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OB/GYN > Disorders of the Vagina and Vulva > Flashcards

Disorders of the Vagina and Vulva Flashcards

1
Q

Normal pH of vagina is what?

A

<4.5 (very acidic)

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2
Q

A vaginal pH 4.5 or higher is indicative of what?

A

infection (makes vagina alkaline)

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3
Q

What is the predominant normal vaginal flora?

A

Lactobacillus predominates

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4
Q

What does Lactobacillus produce?

A

produces hydrogen peroxide

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5
Q

Which vaginal infection is described below?

Gram negative obligate intracellular bacteria that lack the ability to
make it’s own ATP

Infects columnar epithelium

If untreated, up to 40% may develop pelvic inflammatory disease
(PID)

A

Chlamydia

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6
Q

C. trachomatis serotypes L1, L2, L3 cause this

Presents as inguinal or femoral lymphadenopathy in women

A self-limiting vesicle or papule sometimes forms

This is a systemic infection that, if untreated, can cause secondary
infection of the rectal or anal lesions which can lead to abscesses or fistulas

A

Lymphogranuloma Verereum

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7
Q

Which vaginal infection is described below?

Frequently asymptomatic

Mucopurulent cervicitis – angry, red congested cervix

Discharge indistinguishable from gonorrhea

Irregular bleeding (post coital)

Dysuria

A

Chlamydia

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8
Q

Is a test of cure required for chlamydia?

A

Unless erythromycin is used, test for cure is not recommended unless symptoms remain or
reinfection is suspected

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9
Q

Which vaginal infection is described below?

Gram negative intracellular diplococcus

Found in 20% of PID cases

Risk of transmission after one exposure is 70%

Emergence of antimicrobial resistant strains

A

Gonorrhea

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10
Q

What are the multiple methods that can be used to diagnose chlamydia?

A

Culture

Direct fluorescent antibody

Enzyme immunoassay (EIA)

Gen probe – swab

Nucleic acid hybridiziation testing

Nucleic acid amplification testing
(NAAT)

Urine screening

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11
Q

What is the treatment of choice for chlamydia?

A

Azithromycin 1 gm PO once

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12
Q

What is the treatment of choice for chlamydia in pregnant patients?

A

Azithromycin 1 gm PO once

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13
Q

There are concerns that gonorrhea may facilitate transmission of what?

A

HIV

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14
Q

Risk of transmission of gonorrhea after one exposure is what percentage?

A

70%

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15
Q

Which vaginal infection is described below?

Appear within 3-5 days of infection

Copious mucopurulent vaginal discharge in women, may be greenish-yellow

Cervix is inflamed and edematous with discharge from the os

May have purulent anal discharge

A

Gonorrhea

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16
Q

What are the multiple methods that can be used to diagnose gonorrhea?

A

Genital culture

Gen probe

Gram stain

Testing may be added to many liquid based pap smears

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17
Q

What percentage of gonorrhea cases have a co-infection of chlamydia?

A

30%

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18
Q

What is the treatment of choice for gonorrhea?

A

Aggressive therapy for suspected or confirmed

Ceftriaxone (Rocephin) 250mg IM once

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19
Q

Which vaginal infection is described below?

Vulvar erythema and edema

Itching

White, curdy discharge (cottage cheese)

A

Candidiasis

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20
Q

What organisms are responsible for vaginal candidiasis?

A

Candida albicans

Candida glabrata

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21
Q

What are the risk factors for candidiasis?

A

Antibiotic use

Pregnancy

OCP use

Consider screening for diabetes if recurrent

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22
Q

What is the gold standard of diagnosing candidiasis?

A

Vaginal culture

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23
Q

What is the treatment for vaginal candidiasis?

A

Fluconazole (Diflucan) 150mg PO x 1 dose, may repeat in 3 days if
symptoms persist

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24
Q

Which vaginal infection is described below?

Unicellular flagellate protozoan

Colonizes the urethra, vagina, Skene ducts

Non-sexual transmission is infrequent because large numbers of organisms are required to produce infection

A

Trichomonas

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25
Q

What is Trichomonas associated with?

A

Increased incidence of HIV
PID
Endometritis
Preterm birth/low birth weight
Premature rupture of the membranes

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26
Q

Which vaginal infection is described in the presentation below?

Profuse vaginal discharge - Frothy, green-ish in color, foul smelling at times

Swollen and tender labia minora

Dysuria

Dyspareunia

Vaginal itching

Vaginal and cervical erythema with multiple small petechiae

A

Trichomonas

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27
Q

What sign in a Trichomonas infection is found in 10% of cases?

