STIs involving discharges - vulvovaginitis Flashcards
What is sexual health?
- a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity.
What are the 5 P’s related to sexual hx?
- Partners
- Practices
- Prevention
- Pregnancy
- Protection
- Past Hx of STIs
What are the STIs of concern that cause “drips” (discharges)?
- gonorrhea
- Chlamydia
- nongonococcal urethritis/mucopurulent cervicitis
- Trirchomonas vaginitis/urethritis
- Candidiasis
- bacterial vaginosis
What is vulvovaginitis?
the spectrum of conditions that cause symptoms such as vulvovaginal itching, burning, irritation, and abnormal discharge.
What is used to treat trichomoniasis?
metronidazole (can be used in pregnancy)
What is trichamonis vaginitis?
- sexually transmitted parasite that causes vaginitis and cervicitis (STRAWBERRY CERVIX due to inflammation from capillary dilation).
- causes burning, itching, dyspareunia (painful sex) and malodorous yellow/green discharge.
- causes pH greater than 4.5 in vaginosis
How do we diagnose trichamonis vaginosis?
- well show MOTILE trophozoites under wet mount
What is important to remember about treatment for trichamonis vaginosis?
treat BOTH partners
What is Candidiasis?
- fungus that causes “cottage cheese” like discharge, vulvar/vaginal pruritus along with burning, irritation, dyspareunia (painful sex), and burning with urination.
- will see PSEUDOHYPHAE on saline wet mount of vaginal discharge.
How do you treat candidiasis?
- fluconazole
What will bacterial overgrowth of Gardnerella vaginalis do to the protective H2O2-producing Lactobacilli (aka disturbance of natural flora)?
allow for increase in pH and growth of other bacteria or candida species (greater than 4.5).
*normal vaginal pH= 3.8-4.2
What factors can adversely affect the normal vaginal flora?
- douching
- antibiotics
- hormonal changes
- use of oral contraceptives
- foreign bodies (tampons, IUD…)
- semen
- menses
What is the KOH “whiff” test?
- place sample of vaginal secretions in a test tube with KOH and if bacterial vaginosis infection, you will smell a sharp “fishy” odor, indicative of Gardnerella vaginalis.
Where should you take a sample when testing for vaginal pH?
- from the mid portion of vaginal wall; NOT cervix, which has a pH of 7.
What are some general problems associated with Gardnerella vaginalis (aka bacterial vaginosis; BV)?
- PID, preterm birth, chorioamnionitis…
What should we do when pts present with Gardnerella vaginalis; bacterial vaginosis (BV)?
- treat al symptomatic patients.
- screen and treat all “high risk” its (i.e. prior preterm labor/delivery).
Is chronic UTI associated with BV?
YES
Does BV cause elevated pH?
YES
How do you treat Gardnerella vaginalis (aka bacterial vaginosis)?
- metronidazole or clindamycin
What discharge will you see with Gardnerella vaginalis?
grayish-white discharge
** What specific cells will you see with Gardnerella vaginalis?
clue cells= epithelial cells coated with bacteria
How is Gardnerella vaginalis (BV) transmitted?
sexually
What is pelvic inflammatory disease (PID)?
- the acute clinical manifestation of ascending genital-tract infection involving the endometrium, fallopian tubes, and/or adjacent pelvic structures.
- usually due to gonnorhea, chlamydia, or mycoplasma
*** What are the minimum criteria for PID?
- uterine tenderness
- adnexal tenderness +/- cervical motion tenderness
What is chandelier sign?
cervical motion tenderness during painful pelvic exam, indicating PID
What are some additional criteria associated with PID?
- temp greater than 101 (38.3 celsius).
- elevated WBC count
- elevated ESR/CRP
- aka normal markers of inflammation
What are the sequelae of PID?
- tubal infertility
- ectopic pregnancy
- chronic pelvic pain
*** What is Fitz-Hugh Curtis syndrome?
- RUQ pain due to perihepatic adhesions “violin strings” between liver capsule and peritoneum
What is the pathway to PID?
- cervicitis leading to endometritis, which leads to salpingitis/oophoritis/tuboovarian abscess, which leads to peritonitis.
What is the classic symptom of PID?
- abrupt onset of severe lower abdominal pain during or shortly after menses.
Does risk for ectopic pregnancy increase significantly after one episode of PID?
YES