Schuiling Chapter 19: Gynecologic Infections Flashcards
Lactobacillus
Initial defense against infection in the vagina. Maintain vaginal pH between 3.5 and 4.5.
Factors that may lead to vaginal infection
Antibiotics, vaginal lubricants, hormonal contraceptives, douching
Leukorrhea
Increase in the amount of vaginal secretion. Thin or thick white discharge resulting from congestion of the vaginal mucosa and an increase in polymorphonuclear leukocytes. Seen during pregnancy, menstruation, or in presence of infection.
Lifestyle Changes
Mucous discharge for 1-10 days following birth
Pregnant women with increased mucous discharge
During the cycle, estradiol makes the cervical mucus thin and watery, while progesterone makes it thick and tenacious.
Secretions minimal before menarche and following menopause (more susceptible to infection)
Vaginitis
Inflammation of the vagina characterized by increased vaginal discharge containing white blood cells.
Vaginosis
Not associated with increased WBCs
Vulvovaginitis
Inflammation of the vulva and vagina. May be caused by infection, chemical irritants, allergens, foreign bodies.
Normal Vaginal Discharge
pH 3.5-4.5 Normal flora White/clear Thin/mucoid No Amine odor
Bacterial Vaginosis
pH > 4.5
Wet prep + for clue cells, decreased lactobacilli, few WBCs
Increased, thin grayish-white, adherent discharge
Amine odor present
May be asymptomatic
Risk of PID
Vulvovaginal Candidiasis
pH < 4.5
Wet prep with KOH: pseudohyphae with yeast buds
Thick or this, white, curd-like, adherent discharge
No amine odor
Pruritis, burning, swelling, excoriation, redness
Vaginitis Prevention Measures
Adequate rest, reduction of life stressors, healthy diet low in refined sugars.
Hygiene: regular cleansing and drying
Wipe from front to back
Avoid sprays, powders, soaps, and deodorants, douching
Avoid restrictive clothing, daily use of panty liners
Change tampons and pads frequently
Avoid shaving, waxing, etc
Bacterial Vaginosis Risk Factors
Menstrual bleeding, douching, new sexual partner, smoking, lack of condom use, low vitamin D, black, Mexican American, women who have sex with women
Gold Standard for BV Diagnosis
Gram Stain
Amsel Criteria for Clinical Diagnosis of Bacterial Vaginosis
Based on presence of 3 out of 4: White, thin, adherent discharge pH > 4.4 Positive whiff/KOH test Clue cells
BV Patient Education
Complete course of medication
Avoid alcohol while taking metronidazole or tinidazole
Nitroimidazole antibiotics can cause metallic taste, N&V, cramps.
Avoid intercourse and use condoms
Avoid douching
BV in Pregnant Women
Associated with chorioamnionitis, premature rupture of fetal membranes, preterm labor and birth, and postpartum endometritis. Clindamycin not recommended d/t risk of low birth weight/neonatal infections
BV Treatment
Metronidazole 500 mg po BID x 7 days
Metronidazole gel intravaginally daily x 5 days
Clindamycin intravaginally daily x 7 days
Pregnant women: oral metronidazole (or clindamycin oral)
Cause of Vulvovaginal Candidiasis
Candida albicans 90%
Also: Candida glabrata, Candida tropicalis, Candida parapsilisis, Candida krusei (May be more resistant)
Vulvovaginal Candidiasis Risk Factors
Repeated courses of antibiotic therapy Diabetes Pregnancy Obesity High-sugar diet Use of corticosteroids, exogenous hormones Immunosuppressed
Complicated VVC
RVVC, Severe VVC, Non-albicans VVC, Women with diabetes or compromised immune system
VVC Treatment
OTC: Clortrimazole or Miconazole intravaginally or Tioconazole x 1 dose
Prescritption: Butoconazole or Terconazole intravaginally or Fluconazole one dose orally.
Pregnant: Topical azole x 7 days
VVC Patient Education
Bathe daily with minima, unscented soap
Don’t wear underpants to bed, loose-fitting pants
Cotton-crotched underwear
Take full course of tx. No tampon use during tx. Avoid intercourse. Avoid sprays, deodorants, fabric softeners. Take Vitamin C, oral acidophilus, or yogurt with plain cultures. Decrease sugar intake.
VVC in Pregnancy/Breastfeeding
Topical azoles only. Fluconazole should not be used during pregnancy or breastfeeding.
Complicated VVC
Generlly caused by C. albicans or C. galbrata. Respond to longer duration of treatment with azole meds. Boric acid may be used in recurrent and chronic VVC
