Vaginal And Vulvar Disorders Flashcards
What is the most common cause of vaginal Dc
BV
What are the Amsels criteria for BV
Requires 3 of the following 4 (“Amsel’s”) criteria:
- Homogeneous discharge
- pH >4.5
- Positive “whiff” test
- Clue cells on wet prep
What are the recommended Rx for BV
Metronidazole 500mg BID x 7 days
Or Gel
Or Clindamycin Cream x 7 days
What are the bad outcomes of BV
Premature rupture of membranes
Postpartum fever
Post-abortion infection/sepsis
Increased Risk of STI
Persistence of HPV (CANCER)
What is the treatment for a pt with BV x 3 in the last 12 months
Metrogel or PO nitroimidazole x 7-10d, then metrogel 2 x weekly for 4-6m
A pt presents with Vaginal burning/itching, irritation, post-voiding dysuria, odorless thick white “cottage cheese” discharge
With a ph less than 4.5
Think
Candida infection
What are the tx approaches to candida infections
-azoles
Fungal infections
Define recurrent candida
4+ episodes a year
Think
- oral contraceptives ?
- DM?
- Pregnant?
- tight clothing?
- Candida Glabrata?
What is the tx approach to recurrent Candida Infections
Acute recurrent infection treatment:
-Local intravaginal therapy for 7-14 ds
-Oral fluconazole (200mg*) 1 pill every 72 hrs x 3 doses → days 1, 4, & 7
Suppressive treatment:
-Oral fluconazole 100 - 200mg wkly for 6 mos
Start suppressive treatment after completing acute treatment first
May need to continue indefinitely if symptoms recur when stopping txt!
If a pt has recurrent candida infections that is NOT Albicans
What is the tx?
Fluconazole 150-200 mg PO every 72 hrs x 3-4 doses
-50% cure rate
Boric acid 600 mg capsule PV qd for 2 wks:
-60% cure rate
A pt presents with frothy green yellow dc
With frothy dc and a strawberrry cervix
Ph > 4.5
Think
Trichomoniasis
What is the gold standard to test of r Trichomoniasis
NAAT
What is the tx approach for Trichomoniasis
Metronidazole 2g orally or 500 mg BID for 2 weeks
Followed by Test of Cure at 1 and 6 months
What is the one fact about lichen sclerosus
increased risk of squamous cell carcinoma
A pt presents with early pruritus, irritation, and vulvar thickening
With dysparunia, and introital stenosis
With cellophane paper/ tissue paper appearance on genital stretching of the skin
Often involving the perianal region
Think
Lichen Sclerosus
Get a Bx and re-eval in 1 year
A pt with a itch-scratch-cycle of the valvular area think
Lichen-simplex-chronicus
Nocturnal itching
What is the tx approach to lichen simplex chronicus
Eliminate trigger
And lubricate with petroleum jelly
Sits bath
Oral antihistamine
And nocturnal gloves at night
+/- topical steroids
When would you get a Bx for Lichen Simplex Chronicus
If not resolved in 1-3 weeks
How does psoriasis presents on the vulva
Koebnerization! Trauma leading to psoriasis
Instead of the silver fine scales, presents as a fine red scale on the vulva
What is the underlying etiology of psoriasis
Autoimmune
Tx approach to psoriasis of the vulva
Treatment: emollients, steroids
Dovonex (calcipotriene) after control obtained
What is lichen PLANUS?
Autoimmune d/o t-cells affecting both males and females
Drug induced
red erosions with white border!
Chronic vaginal discharge w/ intense vulvovaginal pruritus, burning pain, dyspareunia, & postcoital bleeding
What are the “P”s of Lichen Planus
Purple, pruritic, polygonal, papules & plaques
What is the tx approach to Lichen planus
Topical steroids (clobetasol)
Vaginal hydrocortisone
Suppository
What are the tx for Intertrigo
Drying agents: corn starch, etc.
Inflammation: mild topical steroid
Infection: treat cause
Fungal: nystatin, clotrimazole
Encourage weight loss if obese
Wear light-weight, loose-fitting clothing (natural materials)
What is the most common cause of vaginal irritation after menopause
Strophic vaginitis
What is the tx for strophic vaginitis
Topical estrogen (low dose)
Treat concomitant infection
If uterus still present, caution w/ unopposed estrogen! (short term)
Bartholin Cyst in a pt over 40
Think
CA>?
Women with bartholins abcesses need what screening?
Screen for gonorrhea and chlamydia
2 failed word catheters in a bartholian abcess
Then what?
marsupination with ABX
A pt presents with fever, malaise, diarrhea, with a red rash, and HOTN
Post a recent menses
Think
Toxic shock syndrome
Treat emergency with ABX, fluids
What is the most common vulvar cancer
SCC
WHat is the major risk for smokers with HPV
Vulvar cancer
