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Repro Week 1 > LM 7.3: Vagina Anatomy & Infections > Flashcards

LM 7.3: Vagina Anatomy & Infections Flashcards

1
Q

what is the function of the vagina?

A

it’s a muscular tube that connects the internal reproductive organs like the ovaries and uterus to the external genitalia

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2
Q

what are the protrusions of the cervix into the vagina called?

A

anterior, posterior and lateral fornices

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3
Q

what embryologic structure is the bladder made from?

A

in both males and females it’s formed form the wolffish ducts

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4
Q

what tissue type is the outermost layer of the vagina?

A

nonkeratinizing stratified squamous epithelium

there is no keratin, but the mucosa is protected by its acidic environment

this is the layer that responds to hormones

the cells here produce abundant glycogen, which feeds bacteria, which produce lactic acid

deep to that is a layer of connective tissue, called the lamina propria, which contains vasculature but no glands –> most of the vaginal lubrication during sexual arousal is transudative fluid from the lamina propria

then deep to that is the muscular layer, made up of an outer longitudinal layer of smooth muscle and an inner circular layer

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5
Q

what is the pH of vaginal secretions?

A

3.8-4.2

normal squamous epithelial cells, lactobacilli

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6
Q

what are the cell layers of the vagina from superficial to deep?

A
  1. epithelium: nonkeritinizing stratified squamous epithelium; responds to hormones
  2. lamina propria: loose fibrovascular storma
  3. msucularis: outer longitudinal and inner circular smooth muscle
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7
Q

what is the whiff test used for?

A

diagnosing bacterial vaginosis

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8
Q

what is the most common cause of vaginal inflammation?

A

bacterial vaginosis

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9
Q

what is bacterial vaginosis?

A

a non-sexually transmitted vaginal infection caused by the bacteria Gardnerella vaginalis, which is a normal part of vaginal flora

if the vagina lacks enough of the normal vaginal lactobacilli, other bacteria, such as Gardnerella, will not be kept in check, and can overgrow

symptoms include a musty, characteristically fishy odor, with a thin gray, white, or yellow discharge –> pH of discharge will be higher than normal

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10
Q

what type of bacteria is gardnerella vaginalis?

A

gram variable coccobacilli

facultative anaerobes

it causes bacterial vaginosis

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11
Q

what are the complications asscoatied with untreated bacterial vaginosis?

A
  1. PID
  2. increased risk of acquiring HIV and HSV
  3. premature rupture of membranes before labor in pregnant women
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12
Q

how do you diagnose bacterial vaginosis?

A

gram stain showing gram variable coccobacilli is the gold standard

can also be made clinically if 3+ symptoms:
1. abnormal grey discharge

  1. pH >4.5
  2. positive whiff test
  3. clue cells
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13
Q

what is the Whiff test?

A

used to diagnose bacterial vaginosis

a few drops of KOH added to discharge produces “amine” or “fishy” odor

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14
Q

what are clue cells?

A

vaginal epithelial cells covered in Gardnerella bacteria

one of the clinical diagnostic features of bacterial vaginosis

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15
Q

how do you treat bacterial vaginosis?

A

metronidazole or clindamycin

both safe during pregnancy

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16
Q

what is candidasis?

A

usually caused by the Candida albicans

not sexually transmitted and usually doesn’t co-exist with other vaginal infections

the second most common cause for vaginal inflammation after bacterial vaginosis

17
Q

in what populations are yeast infections more common?

A
  1. pregnancy
  2. diabetic
  3. obese
  4. immunosuppressed
  5. on birth control or corticosteroids
  6. recent antibiotic use

candida species fungi usually need estrogenized tissue to flourish, so yeast infections are less common in pre-pubertal or post-menopausal females

18
Q

what are the symptoms of candidasis?

A
  1. itching
  2. burning
  3. dysuria
  4. pain with sex (dyspareunia)
  5. thick, odorless, cottage-cheese-looking discharge with NORMAL pH

symptoms may worsen before menstruation

20% of women w/ candidiasis will actually be asymptomatic

19
Q

how do you diagnose candidasis?

