Benign and Malignant Vaginas Flashcards
Presentation of a patient with Bacterial Vaginosis (BV).
Gray/White thin vaginal discharge Fishy smell Usually no pruiritis, patients complain because of the odor and discharge
What are the obstestric risks of BV?
PROM premature delivery chorioamnionitis W/ C-sections, increased risk of endometritis
What is the GYN risk of BV?
cuff cellulitis (inflammation of the upper vagina) in post-hysterectomy patients
How is BV diagnosed?
Vaginal pH greater than 5 Clue Cells on microscopy: vaginal epithelial cells that have irregular borders because of they are covered in bacteria Sniff/Whiff test: fishy smell of KOH prep
Best treatment for BV.
Oral Metronidazole (flagyl) -500mg BID for 7 days (less effective is the 1-one 2 gram dose)
What does a physician need to remind a patient to avoid while taking metronidazole.
No alcohol (disulfuram reaction makes patients sick)
Should the patient’s partner be treated for BV as well?
Only if the patient is getting recurrent BV cases.
How does a patient present with candidiasis?
Odorless “cottage cheese” vaginal discharge Vulvar irritation w/ burning on urination
Most common cause of candidiasis.
Broad Spectrum antibiotic use
How is candidiasis diagnosed?
KOH prep shows hyphae
What is the treatment for Candidiasis?
Synthetic Imidazoles (all creams except for fluconazole, but fluconazole is only effective against 1 of the 3 strains)
What are two special cases that influence treatment of Candidiasis?
Pregnancy: treatment requires longer regimen Diabetic Vulvitis: antifungals alone don’t fix the problem. Must also correct blood sugar levels
Presentation of a patient with Trichomonas.
Yellow/gray frothy vaginal discharge Malodorous Strawberry cervix with vaginitis or cervicitis
How is Trichomonas vaginalis diagnosed?
Wet mount shows flagellated protozoans
What is the treatment for Trichomonas vaginalis?
Oral Metronidazole (all regimens equally effective) The partner should definitely be treated in this instance
Number one cause of Pelvic Inflammatory Disease (PID) and why?
Chlamydia -very insidious onset, inflammation and damage to tissue occur before symptoms start.
Treatment of choice for Chlamydia trachomatis
Azithromycin: 1g in 1 dose
What are complications of Chlamydia infection?
Fitz-Hugh-Curtis Syndrome: the PID starts to ascend thru the peritoneal cavity and cause inflammation. The inflammation causes fibrosis and adhesions to abdominal cavity organs like the liver adhereing to parietal peritoneum.
Also can cause ectopic pregnancy due to uterine tube fibrosis.
How do you treat newborns when the mother had a chlamydia infection?
Erythromycin ointment to newborn’s eyes
Top two causes of prepubertal vaginitis.
- Bubble Bath
- Foreign Body
(if caused by infection, suspect sexual abuse)
Most common cause of post-menopausal vaginitis.
Estrogen deficiency leading to atrophic vaginitis
Treatment for atrophic vaginitis.
Local estrogen cream
Presentation of a patient with Herpes Genitalis
with initial episode: Very painful urination, urethritis, urinary retention, patients are miserable. Labia may fuse from inflammation.
Treatment for Herpes Genitalis
Valacyclovir (prodrug)
Acyclovir
(oral treament is better than topical)
What is the management strategy in a patient that goes into labor with active Herpes lesions?
C-section to prevent infection of the newborn.
Presentation of a patient with HPV
Condyloma Acuminata (genital warts)
If warts are seen, do a pap smear and culposcopy.
Treatment for Condyloma Acuminata
Laser vaporization, cryotherapy, 5-FU ointment
Treatment for any Bartholin gland pathology.
Incise and drain
Gland excision
Marsupialization (cutting into the abscess or cyst and stitching the ends together to create a continuous surface)
Name the 3 types of vulvar neoplasia and how to distinguish each.
- Vulvuar Dystrophy
- Vulvar Intraepithelial Neoplasia (VIN)
- Vulvar Squamous Cell Carcinoma
Must do a biopsy to differentiate
Treatment for benign vulvar dysplasia.
Medium Strength Topical Corticosteroids
What is Lichen Sclerosis?
Form of vulvar dysplasia that results in hyperkeratosis (patches of white thin parchment on the skin on and around the genitals)
Treatment for Lichen Sclerosis
Potent Steroid Clobetasol
What are the two forms of VIN?
Paget’s Disease: post menopausal, red/pink pathces of hyperplastic skin
Carcinoma in situ (CIS): any age, lots of color changes (red, pink, brown), pruritic
What is the rule with the two types of VIN (and most other unusual vulvar growths)?
If it doesn’t go away, biopsy it
Describe the five (0-4) stages of Vulvar Squamous Cell Carcinoma
0: carcinoma in situ
1: lessions less than 2cm
2: lesions greater than 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
Treatment for Vulvar Squamous Cell Carcinoma
Classical Radical Vulvectomy (or a modified version)
