Disorders of the vulva, vagina and cervix

Question 1

Vulvar skin is think and wrinkled “cigarette paper appearance. Intense vulvar pruritis.
Tx?
what kind of cancer is associated?

Answer 1

Lichen Sclerosis

• stop itch scratch cycle with antihistamine at night, high potency topical steroids (ex. clobestasol propionate)
• refer to OBGYN for further eval
• *risk of squamous cell carcinoma

Question 2

Intense vulvar pruritus, mainly on labia majora, leathery thickened skin appearance.
Dx and Tx?

Answer 2

Lichen simplex chronicus

tx: oral antihistamines and topical medium potency steroids like betamethasone BID

Question 3

vulvar, vagina, and oral lesions, papules, itching, burning, postcoital bleeding. Inflammatory autoimmune disorder.
Dx and Tx?

Answer 3

Lichen Planus

tx: hydrocortisone foam (colifoam)

Question 4

triad:
-recurrent oral ulcers
-recurrent genital aphthae or ulcerations 
-uveitis
HLA-B51 allele

Answer 4

Behcet’s Syndrome

Question 5

Tx for Condyloma Acuminatum?

Answer 5

trichloroacetic acid, podophyllin, cryosurgery, laser, imiquimod %5 cream

Question 6

Herpes Simplex Virus (HSV) dx and tx?

Answer 6

dx: viral culture, PCR, Tzanck smear
tx: first episode - acyclovir 400 mg PO q 8 hrs x 7-10 days
recurrent- acyclovir 400 mg PO tid X 5 days

Question 7

Atrophic vaginitis tx?

• vaginal dryness, itching, burning, spotting, discharge, frequency, urgency, UTIs
• low estrogen, thin vaginal epithelium, pH elevated (5-7)

Answer 7

tx: topical
- premarin vaginal cream 0.5 g per vagina QD x 3 wks
- estrace vaginal cream
- vagifem tablets

Question 8

Itchy, red crusted lesions on the labia majora, may have a superficial white coating “cake icing”. Diagnosis and treatment?

Answer 8

Paget disease of the vulva

-refer to GYN for biopsy may be associated with in situ adenocarcinoma in the vulva or perianal region

Question 9

Vulvovagial candidiasis
-90% caused my candidiasis albicans
-NOT sexually transmitted
-itching, cottage cheese discharge, pH of 4.5 or >, 
Tx and gold standard diagnosis?

Answer 9

dx: Vaginal culture
-may see budding hyphae on KOH prep
tx: fluconazole 150 mg PO single dose
clotrimazole 1% topical cream x 7-14 days
nystatin 1 tab qd x 14 days

Question 10

Amsel criteria for BV? Need 3 out of 4

Answer 10

1) abnormal gray discharge
2) ph > 4.5
3) + whiff test
4) presence of clue cells should be more than 20%

Question 11

Eversion of columnar epithelium onto the ectocervix, cervix appears red, glandular and inflamed, benign but must rule out cervical cancer. Diagnosis?

Answer 11

Ectropion