S11C106 - Vulvovaginitis

Question 1

BV

Answer 1

• gardnerella vaginalis

- positive whiff test, fishy odor, clue cells, whitish-grey d/c,

Question 2

BV Tx

Answer 2

-flagyl 500mg PO BID x7d
or cinda cream 2% PV qhs x7d
or flagyl gel 0.75% PV BID x5d
-tx of male sexual partners is NOT beneficial in preventing recurrence of BV

Question 3

Candida Vaginitis

Answer 3

• complicated = recurrent, severe, immunocompromised, pregnant
• not an STI
• RF: estrogen therapy, Abx, pregnancy, DM, menses, semen, synthetic tight fitting clothing
• Sx: leukorrhea, pruritus, dysuria, dyspareunia, +/- d/c, not usually malodorous

Question 4

Candida Vaginitis: Tx

Answer 4

• can tx empirically based on symptoms
• nystatin 100,000 unit tablet OD x14d PV
• fluconazole 150mg PO x1 (++ interactions)
• complicated: fluconazole 150mg PO day 1 and day 3
• pregnant pt: topical azole tx only , x7d

Question 5

Trichomonas Vaginitis

Answer 5

• STI
• assoc with preterm birth, LBW of infant, PID, cx cancer
• Dx: frothy malodorous d/c, motiel trichomonads on microscopy (done w/in 20mins of collection), rapid antigen test is better

Question 6

Trichomonas: Tx

Answer 6

• flagyl 2g PO once or 500mg PO BID x7d

- increased clearance if sexual partner treated simultaneously

Question 7

Contact vulvovaginitis (dermatitis)

Answer 7

-Sx: swelling, itching,
-Tx: cool sitz baths, wet compress of dilute boric acid and burows soln for relief if painful
-topical HCT 0.5-2.5% or triamcinolone 0.025% TID
+/- oral antihistamines

Question 8

Vaginal FB

Answer 8

• profuse d/c
• foul odor
• make sure this is on the dx for children!

Question 9

Pinworms

Answer 9

-enterobius vermicularis
-anal/vaginal pruritus ,more intense at night
-dx: tape applied to anus then send for microscopy
-tx: treat all fmaily members, treat twice b/c young worms are resistant
mebendazole 10mmg PO x1 then rpt again in 1w (use caution in pregnancy)

Question 10

Atrophic vaginitis

Answer 10

• dx: dryness, soreness, itchy, dyspareunia, occassional spotting/d/c, epithelium is thin, inflamed or ulcerated
• tx: topical vaginal estrogen cream or estradiol vaginal ring or tablet
• contraindicated if hx of estrogen dependent cancers

Question 11

Bartholin cyst/abscess

Answer 11

-located w/in labia minora
-drain into posterior vestibule at 4 and 8 o’clock
-Sx: mass in posterior introitus, pain, induration, painful
-ddx: leiomyoma, lipoma, carcinoma
-tx: I+D and marsupialization
if not too severe can try Abx and sitz baths