Vaginal Flashcards
Bacterial Vaginosis
Yeast Infections
• Non-specific vaginitis
• Imbalance in the normal vaginal flora
BV S&S
o Vaginal discharge with a fishy odor (Refer)
o Increased quantity of discharge
BV treatment
o Rx meds
Trichomoniasis
• Transmitted via sexual activity
o Men are asymptomatic reservoirs
Trich S&S
o Profuse yellow-gray or green discharge
o Thin and frothy/foamy discharge
o Fishy odor
Trich treatment
o Profuse yellow-gray or green discharge
o Thin and frothy/foamy discharge
o Fishy odor
VVC
- Yeast infection
* Higher incidence in black women
VVC S&S
o Intense pruritis
o Thick, whitish vaginal discharge (cottage cheese like)
o No offensive odor
o Vulvar or vaginal erythema
o Dysuria
o Discomfort or pain during or after sexual intercourse
o Pain during urination
VVC treatment goals
- Relief of symptoms
- Eradication of the infection
- Reestablishment of normal vaginal flora
VVC Uncomplicated
• Self-treat
• Infrequent
• Mild to moderate symptoms
*Refer if first time
VVC Complicated
- Refer
- Severe symptoms
- Concurrent predisposing factors
VVC Recurrent
- Refer
* 4 infection/year
Exclusions to self-treatment
• Pregnancy
• Girls < 12 y.o. (usually treated topically)
• Fever
• Pain in the lower abdomen, back, or shoulders
• Meds that can predispose
o Corticosteroids
o Antineoplastics
Exclusions to self-treatment cont.
• Med disorders o HIV oDiabetes • Recurrent o >3/year or 1 in past 2 months • Never been medically diagnosed o At least 1 previous episode should be medically diagnosed before recommendation is made
Nonpharm Treatment
• Decreased consumption of sucrose and refined carbohydrates
• Increased consumption of yogurt with a yeast culture
• D/C drug that is causing
o Antibiotics
• Clothing should be loose fitting and cotton – no nylon
• Lactobacillus acidophilus
o Tablets/capsules or yogurt (8oz/day)
o Oral or vaginal
Nonpharm treatment cont.
- Vaginal douche of plain yogurt or vinegar
- Sodium bicarbonate sitz bath – vulvar irritation
- Gentian violet soaked tampon overnight or for several hours, once generally sufficient, but may used qd or bid for up to 5 consecutive days
- Boric acid 600mg in a size 00 gelatin capsule vaginally hs x 14 days
Self-treatment OK if which criteria is met
• Infrequent symptoms
o <3/year and none within the past 2 months
• At least one previous episode diagnosed
• Current symptoms are mild to moderate and consistent with signs and symptoms of VVS
o No malodorous discharge
Non-RX treatment
• Antifungals still need a prescription for orals • Imidazoles o Clotrimazole o Miconazole o Tioconazole
Non-Rx treatment dosage forms
o Creams
o Suppositories
o Tablets
Drug interactions
• Miconazole – Warfarin
Special Pops
- Not <12 y.o.
- OK pregnancy but physician should recommend (7 days best)
- Breastfeeding OK
1 day treatment
Too much too soon
Troconazole 6.5% ointment
Miconazole 1200mg supp
3 day
Best option
Clotrimazole 2% cream
Miconazole 4% cream
Miconazole 200mg supp
7 day
best for pregnancy, on period, or anitbiotics Clotrimazole 1% cream Clotrimazole 100mg supp Miconazole 2% cream Miconazole 100mg supp
