TV BV And Thrush

Question 1

What % of women with TV will have a vaginal discharge?

Answer 1

70%

Question 2

What % of women with TV will have a strawberry cervix?

Answer 2

2%

Question 3

What’s the intra-vaginal treatment cure rate of TV?

Answer 3

50%

Question 4

Who should you test for TV? (and how?)

Answer 4

• women with discharge of vulvitis (NATTs)
• men who are contacts of TV (urine 1st pass culture AND urethral culture)
• men with persistent urethritis

Question 5

What to do in TV treatment non-responders (6 steps)

Answer 5

1) Exclude re-infection and non-adherence
2) Repeat 7/7 course
3) Increased dose of metronidazole eg 2g OK for 5-7 days, 800mg TDS for 7/7
4) Resistance testing
5) V high Tinidazole dose eg 1g TDS or 2g BD for 14/7
6) ? not enough evidence. Ideas include intravaginal paromomycin

Question 6

What % of women will have recurrent thrush?

Answer 6

6%

Question 7

What might you see on microscopy for candida Glabrata?

Answer 7

Spores and neutrophils only

Question 8

Treatment in severe thrush?

Answer 8

150mg Fluconazole or 500mg Clotrimazole pessary OD on days 1 and 4

Question 9

Treatment in recurrent thrush?

Answer 9

Fluconazole PO every 72 hours x3 then once a week for 6/12

Question 10

Thrush treatment in pregnancy?

Answer 10

Clotrimazole 500mg pessary ON for 7/7

Question 11

What should you use for thrush treatment when breast feeding?

Answer 11

Single dose Fluconazole is ok but avoid high or repeated doses

Question 12

Candida Glabrata is more common in what group? And how do you treat it?

Answer 12

Diabetics. Need higher dose of fluconazole eg 300mg OD every 48 hours for a week

Question 13

Treatment for candida Krusei?

Answer 13

14 day course of non-azole therapy

Question 14

What are non-azole therapies for candida?

Answer 14

Nystatin pessaries 100 000 units
Boric acid vaginally 600mg OD
Amphotericin B vaginally 50mg OD

Question 15

Treatment of TV in breastfeeding?

Answer 15

Intravaginal treatment ideally