Chapter 21,22 Gynecologic Condition Flashcards
Vaginal pH normal
Dominant organism of vagina
What acid is produced in vagina
3.5-4.5
Lactobacillus
Lactic acid
Vaginitis
Inflammation of the vagina
increased vaginal discharge
increased WBC
Vaginosis
Not associated with wbc. Vaginal environment is altered.
Vulvovaginitis
Inflammation of vulva and vagina c/b vaginal infection and leukorrhea
Bacterial Vaginosis
s/s
speculum finding
vaginal wall color
Gardanella
Vaginal pH more alkaline
s/s: fishy odor , mild irritation, vulvular pruritic, postcoital spotting, irregular bleeding episode, vaginal burning, urinary discomfort
speculum: thin white, grey milky discharge
vaginal wall color: pale and pink
BV dx (Amsel criteria)
How much to diagnose
1) White thin,yellow vaginal discharge
2) ph >4.5
3) Positive whiff/KOH test (fishy)
4) Clue cell on microscopic exam
3/4 must be to diagnose
BV Medication Treatment (non pregnant)
Primary treatment
Treatment if you are allergic
what can tx weaken?
Metronidazole (Flagyl) 500 mg orally BID for 7 days
Metronidazole gel 0.75% one applicator (5g) vaginally bedtime for five days
Clindamycin cream 2% one full applicator (5 g) intra vaginally at bedtime for seven days
ALT: Clindamycin 300 mg PO BID for seven days
Clindamycin ovules 100 mg intravaginally once at bedtime for three days
Secnidazole 2 g oral granules in a single dose (sprinkled onto applesauce or yogurt)
Tinidazole 2 g orally once daily for two days
Tinidazole 1 g orally once daily for five days
Tx can weaken latex condom/contraceptive
BV Medication Treatment (pregnant)
Metronidazole (Flagyl) 500 mg orally BID for 7 days
Metronidazole (Flagyl) 250 mg orally TID for 7 days
Clindamycin 300 mg orally BID x 7 days
BV Med Tx RECURRENT
Retreat with original therapy
BV should partners be treated
NO
BV patients should be screened for
STI/HIV
What should you avoid when taking metrodinazole and tinladinozole?
Avoid alcohol 24/72 hours
Is VVC an STD?
NO
VVC pathogen
Candida albicans
VVC s/s
Discharge description
Vaginal pruritis
Thick, white, curdlike
Dyspareunia , vaginal irritation
Uncomplicated VVC
tx
Sporadic VVC , Mild to moderate
tx: Oral fluconazole 150 mg SINGLE DOSE
Complicated VVC
Recurrent, Severe VVC, non-albicans candidiasis
DM, immunocompromised
tx: oral fluconazole 150 mg every 72 hours 2-3 doses
Recurrent VVC
4 or more episodes in 1 YEAR
2 weeks topical therapy OR fluconazole THEN Fluconazole 150 mg weekly x 6 months
VVC topical therapy OTC
Topical clotrimazole , miconazole (Momistat)
Atrophic Vaginitis
what is a high risk of getting
Menopause (pre & post) and lactating
s/s: vaginal dryness, discharge, odor, urinary fequency, nocturia, UTI
dryness with intercourse
AV Speculum
Cervic
vaginal pH
small narrow speculum instrument
Cervical stenosis, petechiae on the cervix
pH >5.0
Vaginal maturation index test
Atrophic Vaginitis primary treatment
Low dose vaginal estrogen and can be used in breastfeeding females
Atrophic Vaginitis Vaginal estrogen therapy contraindications
high risk of what
breast ca******* , estrogen ca, liver dz, PE, DVT, use of vaginal estrogen
high risk of endometrial cancer
AV
Moderate to severe dyspareunia tx (SERM)
(OTR) ***
Ospemifine ( Osphena) 60 mg PO daily
DONT TAKE Fluconazole + Ketoconazole
Tamofixen & Raloxifene
AV
Decrease pain with sexual activity
Dehydroepiandrosterone (intrarosa)
Intravaginal suppository nightly 6.5 mg
Bartholin Duct Abscess
Abscess on Bartholin duct transport fluid become ducts
Ecoli, MRSA
Culture with I+D
Bartholin Duct Cyst
Management
Non tender swollen
Unilateral
No erythema
Mgmt: Cyst <2 cm no sx. Sits bath & NSAIDS
Bartholin Duct Abscess
Mass, tender, erythema, >5 cm swollen
Bartholin Duct Abscess MED TX
First Line
Second Line
First: BACTRIM****
Seconds: Amoxicillin, Doxycycline, Cefixime
Bartholin Duct Abscess Surgical TX (4)
In office:
Recurrent mass:
Cancer concern:
Culturing:
In office: Fistulation
I+D
Marsupialization: Recurrent mass
Excision of bartholin: Cancer concern
