inflammatory diseases of female vaginal tract

Question 1

ph of vagina

Answer 1

3.8-4.5 - acidity decreases

Question 2

most common causes of vulvovaginitis

Answer 2

1. bacterial vaginosis - most commn
2. candidiasis
3. trichomonias

Question 3

what commensal bacteria do we have in vagina

Answer 3

lactobacilli and corynebacterium which help. keep the ph acidic and stop overgrowth of other bacteria

Question 4

diagnosis for BV

Answer 4

AMSEL CRITERIA need 3/4

1. increased white non inflammatory discharge (not as much as candida)
2. clue cells on microscope
3. no leukocytes on micrscopy
4. ph >4.5
5. whiff test: fishy discharge after adding 10% KOH
6. pruritus and pain are uncommon

Question 5

tx bv

Answer 5

metronidazole and oral probiotics

Question 6

complications of bV

Answer 6

miscarriage, preterm labour , PID , vaginal cuff cellulitis

Question 7

risk factor for candiadisas

Answer 7

pregnancy
oral contraceptives - changing your hormone balance
freuquent STDS
syatemic antibiotic treatment
increased PH
TIGHT FITTING UNDERWEAR - increases moisutre, temp, humidity
anything that decreases your glycogen store- DM, pregnancy,

Question 8

symptoms of candidiasis AND DIAGNOSIS

Answer 8

leucorrhoea- whitish clear milky discharge
severe pruritis NB
dysuria
dyspareunia
sometime unsual odour
vulval vaginal erythema
white crumbly stick discharge (cottage cheese_ typically odourless - NB

budding yeats, hyphae and pseudophyphae on microscopy

Question 9

tx candida

Answer 9

candida like sazoles like clotrimazole or nyatsin but azole are CI in pregnancy . males per os is enough no need for topical

Question 10

diagnosis of trichomoniasis

Answer 10

strawberry cervix - pathognomic but only seen in 20% of people

microscopy but can be negative so culture
ph of vagina will be more than 4.5

Question 11

trichomoniasis

Answer 11

discharge varies - frothy, yellow greenish or purrelent

producing more discharge than normal, which may also have an unpleasant fishy smell.
soreness, swelling and itching around the vagina – sometimes the inner thighs also become itchy.

Question 12

tx trichomanios

Answer 12

metronadizole for partner too

Question 13

gential herpes

Answer 13

involves the cervix 80%
begin as fluid filled vesicles that become ulcers (ulcers make it difficult to urinate)
After the initial infection, the virus lies dormant in your body and can reactivate several times a year.

There’s no cure for genital herpes, but medications can ease symptoms and reduce the risk of infecting others. Condoms also can help prevent the spread of a genital herpes infection.

During an initial outbreak, you may have flu-like signs and symptoms such as swollen lymph nodes in your groin, headache, muscle aches and fever.

Question 14

diagnosis of atrophic vaginaitis

Answer 14

pap smear

Question 15

key words to describe

Answer 15

epithelium is thin inflammed and ulcerated

Question 16

tx atrophic vaginitis

Answer 16

topical estrogen creams or vaginal tablets OR HRT but not recommended if its just for atrophic vaginitis and also has a lot of CI

Question 17

VAGINAL FOREIGN BODY

Answer 17

Any foreign body left in the vagina >48hrs  severe localised infection due to E.coli
anaerobes or vaginal flora overgrowth
 Clinical picture: foul smelling discharge with/without blood
 Treatment: removal of foreign body

Question 18

tx chlamydia

Answer 18

doxycline for 7 days 2x 100mg or azithrmycin

Question 19

diagnosis of chlamydia

Answer 19

CERVICAL SWABS! vaginal secretions may not be enough

Question 20

PID SYMPTOMS

Answer 20

pelvic pain lower abdominal pain 
discharge 
dyspearunia 
bleeding in betwene periods 
fever