
What is the most common vulvovagintis seen
Bacterial vaginosis
name the 4 types of bacterial vaginosis
- non-specific vaginalis
- gardnerella vaginalis
- haemophilus vaginalis
- corynebacterium vaginalis
what the s/s of bacterial vaginosis
- homogenous THIN discharge
- White/grey discharge
- “fishy” amine smell (especially with a change in pH)
- NOT pruritic
What can cause a change in vaginal pH
sex and period
What are the OB risks of bacterial vaginosis
- PROM
- premature delivery
- chorioamnionitis
- C-section
If you have bacterial vaginosis and have a C-section what are you at risk for
6x risk of post-cesarean endometritis
What is a GYN risk in presence of B.V
increased risk of vaginal cuff cellulitis in post-hysterectomy
How do you diagnose B.V
- discharge
- vaginal pH >5 (becoming less acidic)
- Clue cells
- sniff and whiff test –> 10% KOH added to discharge emits fishy, amine smell
what is clue cells
wet smear of epithelial cells with large # of bacteria on cells surface
-obscuring cell borders –> fuzzy cells
What methods can B.V be treated with
oral and topical
What oral meds treat BV
metronidazole
500mg BID for 7 days (Preferred) OR
2 grams single dose (less effective)
what should you avoid while taking metronidazole, why
alcohol; d/t disulfuram-like rxn –> makes you very sick
What topical treatments are used for BV
-Clindamycin cream 2%
once before bed for 7 days
-metronidazole vaginal gel
once before bed for 5 days
How should the partner of BV pt be treated
oral metronidazole simultaneously in recurrent cases
What is the 2nd most common vulvovaginitis
candidiasis
aka monilial vaginitis
what are the 3 causative agents of candidiasis
candida albicans
candida glabrata
candida tropicalis
what are the s/s of candidiasis
- THICK discharge
- white, cottage cheese, or curdish
- odorless OR “yeasty”
- Vulvar irritation
what symptoms are involved with vulvar irritation
erythema, intense pruritis, swelling of the vulvar
- can cause burning on peeing
what condition can candidiasis s/s be confused with
Herpes d/t the pain
How do diagnose candidiasis
10% KOH added to wet smear reveals HYPHAE under the microscope
what is the most COMMON pre-disposing factor of candidiasis
Broad -spectrum antibiotics
what are the other pre-disposing factors of candidiasis
- corticosteriods
- oral contraceptives
- Diabetes
- Pregnancy
- TIght fitting clothes - moisture/heat
how do you treat candidiasis
cream and oral
what are the different creams that can be used for candidiasis
butoconazole terconazole tioconazole clotrimazole miconazole
what is the oral treatment for candidiasis
Fluconazole (1x dose)
what is the drawback for using just Fluconazole
its only effective against 1 of 3 species therefore it should be given with a cream too.
How do you treat a preggers with candidiaiss
same treatment BUT requires a longer treatment regimen
how do you treat a diabetic with candidiasis
you give the antifungals BUT you need to control their blood sugar or else the s/s won’t clear
are candidia and BV infections
Nope; they are common inhabitants of the vagina and usually “in balance”
So how does a person get one or the other (bv, candidiasis)
its usually a result of an imbalance and an overgrowth of one as compared to the other
Does treating candidiasis and BV totally eradicate them from the body
Nope; it just regresses the overgrowth so that it can go back to “checks and balances”
True/False; Trichomonas vaginalis and Chlamydia trachomatis are both true infections and STI
True
What are the s/s of Trichomonas vaginalis
- yellow -grey frothy discharge
- malodorous
- possible inflammation of vagina and cervix
strawberry cervix can be seen in what
Trichomonas vaginalis
how do you diagnose Trichomonas vaginalis
flagellated trichomonads on wet mount
how do you treat Trichomonas vaginalis
metronidazole
250mg TID for 7 days OR
500mg BID for 7 days OR
2 g 1x dose
all of the above have have equal effectiveness
can you treat Trichomonas vaginalis with creams too
NOPE! just oral therapy
when should the partner be treated
at the same time
What is the #2 most common STD
Chlamydia trachomatis
what is the #1 cause of PID
Chlamydia trachomatis
Chlamydia trachomatis can also commonly cause …
acute salpingitis
what is the associated syndrome with Chlamydia trachomatis
Fitz-Hugh-Curtis Syndrome
what is Fitz-Hugh-Curtis Syndrome
peri-hepatitis, liver capsule adhering to parietal peritoneum
aka “banjo string adhesion”
can Chlamydia trachomatis be transferred to a newborn
YES! law requiring erythromycin ointment application to newborn eyes
What is a symptom for Chlamydia trachomatis
mucopurulent cervicitis - a little more moisture than normal, often unnoticed
how do you diagnose Chlamydia trachomatis
culture specific for chlamydia
Increased of post-partum and post-C-section endometritis
Chlamydia trachomatis
how do you treat Chlamydia trachomatis
Azithromycin (TOC) 1g x1 dose