A

Strawberry cervix

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28
Q

What is the gold standard for diagnosing Trichomonas?

A

Culture

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29
Q

What is the only FDA approved treatment for Trichomonas?

A

Metronidazole

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30
Q

Which vaginal infection is described below?

Common viral infection capable of causing superficial oral and vulvar
ulcerations or necrotic mass of the cervix leading to profuse vaginal
discharge

A

Herpes Simplex Virus

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31
Q

Which type of herpes infection is described below?

Causes most genital lesions

Genital recurrence likely

After primary infection - 1 outbreak – 90% within 1 year, 6 outbreaks – 38%, >10 outbreaks – 20%

A

HSV-2

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32
Q

Which type of herpes infection is described below?

Oral cold sores

Responsible for 10-15% of genital (80% of new genital infections)

Increasing among adolescents and young adults

Genital recurrence not likely

A

HSV-1

33
Q

HSV virus may be shed up to how long after lesions appear?

A

up to 3 weeks

34
Q

What are not effective at eliminating transmission of HSV?

A

Condoms

35
Q

What is a definitive test for HSV?

A

PCR testing

36
Q

Pregnant patients with known HSV-2 should be offered suppressive therapy started at how many weeks?

A

36 weeks

37
Q

In pregnant patients, what is recommended if herpetic lesions are identified at the time of labor, regardless of whether it is primary or recurrent?

A

C section

38
Q

Which vaginal infection is described below?

Caused by Treponema pallidum – spirochete

Spirochetes pass through intact mucous membranes and abraded skin

10-90 days later, a primary lesion or chancre appears

A

Syphilis

39
Q

Transplacental spread of syphilis may occur when during pregnancy?

A

at any time

40
Q

indurated, firm, painless ulcer with rolled borders

A

Chancre- - seen in primary syphilis

41
Q

How long does it take for chancre to heal in primary syphilis?

A

Heals spontaneously within 3-6 weeks

42
Q

Secondary syphilis develops in what time frame following untreated primary syphilis?

A

4-8 weeks

43
Q

Secondary syphilis resolves spontaneously in what time frame?

A

2-6 weeks

44
Q

Which stage of syphilis is described below?

Diffuse systemic spread hematogenously

Viral syndrome with diffuse lymphadenopathy - Fever, HA, fatigue, weight loss, muscle aches, patchy hair loss

Skin rash - Rough, red or brown lesions on palms and soles

Condyloma lata - Moist appearing patches, Highly infective, Broad-based and flat

A

Secondary syphilis

45
Q

Which stage of syphilis is described below?

Chancre- indurated, firm, painless ulcer with rolled borders, 10-60 days after infection

Penis, vulva, vagina, cervix, anus, lips, nose, nipple can be affected

Heals spontaneously within 3-6 weeks

Painless, rubbery, regional lymphadenopathy

A

Primary syphilis

46
Q

Which stage of syphilis is described below?

2-6 weeks following untreated secondary syphilis

No signs or symptoms of disease

Transmission during this stage unlikely except through blood or placental transfusion

A

Latent Syphilis

47
Q

Which stage of syphilis is described below?

Develops in 1/3 of untreated cases

Cardiac manifestations

Ophthalmic and auditory lesions

Gummas – lesions of bone and skin

Neurologic manifestations

A

Tertiary Syphilis

48
Q

Due to high risk of false positives, what is the preferred way to diagnose syphilis?

A

Must have two positive tests due to possible false-positives with the
non-treponemal tests (RPR and VDRL)

Common to screen with RPR and confirm with one of the other treponemal-specific tests

49
Q

What is the follow up schedule for patients treated for syphilis?

A

Quantitative VDRL titers and exams at 3,6 and 12 months

Abstain from sexual intercourse until all lesions are completely healed

50
Q

What is the DOC for treating syphilis?

A

Benzathin penicillin G 2.4 million units IM once

51
Q

Which vaginal infection is described below?

This is not an STD – can be due to a change in vaginal pH

Caused by polymicrobial change in vaginal flora

Anything that changes the pH of the vaginal

A

Bacterial Vaginosis

52
Q

What is the most common organism responsible for bacterial vaginosis?

A

Gardnerella vaginalis

53
Q

What are the Amsel criteria in gardnerella vaginalis?

