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OTC > Vaginal and Vulvovaginal Disorders > Flashcards

Vaginal and Vulvovaginal Disorders Flashcards

1
Q

What factors impact the vaginal ecosystem

A

number and types of endogenous organisms, vaginal pH, glycogen concentration, hormonal fluctuations, drug therapy, douching, sex partners

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2
Q

What is the normal vaginal pH

A

4-4.5

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3
Q

What are the characteristics of normal vaginal discharge

A

odorless
clear to white in color
high vicosity

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4
Q

When are increases in vaginal secretion normal

A

ovulation
pregnancy
after menses
sexual excitement

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5
Q

What are the common causes of vaginitis

A

BV
VVC
Trichomoniasis

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6
Q

Why is it important to distinguish VVC from BV and trichomoniasis

A

VVC can be treated with OTC antifungal while BV and trichomoniasis require treatment with prescription medications

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7
Q

What is the cause of BV

A

polymicrobial resulting from imbalance in normal vaginal flora

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8
Q

What are the presenting symptoms of BV

A

fishy odor
discharge
pruritis

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9
Q

What are the risk factors that can lead to BV infections

A

multiple or new sexual partners
use of IUD
douching
sexual practices
tobacco use
prior pregnancy

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10
Q

Does BV change pH

A

yes it increases

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11
Q

What causes trichomoniasis

A

STI caused by trichomonas vaginalis

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12
Q

What are the symptoms of trichomoniasis

A

pruritis
yellow-green discharge
irritation is possible
dysuria
*asymptomatic in 50% patients

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13
Q

What are the risk factors of trichomoniasis

A

multiple or new sexual partners
nonuse of barrier contraceptives
presence of other STIs

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14
Q

Does trichomoniasis change vaginal pH

A

yes it increases

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15
Q

What is the cause of VVC

A

candida overgrowth

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16
Q

What are the symptoms of VVC

A

pruritis
discomfort
dysuria
thick, clumpy discharge

17
Q

What are the risk factors of VVC

A

pregnancy
use of antibiotics and immunosuppressive agents

18
Q

Does VVC change vaginal pH

A

no

19
Q

What are presenting symptoms of VVC

A

vulvar pruritis
thick, white, curdy vaginal discharge
erythema
irritation
external dysuria and dyspareunia
normal vaginal pH

20
Q

What are self-screening skits used for

A

used to identify elevations in pH
*patients with a pH above 4.5 need to be referred to a provider

21
Q

What are the limitations of self-screening kits

A

must wait at least 72 hours after using any vaginal preparation
must wait at least 48 hours after sexual intercourse
must wait at least 5 days after a menstrual period

22
Q

What is uncomplicated VVC

A

sporadic or infrequent
mild-to-mod symptoms
likely C. albicans
non-immunocompromised women
responds to short course regimen

23
Q

What is complicated VVC

A

recurrent VVC (>3 episodes/year or recurrence within 2 months)
severe symptoms
non-albicans candidiasis
women who are pregnant
women with uncontrolled diabetes
immunocompromised women

should be evaluated by a healthcare provider
*may require longer treatment

24
Q

What are exclusions from self-treatment of VVC

A

pregnancy
children under the age of 12
concurrent symptoms of fever or pain in pelvic area, lower abdomen, back or shoulder
medications that predispose you to VVC
medical disorders that predispose you to VVC
recurrent VVC
first vulvovaginal episode
symptoms consistent with BV or trichomoniasis

25
Q

What is the OTC treatment option available for VVC

A

vaginal antifungals
recommended for initial therapy for uncomplicated VVC
provide relief of external vulvar itching and irritation associated with infection

26
Q

What is the MOA of imidazoles and what OTC drugs fall into this category

A

MOA: alter fungi membrane permeability through decreased synthesis of the fungal sterol ergosterol
OTC drugs: clotrimazole, miconazole, and tioconazole

27
Q

When should patients seek further medical attention

A

symptoms persist after 1 week of treatment
symptoms recur within 2 months
vaginal symptoms worsen or change

28
Q

When should relief of symptoms occur

A

with 3 days of starting treatment but may take a week for complete resolution
**important to complete full course of treatment even if symptom relief is sooner

29
Q

What are some non-pharmacologic measures someone can do

A

sodium bicarb sitz bath may provide quick, temporary relief of vulvar irritation

lactobacillus preparations: proposed to reestablish normal vaginal flora
vaginal tea tree oil: proposed to be antibacterial and antifungal
gentian violet
Boric acid vaginal suppository: may be useful for non-C.albicans infections

30
Q

What is genitourinary syndrome of menopause(GSM)

A

vaginal atrophy that can lead to genital, sexual and urinary symptoms

31
Q

What is the pathophysiology of GSM

A

decreased estrogen levels lead to decreased vaginal lubrication and thinning of vaginal epithelium

32
Q

What are the vaginal and sexual symptoms of GSM

A

vaginal dryness
dyspareunia
vaginal irritation
itching
vaginal tenderness
vaginal bleeding/spotting during intercourse

33
Q

What are the urinary symptoms of GSM

A

dysuria
urgency
frequency
nocturia
urinary incontinence
recurrent UTIs

34
Q

What are the exclusions for self-treatment of GSM

A

severe symptoms
symptoms that are not localized
vaginal dryness of dyspareunia not relieved by vaginal lubricants or moisturizers

35
Q

What are vaginal moisturizers and lubricants

A

products used to relieve symptoms by temporarily moistening the vaginal tissues
can be applied internally and externally

36
Q

When should a moisturizer be used over a lubricant

A

when pt bothered by vaginal dryness outside of intercourse

37
Q

When should a pt use a lubricant over a moisturizer

A

experiencing dryness during intercourse

38
Q

When should a patient start to experience symptom relief

A

may be apparent within hours after first dose
typically improves within a few days

39
Q

When should a patient seek medical attention for GSM

A

if no response within one week
worsening of symptoms
vaginal bleeding

OTC (33 decks)

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