All other Tx is 7-10 days
Tetracyline
Doxycycline (2nd TOC) - less irritation of GI
Erthromycin
What is the most common cause of prepubertal vaginitis
allergic rxn to bubble bath #2 is forgein objects
if the culture comes back positive for GC, chlamydia or mycoplasma for prepubertal vaginitis what must be considered
sexual abuse
how should the culture be taken for prepubertal vaginitis
with a q-tip, not a speculum
what is the primary cause of post-menopausal vaginitis
estrogen deficiency (atrophic vaginitis)
How do you treat post meno vaginitis
replace estrogen (oral or topical)
acquired by sexual contact with someone with a reactivation of recurrent infection
The herps (herpes genitalis)
Type 1 and Type 2 are generally categorized how
Type 1 - oral
Type 2 - genitals
What are s/s of initial episodes of herps
pain, burning with peeing, urethritis, possible urinary retention
-flu sympt
What will a primary herpes genitalis infection have
a vesicle full of viral particles with a red ring around it
what is a complication Beaton talked about with herpes genitalis
labia may fuse from inflammation if desquamation occurs
When does recurrent herpes outbreaks usually occur
common with stress or immune system suppression
herpes is known for its prodrome, what s/s is it
burning or tingling felt by 60-70% of people at site of recurrence
-then lesion appears 1-3 days after
how do you diagnose herpes
viral culture for herpes
how do you treat herpes
valacyclovir or acyclovir (oral tabs) will reduce s/s and length of healing time BUT will not cure herpes
what is better for herps, oral or topical
oral is way better
What else is going to help with reducing s/s of herps
boost immune system, rest, nutrition, reduction of stress
What are the 3 treatment alternative approaches
episodic, suppressive, and prophylactic
what do you do when herps is episodic
treat when recurs
what do you do to suppress herps
LONG TERM daily LOW DOSE Tx
-reduce recurrence
What do you do as prophylaxis of heprs
SHORT TERM daily LOW DOSE Tx
-reduce outbreaks during anticipated stressful times
what do you do for preggers how have herps
C-section if active lesions at time of labor
what is the #1 STD
HPV
HPV is a causitive agent for what infection
Condyloma acuminata (genital warts)
HPV is also considered an agent in some cases of what
vulvar intraepithlelial neoplasm (VIN)
what needs to be done when Condyloma acuminata is obseverd
pap smear with culposcopy of vulva, vagina, and cervix
how do you treat HPV (im assuming he talking Condyloma acuminata )
laser vaporization cryotherapy 5-FU- tpoical trichloroacetic acid bichloroacetic acid 25% podophyllin
Regardless of Tx of Condyloma acuminata, what is the recurrence rate
20%
How do you Tx Bartholin’s gland
incise and drainage
marsupialization
gland excision
AND if infection is present –> antibiotics
what is marsupialization
incision in abscess to drain and also suture around the opening to keep it open, so it can continuously drain
what are some characteristics of vulvar neoplasm
- hyperplastic OR atrophic lesion
- most COMMON –> persistent itch
- but maybe asymptomatic (stupid)
Name three vulvar neoplasia
vulvar dystrophy
vulvar intraepitheial neoplasia
vulvar squamous cell carcinoma
is vulvar dystrophy benign or malignant
Benign
- however foudn to have potential to become CA (again stupid)
vulvar dystrophy is hyperplatstic, why
mostly d/t local irritation
-raised, erythematous lesion with thickened keratin epithelial d/t acute insult
how do you treat vulvar dystrophy
topical corticosteriods
what is a type of vulvar dystropy mentioned in lecture
lichen sclerosis
unknown etiology
what are the s/s of lichen sclerosis
thin, parchment like skin, itchy**
how do you treat lichen sclerosis
potent steroid Clobetasol
what do you do if tx doesnt work for lichen sclerosis
Biopsy
is vulvar intraepithelia neoplasm (VIN) benign or malig
pre-malignant? (soooo yes?)
if these vulvar crap doesn’t go away with Tx, whats the next step
BIOPSY
name 2 types of VIN
paget’s disease and vulvar CIS
Everything about Paget’s disease, go!
post-meno
red/pink w/ patches of hyperplastic white
looks like severe candidiasis
what is the most common VIN
Vulvar CIS
EVerything about vulvar CIS, GO!
happens at ANY AGE
various colors (red, pink, brown, white)
pruritic
how is malignancy of vulvar squamous cell carcinoma dealt with
usually sent to gyn oncology
what s/s is present 50% of the time for vyvlar squamous cell
long term pruritis or a lump/mass of vulva
how is vulvar squamous cell carcinoma staged
0 Carcinoma in situ
1 Lesions < 2 cm
2 Lesions > 2 cm
3 Involves anus, LOWER urethra, vagina, and/or unilateral inguinal nodes
4 Involves UPPER urethra, bladder, rectal mucosa, bilateral inguinal nodes or distant sites
how vulvar squamous cell carcinoma treated
- classical radical vulvectomy
- modified radical vulvectomy (via 3 incision apporach)
- lower morbidity, lower wound breakdown
