Vaginal

Question 1

Bacterial Vaginosis

Answer 1

Yeast Infections
• Non-specific vaginitis
• Imbalance in the normal vaginal flora

Question 2

BV S&S

Answer 2

o Vaginal discharge with a fishy odor (Refer)

o Increased quantity of discharge

Question 3

BV treatment

Answer 3

o Rx meds

Question 4

Trichomoniasis

Answer 4

• Transmitted via sexual activity

o Men are asymptomatic reservoirs

Question 5

Trich S&S

Answer 5

o Profuse yellow-gray or green discharge
o Thin and frothy/foamy discharge
o Fishy odor

Question 6

Trich treatment

Answer 6

o Profuse yellow-gray or green discharge
o Thin and frothy/foamy discharge
o Fishy odor

Question 7

VVC

Answer 7

• Yeast infection

* Higher incidence in black women

Question 8

VVC S&S

Answer 8

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

Question 9

VVC treatment goals

Answer 9

• Relief of symptoms
• Eradication of the infection
• Reestablishment of normal vaginal flora

Question 10

VVC Uncomplicated

Answer 10

• Self-treat
• Infrequent
• Mild to moderate symptoms
*Refer if first time

Question 11

VVC Complicated

Answer 11

• Refer
• Severe symptoms
• Concurrent predisposing factors

Question 12

VVC Recurrent

Answer 12

• Refer

* 4 infection/year

Question 13

Exclusions to self-treatment

Answer 13

• 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

Question 14

Exclusions to self-treatment cont.

Answer 14

•	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

Question 15

Nonpharm Treatment

Answer 15

• 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

Question 16

Nonpharm treatment cont.

Answer 16

• 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

Question 17

Self-treatment OK if which criteria is met

Answer 17

• 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

Question 18

Non-RX treatment

Answer 18

•	Antifungals  still need a prescription for orals
•	Imidazoles
o	Clotrimazole
o	Miconazole
o	Tioconazole

Question 19

Non-Rx treatment dosage forms

Answer 19

o Creams
o Suppositories
o Tablets

Question 20

Drug interactions

Answer 20

• Miconazole – Warfarin

Question 21

Special Pops

Answer 21

• Not <12 y.o.
• OK pregnancy but physician should recommend (7 days best)
• Breastfeeding OK

Question 22

1 day treatment

Answer 22

Too much too soon
Troconazole 6.5% ointment
Miconazole 1200mg supp

Question 23

3 day

Answer 23

Best option
Clotrimazole 2% cream
Miconazole 4% cream
Miconazole 200mg supp

Question 24

7 day

Answer 24

best for pregnancy, on period, or anitbiotics
Clotrimazole 1% cream
Clotrimazole 100mg supp
Miconazole 2% cream
Miconazole 100mg supp

Question 25

Pramoxine HCl 1%

Answer 25

• External itchiliners relief spray

* external analgesic

Question 26

Oxygen infused pant

Answer 26

• Keeps you fresh for 8 hours

* Helps prevent odors before they start

Question 27

Dimethacone

Answer 27

Monistat soothing care

Question 28

Benzocaine

Answer 28

• Topical external anesthetic

*allergic rxs

Question 29

Hydrocortisone

Answer 29

• Topical external corticosteroid

masks infection

Question 30

Povidone-iodine

Answer 30

• Antimicrobial

*Douche-do not recommend

Question 31

Homeopathic

Answer 31

Not proven to work
• Pulsatilla
• Candida Parasilosis
• Candida Albicans

Question 32

Misc.

Answer 32

• Corn starch, aloe, mineral oil
• Trimpelennamine
*odor protection

Question 33

Atrophic Vaginitis S&S

Answer 33

• Decrease in vaginal lubrication
• Vaginal irritation, dryness, burning, itching, leucorrhea, dyspareunia
• Thin, watery or yellow malodorous discharge
• “Spotting”
• Vaginal bleeding or spotting after sexual activity

Question 34

AV- Treatment Goals

Answer 34

• Reduce/eliminate symptoms of vaginal dryness, burning, and itching
• Eliminate dyspareuria
o Discomfort or interference with intercourse
o Apply lubricant to vaginal opening and penis

Question 35

General Treatment Approach

Answer 35

• Topical lubricants

Question 36

Exclusions to Self-treat

Answer 36

• Sx are mild to moderate

* Confined to vaginal area

Question 37

Vaginal Lubricants

Answer 37

• Do NOT use Vaseline
o Difficult to remove
o Cannot be used with a latex condom or diaphragm

Question 38

Vaginal Douching

Answer 38

• Douching rates are influenced by race, geographic region, socioeconomic status, education
o Vaginal hygiene after menstruation or intercourse
• Not proven as either safe or effective

Question 39

VD- AE

Answer 39

o	Increased risk for PID
o	Reduced fertility
o	Ectopic pregnancy
o	Vaginal infections
o	STIs
o	Low birth weight
o	Cervical cancer
•	Disrupts normal vaginal flora and pH
•	Local irritation, contact dermatitis possible

Question 40

VD - Pt. Counseling

Answer 40

• Not necessary
• Discourage
• Contraindicated in pregnancy
• Wait 6-8hrs after sexual intercourse if vaginal spermicide was used
• Gently washing, using fingers, with lukewarm water and mild soap is a better alternative