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
