Lecture 8- PapSmear/ Vulvovaginitis Flashcards
What is when cells are scraped from the cervix and examined under a microscope to check for cancer or other problems ?
Pap smear
What age should women get a pap smear?
21 and older
Do women with a total hysterectomy need a pap smear?
No as long as it wasn’t done as treatment for cervical pre-CA or CA
Is a Pap Smear a diagnostic test?
No- it is only screening
What is a diagnostic test to get a tissue biopsy to confirm the findings of the pap smear?
Colposcopy
Testing for what other conditions can also be obtained if the Pap is liquid based?
Gonorrhea and chlamydia
When can paps normally be stopped?
After age 65 with a normal history
Most HPV infections clear the immune system within how many months?
24-36 months
how many subtype of HPV are there?
More than 100
What are the 2 most high risk strains of HPV?
16 and 18 cause 2/3 of cervical cancer
how long does it take for invasive cervical CA to develop after detection of a precancerous state (CIN2/3)?
average of 10 years
What can increase the risk of getting HPV?
Multiple sexual partners Engaging in intercourse at a young age Multiparity Immunodeficiency Smoking
What does ASC-US stand for?
Atypical squamous cells of undetermined significance
what is the advantage of testing for HPV over 30?
Immune system isn’t as robust, most susceptible to infection
What does the HPV vaccine have?
viral like particles which lack viral genetic
material and are non-infectious.
What does CIN stand for?
Cervical intraepithelial neoplasia
What 2 strains are most commonly associated with genital warts?
Types 6 and 11
What are encapsulated HPV virons expressed as morphologically?
koilocytes
What are the two types of cervical epithelium?
Columnar (glandular)
Stratified non-keratinizing squamous epithelium
Where do most neoplasms arise?
Squamocolumnar Junction (SCJ)
What is the are b/w the original SCJ and teh active SCJ (area of squamous metaplasia)
Transformation Zone (TZ), area most vulnerable to oncogenic changes
What is a cyst that happens when glands within the columnar epithelium becomes trapped causing these cysts.
Nabothian Cysts
What does LGSIL stand for?
Low grade squamous interepithelial lesions
what determines the grade and extent of the lesion
colpo (coloposcopy)
What are options for abnormal pap results?
Repeat Pap in 6 months (for low grade)
HPV testing (already done with reflexive testing)
Colposcopy (most common(
Endocervical curretage (ECC)
If there is a ASCUSC with negative HPV what should you do?
Repeat Pap in 1 year
Where are glandular cells located?
Endocervical canal
What do AGC stand for?
Atypical glandular cells
What could AGC indicate?
Uterine, fallopian tube, glandular cancers
or could be CIN (mis-identified)
What should be done after an AGC comes back?
Colpo
Endocervical sampling
What are excisional treatments for CIN? (most common)
Cold-knife cone
LEEP
LLETZ (laser conization and electrosurgical needle conization)
WHat are some ablation techniques for CIN? (not as common)
cryotherphy
Laser ablation
Electrofulguration and cold coagulation
After treatment for noninvasive abnormalities how often should a Pap be done?
Every 6 months for 2 years
What are the two major types of cervical cancer?
Squamous cell and adenocarcinoma
What is the most common form of cervical cancer?
Squamous cell
What is the good bacteria in the vagina? Formed after puberty.
Lactobacilli
What do lactobaccili break down glycogen to to keep the vagina acidic?
lactic acid
What give vaginal secretions a white to off-white color?
Exfoliated squamous cells
What is a polymicrobial infection characterized by a lack of H2O2 producing lactobacilli and an overgrowth of facultative anaerobic organisms.
Bacterial vaginosis (BV)
What are common symptoms of bacterial vaginosis (BV)?
discharge, odor that gets worse after intercourse
What will the discharge smell like with bacterial vaginosis (BV)?
musty of fishy odor because of bacteria producing amines
What is a way to test for BV?
Drop KOH on swab with vaginal discharge and will have fishy smell.
what does the discharge look like with BV?
thin, homogenous, white adherent discharge
What type cells are present on microscopic appearance with BV?
Clue cells
How do you treat BV?
Oral or topical metronidazole (flagil) or oral or topical clindamycin
What form of metronidazole should you give if the person is going to drink?
Topical form
What is an infection caused by ubiquitous airborne fungi, approximately 90% of these infections
Yeast infection (candidiasis)
What will the pH be like with a yeast infection?
Normal (lactobacilli aren’t disrupted)
What are common symptoms of a yeast infection?
Itching, burning, irritation, thick, white discharge
What does the discharge look like with yeast infection?
Thick, white cottage cheese like
What will the vulva and vaginal tissues look like with a yeast infection?
Bright red in color
What is the microscopic appearance of a yeast infection?
Hyphae and buds (apply KOH and look at under 10x power)
How do you treat a yeast infection?
Topical antifungals (micronazole, clotrimazole, terconazole, etc.) Oral fluconazole (only one pill, one dose) -STD lecture: butocanzole or fluconazole
What is flagellate protozoan that lives only in the vagina, Skene ducts, and male or female urethra?
Trichomonas Vulvovaginitis (trich)
What is the pH with trich?
Greater than 4.5
What is the most common symptom with trich?
Frothy discharge (gray-green)
What will the cervix look like with trich?
Strawberry cervix
What is the microscopic appearance with trich?
Flagellated organisms present (look at 40x)
move independently
What is the treatment for trich?
Metronidazole or Tinidazole
What is Atrophy of the vaginal epithelium due to diminished estrogen levels?
Atrophic vaginitis
What is a vaginitis that occurs with a dry vagina?
Atrophic vaginitis.
How do you treat atrophic vaginitis?
Topical estrogen therapy
What is a vaginitis that is characterized by purulent discharge, exfoliation of epithelial cells and vulvovaginal burning and erythema?Generally seen in peri and postmenopausal women
Desquamative inflammatory vaginitis
How do you treat desquamative inflammatory vaginitis?
Clindamycin cream 2% applied for 14 days