A

Abnormal grey discharge

pH greater than 4.5 (normal is 3.2 to 4.5)

Positive “whiff” test

Presence of clue cells on saline wet mount (epithelial cells stippled with
bacteria)

54
Q

Which vaginal infection is described below?

Fishy vaginal odor especially after intercourse

Creamy grey-white or yellow vaginal discharge

Little or no vaginal irritation

Recurrence very common

A

Bacterial Vaginosis

55
Q

What factors can help prevent the recurrence of bacterial vaginosis?

A

Condoms

Longer treatment length

Prophylactic treatment

Acidify the vagina

Note: Treating partrer does not decrease recurrence

56
Q

Condition of the vulva involving thinning, dryness, and irritation of the mucosa

Tissue is dry, whitish, non-elastic

Found in situations of low estrogen

A

Vaginal Atrophy

57
Q

Vaginal epithelium is thin and more susceptible to what in atrophic state?

A

infection and trauma

58
Q

What are some signs and symptoms of vaginal atrophy?

A

Vaginal mucosa is thin with few or absent vaginal folds

Vaginal dryness

Dyspareunia (Lack of elasticity and dryness)

59
Q

Vaginal wall defects may result from what?

A

Childbirth and resulting injury to cardinal ligaments (main support structures of the uterus)

Weakening of pelvic structures with aging

Increased intra-abdominal pressure (obesity, repeated heavy lifting, chronic cough, etc)

60
Q

What is the most common cause of vaginal wall defects?

A

Childbirth

61
Q

What are the four types of vaginal wall defects?

A

Uterine
Anterior vaginal wall (Cystocele, Cystourethrocele)
Posterior vaginal wall (Rectocele, Enterocele (rectum + bowel)
Vaginal vault (post-hysterectomy)

62
Q

Uterus protrudes into the vagina

A

Uterine Prolapse

63
Q

Relaxation and descent of bladder into vagina due to weakening or
injury (childbirth) to pelvic fascia

A

Cystocele

64
Q

What are some signs/symptoms of a cystocele?

A

“something is bulging or falling out”

Incontinence

Frequent UTIs due to incomplete bladder emptying

May be asymptomatic

65
Q

Relaxation and descent of rectum posteriorly into vagina resulting
from injury and/or weakness of pelvic fascia

A

Rectocele

66
Q

What is the most common symptom seen with rectoceles?

A

constipation

67
Q

What are some signs/symptoms of a rectocele?

A

Most common symptom is constipation

“something is bulging or falling out”

Splinting - Patient will use thumb or toilet paper to apply pressure to posterior vaginal wall to help initiate defecation

68
Q

Posterior vaginal wall herniation at Pouch of Douglas (posterior culdosack)

Likely to contain loops of bowel (Can present as a bowel obstruction)

Typically high in vaginal vault - May be able to differentiate
this from high rectocele with rectovaginal exam

A

Enterocele

69
Q

Uncommon cancer

Accounts for only 5% of gynecological cancers

Primarily a disease of postmenopausal women

A

Vulvar Cancer

70
Q

What is strongly associated in women of younger ages, but not older
women with vulvar cancer?

A

HPV

71
Q

In cases of vulvar cancer, what is the presenting symptom in >50% of cases?

A

Pruritis

72
Q

What are the types of vulvar cancer?

A

Squamous Cell carcinoma

73
Q

What is the most common type of vulvar cancer?

A

Squamous Cell carcinoma
Malignant melanoma
Basal cell carcinoma
Carcinoma of Bartholin’s gland

74
Q

In vulvar cancer, what percentage of squamous cell cancers arise from labia minora or majora?

A

65%

75
Q

In vulvar cancer, what percentage of squamous cell cancers arise from clitoris or
perineum?

A

25%

76
Q

What is the second most common type of vulvar cancer?

A

Malignant melanoma

77
Q

~2-6% of vulvar cancers

Most commonly arise on labia minor or clitoris with a tendency
to spread toward the urethra and vagina

Raised, irritated, pruritic, pigmented lesion

A

Malignant melanoma

78
Q

Account for ~1% of vulvar cancers

Most are small elevated lesions with an ulcerated center and rolled edges

Found almost exclusively on labia majora

A

Basal cell carcinoma

79
Q

Account for ~1% of vulvar cancers

Because it is difficult to clinically differentiate a tumor of the
Bartholin gland from a benign Bartholin cyst, any woman >40
years old should undergo biopsy

Recurrence common

5 year survival rate is 65%

A

Carcinoma of Bartholin’s gland

OB/GYN (14 decks)

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