Trichomoniasis, Gardnerella, and Vulvovaginal Candidiasis Flashcards
What is the causative organism of trichomoniasis?
Trichomonas vaginalis, a sexually transmitted protozoan.
What is the primary mode of transmission of Trichomonas vaginalis?
Sexual contact.
What other STIs should be screened for in patients diagnosed with trichomoniasis?
Chlamydia, gonorrhea, HIV, and syphilis, as co-infections are common.
What are the characteristic symptoms of trichomoniasis?
- Vulvovaginitis
- Pruritus
- Burning
- Copious frothy yellow-green malodorous vaginal discharge
- Punctate hemorrhages on the cervix (strawberry cervix)
What is the vaginal pH in trichomoniasis?
Greater than 4.5 (basic environment).
What is the diagnostic test for trichomoniasis?
- Wet mount microscopy showing motile, pear-shaped trophozoites
- vaginal pH > 4.5
- NAAT (nucleic acid amplification test) for confirmation
What is the gold standard diagnostic test for Trichomoniasis?
NAAT (Nucleic Acid Amplification Test) is the most sensitive test, but wet mount is the fastest and most commonly used.
What is the treatment of choice for trichomoniasis?
Metronidazole (oral, 7-day course preferred over single dose).
What should breastfeeding women do when treated with oral metronidazole?
They can continue breastfeeding, as the amount in breast milk is less than therapeutic doses given to infants.
What is the alternative treatment for trichomoniasis in pregnancy?
Metronidazole remains the treatment of choice; safe in all trimesters. Metronidazole was historically considered contraindicated in the first trimester due to concerns about teratogenicity. However, more recent evidence has shown that metronidazole is actually safe in all trimesters, including the first trimester.
Is vaginal metronidazole recommended for trichomoniasis?
No, it has lower cure rates and does not eliminate the infection from all reservoirs. Unlike systemic therapy with oral metronidazole, vaginal metronidazole therapy fails to eradicate T vaginalis from all reservoirs of infection (eg, concomitant urethral and periurethral gland infections). Therefore, it is an inadequate treatment (cure rates <50% compared to oral therapy) and not recommended.
Should sexual partners be treated for trichomoniasis?
Yes, all sexual partners should be treated to prevent reinfection.
What is the recommended preventive measure for trichomoniasis?
Consistent use of condoms during sexual activity.
What type of bacterium is Gardnerella vaginalis?
A gram-variable coccobacillus (stains either gram-positive or gram-negative).
What is the most common cause of bacterial vaginosis (BV)?
Gardnerella vaginalis is the most common cause of bacterial vaginosis (BV), which occurs due to a disruption of normal vaginal flora with a decrease in Lactobacilli and an overgrowth of anaerobic bacteria.
What causes bacterial vaginosis (BV)?
An imbalance in vaginal flora, particularly a decrease in lactobacilli, which allows Gardnerella vaginalis to proliferate.
Increased risk with sexual activity, frequent douching, and smoking.
What are the clinical features of BV?
BV presents with a thin, gray-white, malodorous (‘fishy’) vaginal discharge without significant inflammation. It is often asymptomatic but can cause vaginal irritation.
What are the characteristic symptoms of bacterial vaginosis?
Thin, grey-white, malodorous discharge.
Distinctive “fishy” odor.
What is the typical vaginal pH in bacterial vaginosis?
pH > 4.5 (commonly between 5.0 and 6.5).
What diagnostic test confirms BV?
Amsel criteria:
(1) Thin, gray discharge
(2) Positive whiff test (fishy odor with KOH)
(3) Clue cells on wet mount microscopy
(4) Vaginal pH > 4.5
What are clue cells, and how are they identified?
Vaginal epithelial cells coated with Gardnerella vaginalis bacteria, seen under microscopy in a wet mount.
What is the first-line treatment for BV?
Oral or vaginal metronidazole OR vaginal clindamycin.
What is the whiff test, and how is it performed?
A diagnostic test for BV using 10% KOH solution added to vaginal discharge.
Positive result: Strong fishy odor.
What is the primary treatment for bacterial vaginosis?
Metronidazole (PO for 5 to 7 days or topical for 5 days).
Alternative: Clindamycin (vaginal or PO).
What distinguishes BV discharge from other vaginal infections?
The fishy odor and a pH higher than 4.5.
If a pregnant patient has BV, what major complication can occur?
Preterm labor.
What organism is responsible for vulvovaginal candidiasis?
Candida albicans, an opportunistic fungus that thrives in a high-estrogen environment, diabetes, or immunosuppression.
What are the clinical features of vulvovaginal candidiasis?
Thick, white, ‘cottage cheese’ vaginal discharge with intense itching, erythema, and swelling of the vulva and vagina.
How is vulvovaginal candidiasis diagnosed?
Visualization of budding yeast and pseudohyphae on KOH prep; vaginal pH is normal (3.8-4.5).
What is the first-line treatment for vulvovaginal candidiasis?
Fluconazole (oral) OR topical azoles (clotrimazole, miconazole).
How can you differentiate between the types of vaginitis based on vaginal pH?
BV and trichomoniasis both have a vaginal pH > 4.5, whereas vulvovaginal candidiasis has a normal vaginal pH (3.8-4.5).
Which types of vaginitis require treatment of sexual partners?
Only trichomoniasis requires partner treatment. BV and vulvovaginal candidiasis do not.
