C 20 Vaginitis Flashcards
3 categories of vaginitis:
- hormonal
- irritant
- infectious
hormonal vaginitis aka atrophic vaginitis
found in postmenopausal or postpartum women, occasionally in young girls before puberty.
Irritant vaginitis
due to allergies to substances such as latex in comdoms, spermicides, deodorant, soaps, perfumes, semen , or douches. may also be due to hot tub, mechanical abrasion, sanitary napkins, tampons, toilet tissue, or topical medications.
MOST vaginitis due to vaginal infection.> 90% vaginitis is caused by
bacterial vaginosis, candidiasis, or trichomoniasis. less common infectious causes of vaginitis : gonorrea, chlamydia, mycoplasma, campylobacter, even parasites like pinworms and giardia.
vaginitis is often a disorder of imbalance of normal vaginal flora. many of organisms that are responsible for vaginitis like gardnerella, mycoplasma, staph, E coli and candida are naturally occuring in healthy vagina.
these organisms only become problematic when the DELICATE balance of beneficial bacteria like AEROBIC LACTOBACILLUS is disrupted.
factors that may adversely affect this balance by reducing lactobacilli population such as
lubricants, nonoxynal-9 (spermicide), oral contraceptives (OCs), hormonal changes, and antibiotics.
to properly treat vaginitis and avoid potential treatment complications, it is essential to know the exact diagnosis
true
Bacterial Vaginosis
most common cause of vaginal infections and abnormal vaginal discharge and odor. it can also be one of the infections most resistant to treatment.
Bv consists fo significant polymicrobial overgrowth. it is result of alterations in vaginal ecosystem, rather than an infection caused by any single microorganism
true
BV is characterized by decreased or absent lactobacillus species and increased concetrations of potentially pathogenic bacteria. other characteristics include:
elevated pH >4.5 formation of clue cells odor due to increased vaginal fluid concentrations of diamines, polyamines organic acids.
3 main factors that are responsible for decline of lactobacilli and consequential BV:
- intercourse without condoms: sperm alkalinizes vagina, which depletes lactobacilli
- douching, which also depletes lactobacilli
- the absence of the kind of lactobacilli that produce peroxide. broad-spectrum antibiotics can also eliminate healthy vaginal lactobacilli.
hispanic women 50% more likely than caucasian women to develop BV and African American women twice as likely as caucasian women to have BV. reason?
not clear, may be due to less condom use in hispanic women and increased douching in african american women
potential consequences of untreated or undertreated BV. bacteria can migrate into the uterus and the upper genital tract and cause PID in a minority of women who have infection. BV can cause premature rupture of membranes and premature labor, and it is responsible for 70-80% of all perinatal deaths.
true
goal of treatment is to restore vaginal ph to less than 4.5 and reestablish normal vaginal ecology.
true
if pH remains greater than 4.5 following treatment, more aggressive use of lactobacillus and/or vaginal __ suppositories should be utilized
boric acid.
the first follow up should occur after designated treatment time of 7-14 days then again in one month
true
women who have recurrent BV following intercourse may need to
- use condoms or
2. consider having sexual partner treated at the same time.
candida vaginitis. only __ of vaginitis cases are in fact VVC
33%
it encompasses a broad range of issues, ranging from those who have colonization of yeast but are asymptomatic to those who have frequent, recurrent, and symptomatic episodes.
true
candida albicans is the most common cause of VVC. organism identified in 85-90% of positive vaginal yeast cultures. there are infections with nonalbicans species such as
C. glabrata,
C. tropicallis
C. krusei
of VVC cases due to nonalbicans species is increasing and rose from 9.9% in 1988 to 17.2% in 1995. due to increased use of otc treatment medications and that nonalbicans species are becoming less and less suseptible to these agents.
true
self diagnosis of VVC is unreliable. often results in misdiagnosis.
true
recurrent VVC an be dangerous as the underlying condition could go undiagnosed because woman is repeatedly treating what she thinks are simple vaginal yeast infections. Recurrent VVC commonly affects women who are immunocompromised as ar esult of
aids diabetes cushing's disease addison's isease hypothyroid / hyperthyroidism leukemia. other predisposing factors in recurrent infections: 1. high estrogen medication 2. antibiotics 3. hormones 4. contraceptive devices 5. cytotoxic drugs 6. immunosuppressive drugs 7. radiotherapy / chemotherapy 8. tight clothing 9. nylon underwear 10. pregnancy 11. excessive sugar in the diet.
