Schuiling Chapter 19: Gynecologic Infections

Question 1

Lactobacillus

Answer 1

Initial defense against infection in the vagina. Maintain vaginal pH between 3.5 and 4.5.

Question 2

Factors that may lead to vaginal infection

Answer 2

Antibiotics, vaginal lubricants, hormonal contraceptives, douching

Question 3

Leukorrhea

Answer 3

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.

Question 4

Lifestyle Changes

Answer 4

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)

Question 5

Vaginitis

Answer 5

Inflammation of the vagina characterized by increased vaginal discharge containing white blood cells.

Question 6

Vaginosis

Answer 6

Not associated with increased WBCs

Question 7

Vulvovaginitis

Answer 7

Inflammation of the vulva and vagina. May be caused by infection, chemical irritants, allergens, foreign bodies.

Question 8

Normal Vaginal Discharge

Answer 8

pH 3.5-4.5
Normal flora
White/clear
Thin/mucoid
No Amine odor

Question 9

Bacterial Vaginosis

Answer 9

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

Question 10

Vulvovaginal Candidiasis

Answer 10

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

Question 11

Vaginitis Prevention Measures

Answer 11

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

Question 12

Bacterial Vaginosis Risk Factors

Answer 12

Menstrual bleeding, douching, new sexual partner, smoking, lack of condom use, low vitamin D, black, Mexican American, women who have sex with women

Question 13

Gold Standard for BV Diagnosis

Answer 13

Gram Stain

Question 14

Amsel Criteria for Clinical Diagnosis of Bacterial Vaginosis

Answer 14

Based on presence of 3 out of 4:
White, thin, adherent discharge
pH > 4.4
Positive whiff/KOH test
Clue cells

Question 15

BV Patient Education

Answer 15

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

Question 16

BV in Pregnant Women

Answer 16

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

Question 17

BV Treatment

Answer 17

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)

Question 18

Cause of Vulvovaginal Candidiasis

Answer 18

Candida albicans 90%

Also: Candida glabrata, Candida tropicalis, Candida parapsilisis, Candida krusei (May be more resistant)

Question 19

Vulvovaginal Candidiasis Risk Factors

Answer 19

Repeated courses of antibiotic therapy
Diabetes
Pregnancy
Obesity
High-sugar diet
Use of corticosteroids, exogenous hormones
Immunosuppressed

Question 20

Complicated VVC

Answer 20

RVVC, Severe VVC, Non-albicans VVC, Women with diabetes or compromised immune system

Question 21

VVC Treatment

Answer 21

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

Question 22

VVC Patient Education

Answer 22

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.

Question 23

VVC in Pregnancy/Breastfeeding

Answer 23

Topical azoles only. Fluconazole should not be used during pregnancy or breastfeeding.

Question 24

Complicated VVC

Answer 24

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