A

swabbing the vagina and observing blastospores or pseudohyphae on microscopy, OR with a postivie culture in a symptomatic patient.

however, most times clinicians just diagnose based on history and presentation and only do a vaginal swab if the patient doesn’t respond to OTC treatment

20
Q

how do you treat candidasis?

A

vaginal imidazoles or a single dose of fluconazole

in pregnant women, nystatin is used
20-30% pts experience recurrences 1 month after tx and in patients with recurrent yeast infections (more than four per year), weekly therapy w/ oral fluconazole for 6 months or weekly to twice-weekly topical therapy can be considered, and will prevent recurrences in 50% of women

if a woman has more frequent recurrences, she should be evaluated for risk factors like diabetes or autoimmune dz

21
Q

when prescribing metronidazole what should you counsel the patient to avoid?

A

alcohol

22
Q

what is trichomonas?

A

an infection caused by the protozoan trichomonas vaginalis

transmitted sexually and recent data has shown that it can also be transmitted rarely through fomites, such as towels, pools, or hot tubs

23
Q

what type of protozoan is trichomonas vaginalis?

A

motile and flagellated, and looks like a tiny coffee bean with tails

24
Q

what are the symptoms of trichomonas?

A

70% of women are asymptomatic

  1. itching
  2. burning
  3. malodorous frothy green, yellow or gray thing discharge with elevated pH
  4. dysuria
  5. dyspareunia
  6. petechiae of upper vagina/cervix (strawberry cervix)
25
Q

what are the complications of untreated trichomonas?

A
  1. PID
  2. infertility
  3. ectopic pregnancy
  4. preterm birth
26
Q

how do you diagnose trichomonas?

A

wet mount microscopy

vaginal secretions are placed on a slide w/ normal saline and Trichomonas itself is seen

if a patient is dx w/ trichomoniasis, she should also be screened for gonorrhea/chlamydia

27
Q

how do you treat trichomonas?

A

oral metronidazol

patient’s sexual partners should also be treated to prevent reinfection

avoid alcohol while taking metronidazole, as it can cause a disulfiram-like reaction

28
Q

what is chalmydia?

A

STD caused by bacterium chlamydia trachomatis

the most frequently reported infectious disease in the US

it can be asymptomatic, and since 40% of cases of untreated chlamydia will progress to pelvic inflammatory disease, all sexually active women under 25 should be screened annually

29
Q

why type of bacterial is chalmydia?

A

gram negative intracellular bacterium

30
Q

what are the symptoms of chlamydia?

A
  1. urethritis
  2. abnormal/mucopurulent vaginal discharge or bleeding
  3. cervicitis
  4. mild salpingitis if the infection ascends into tubes
31
Q

how do you diagnose chlamydia?

A
  1. culture
  2. direct immunofluorescence
  3. enzyme immunoassay
  4. nucleic acid hybridization
  5. nucleic acid amplification of endocervical swabs (most sensitive)

NAAT is often what we do today, and if a patient cannot or does not want to undergo a pelvic exam, this can be done on a clean-catch urine sample as well

32
Q

how do you treat chalmydia?

A

azithromycin or doxycycline –> either a single dose (where the patient takes 4 250mg pills) or 7d regimen

in patients with persistent symptoms, in whom noncompliance is suspected, or who may have been reinfected, a test of cure can be done after 4w

all patients should be rescreened after 3m, and all sexual partners should be treated, with abstinence from sex until treatment is complete

33
Q

what is gonorrhea?

A

an infection caused by neisseria gonorrhoeae

34
Q

what type of bacteria is gonorrhea?

A

gram negative intracellular diplococcus

35
Q

what are the symptoms of gonorhea?

A

often asymptomatic, and can facilitate transmission of HIV

if symptomatic they will present within 3-5 days of infection with:
1. urethritis

  1. erythematous, tender vagina and/or cervix
  2. mucopurulent discharge from urethra, cervix, vagina or anus
36
Q

how do you diagnose gonorrhea?

A

nucleic acid amplification testing (NAAT)

you should also test for chlamydia, syphilis, HIV

37
Q

how do you treat gonorrhea?

A

IM ceftriaxone plus oral azithromycin or doxycycline to treat for concurrent chlamydial infection unless it’s been ruled out by NAAT

Repro Week 1 (27 decks)

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