first step in the physical evaluation is to determine if there is a vulvitis:
inflammation of external genital tissue and or vaginitis. some women may have vulvar hyperplasia (proliferative cell growth)
vestibulitis
inflammation of the tissue surrounding the opening to the vagina.
a thorough exam of external genitalia involves looking for
- erythema
- hypopigmentation
- hyperpigmentation
- fissures
- vesicles
- ulcerations
- thinning, and thickening.
diagnosis of VVC made in office by using
10% potassium hydroxide (KOH) and microscopy that demonstrates features of yeast.
another diagnostic tool is pH paper.
vaginal pH of <4.5 helps to exclude bacterial vaginosis, trichomoniasis, atrophic vaginitis, or a mixed bacterial/yeast infection.
it cannot be overemphasized how the health of the entire body affects the internal ECOSYSTEM of the vagina. the VAGINAL PH and MICROFLORA, the HORMONAL CYCLES, and the VAGINAL IMMUNE tissue are all influenced by our general health and dietary habits. a healthy diet assurs our body’s defense system. a diet LOW in sugars and refined carbohydrates is particularly important in preventing candida vaginitis.
true.
some women who have severe, stubborn cases of chronic candida vaginitis may benefit from STRICTER diets that avoid fermented foods
HOWEVER; many anticandida diets can be rigorous and unnecessarily stressful. some of these diets are so restricted that they actually cause other health problems.
SYSTEMIC candida
describes situation when candida contaminates the blood stream and spreads throughout the body causing profound illness affecting a wide variety of organ systems. ONLY occurs in seriously immunocompromised patients such as HIV + INDIVIDUALS.
prevention of candida vaginitis:
- avoid wearing tight clothing
- avoid wearing pantyhose
- use condoms to prevent all types of vaginitis and maintain normal PH in vagina
- eat whole foods diet with vary little to no sugar and refined carbs
- determine possible allergies to food, pollen, clothing detergent, and semen for recurrent cases
- determine possible infection with other organisms for recurrent cases.
- increase intake of acidophilus yogurt and/or take lactobacillus supplements, especially when using antibiotics.
- vaginal estrogen may be necesesary to maintain acidic vaginal environment in postmenopausal women.
Trichomonas Vaginalis
motile, flagellate, anaerobic protozoan, and si far more prevalent sexually transmitted infection than either chlamydia trachomatis or neisseria gonorrhoeae.
trichomoniasis is associated with several significant health consequences, including
transmission of HIV, infertility, aytpical pelvic inflammatory disease (PID), increased risk of postop infection, preterm births, and cervical dysplasia.
pregnancy adverse effects: premature rupture of membranes, low birth weight infants.
Vitamin E. intravaginally and topically.
Intravaginal suppository or gelatin capsule qd or bid x 7 days or more.
vitamin E provides a very soothing effect. the tissue becomes less irritated with a decrease in redness, swelling, and congestion. Vitamin E relieves burning and itching within 1-3 days of use. it can be adminstered as a suppository or from a GELITIN CAPSULE that is inserted into the vaginal ONCE or TWICE daily for seven or more days.
Vitamin E oil or ointment can also be applied externally or to vulvar tissue to relieve discomfort there. useful in cases of allergic and irritant-induced vaginitis because it is so soothing.
Vitamin C adminstering 250mg vitamin C vaginally for 6 days significantly improves both subjective and objective parameters of vaginitis, like eradicating bacteria and clue cells, increasing lactobacilli, and lowering pH.
insert 250mg vitamin C tablet in the vagina for 6 days.
Vitamin A and beta carotene.
intravaginal suppository or gelatin capsule once daily x 7 days. use vitamin E, daily for 1 week before repeating this dosage.
both necessary for normal healthy growth of epithelial tissues that make up vaginal mucosa.
Boric Acid - most successful natural treatment for VVC.
ACUTE: 600mg vaginal suppositorities bid x 3-7days
CHRONIC: 600mg vaginal supp BID 2-4 weeks
PREVENTION: 600mg vag supp 4 days / month during menses for 4 consecutive months.
downside - if tissue has been irritated by infection, the boric acid may burn during urination. using vitamin E oil, lanolin, or vaseline on external genitalia protects tissue from boric acid and averts any significant discomfort.
