Infections Flashcards
What causes bacterial vaginosis?
overgrowth of commensal anaerobic microorganisms and loss of normal vaginal lactobacilli.
Most common organism for BV
Gardnerella vaginalis is the most commonly implicated organism
RFs for BV
Multiple sexual partners
Intrauterine device
Smoking
Douching
Presentation of BV
Offensive vaginal discharge (commonly described as having a fishy odour)
Homogenous off-white discharge
Investigations for BV
Bedside
Microscopy of Vaginal Discharge :
Amsel Criteria
Vaginal pH > 4.5
Typical Discharge
Clue Cells
Positive Whiff-Amine Test
What is Amsel criteria?
Vaginal pH > 4.5
Typical Discharge
Clue Cells
Positive Whiff-Amine Test
Management of BV
Reduce exposure to precipitants (e.g. vaginal douching, bubble baths, shampoos)
1st Line: Oral Metronidazole 400 mg BD for 5-7 Days
If concerns about compliance: a single oral dose of 2 g metronidazole can be used
If topical treatment preferred: intravaginal metronidazole gel 0.75% OD for 5 days or intravaginal clindamycin cream 2% OD for 7 days
Alternative oral options: clindamycin and tinidazole
1st line management for BV
1st Line: Oral Metronidazole 400 mg BD for 5-7 Days
Cause of Trichomoniasis
Vaginal infection caused by Trichomonas vaginalis (flagellate protozoan) that is usually sexually transmitted.
Presentation of trichomoniasis
Foul-smelling, frothy green-yellow vaginal discharge
Vulval itching and discomfort
Dysuria
Abdominal pain
Balanitis in men
What colour discharge in trichomoniasis?
Foul-smelling, frothy green-yellow vaginal discharge
Investigations for trichomoniasis
Bedside
Speculum Examination
Strawberry cervix appearance (only present in the minority of cases)
High Vaginal and Endocervical Swabs
Microscopy will reveal motile trichomonads
Full STI Screening
What will be seen on speculum examination in trichomoniasis?
Strawberry cervix appearance (only present in the minority of cases)
strawberry cervix
trichomoniasis
What is seen on high vaginal and endocervical swabs in trichomoniasis?
Microscopy will reveal motile trichomonads
Management of trichomoniasis
1st Line: Oral Metronidazole 400-500 mg BD for 5-7 days
Alternative: Metronidazole 2 g STAT or tinidazole 2 g STAT
NOTE: this is not recommended if the patient is pregnant or breastfeeding
Offer treatment for current partner(s) and any partners from the 4-week period prior to presentation
1st line management of trichomoniasis
1st Line: Oral Metronidazole 400-500 mg BD for 5-7 days
RFs for vulvovaginal candidaias
Pregnancy
Immunosuppression
Poorly-controlled diabetes
Presentation of vulvovaginal candidiasis
Vulval itching and irritation
Thick, white vaginal discharge
Investigations of vulvovaginal candidiasis
High Vaginal and Endocervical Swab
Vaginal pH
Conservative management of vulvovaginal candidiasis
Use simple emollients as soap substitutes to wash the vulval area
Avoid contact with potentially irritant soaps
Avoid vaginal douching
Avoid wearing tight-fitting and/or non-absorbent clothing
Antifungal treatments for vulvovaginal candidiasis
1st Line: Fluconazole 150 mg PO STAT
2nd Line: Clotrimazole 500 mg intravaginal pessary STAT
1st line treatment for vulvovaginal candidiasis
1st Line: Fluconazole 150 mg PO STAT
What antifungal treatment if primarily vulval symptoms in vulvovaginal candidiasis?
If primarily vulval symptoms: consider using topical imidazole (e.g. clotrimazole 1%) in addition to an oral or intravaginal antifungal
