Vaginal Dc Flashcards
Vaginal discharge is a common presentation of
those STIs responsible for_______
PID.
The first step in diagnosis is to determine if the
discharge is _____ or ______
cervical or vaginal in origin
One of the simplest methods of making a proper
diagnosis is a ________
wet film examination
The two most common causes of vaginal discharge
are _______ and ________
physiological discharge and infective vaginitis.
Normal physiological discharge is usually milky-white or clear mucoid and originates from a combination of the following sources: 1 2 3 4 5
• cervical mucus (secretions from cervical glands)
• vaginal secretion (transudate through vaginal
mucosa)
• vaginal squamous epithelial cells (desquamation)
• cervical columnar epithelial cells
• resident commensal bacteria
The predominant bacterial flora in vaginal dc are _________ which produce lactic acid from glucose derived from the epithelial cells
lactobacilli,
Other commensal bacteria in vaginal dc include
1
2
3
staphylococci, diphtheroids and streptococci
T or F
With physiological discharge there is usually no
odour or pruritus.
T
The commonest cause of infective vaginitis is
______________ which
accounts for 40–50% of cases of vaginitis
bacterial vaginosis (formerly bacterial vaginitis, Gardnerella vaginalis or Haemophilus vaginalis )
________ is the causative agent in 20–30% of cases
while ________causes about 20% of cases
in Australia.
Candida albicans
Trichomonas vaginalis
_______ infection of
vaginal epithelium may cause excess discharge
Human papilloma virus
________ of the cervix or vaginal vault may
cause a bloody or brownish discharge
Endometriosis
A mucopurulent discharge appearing from the________may be the clue to an STI such as Chlamydia and gonorrhoea
endocervix
_______ infection may not show the characteristic
curds, ‘the strawberry vagina’ of ________ is
uncommon and bubbles may not be seen.
Candida
Trichomonas
___________ is useful in removing the discharge
and mucus to enable a clearer view of the cervix and
vaginal walls
Acetic acid 2%
_______add a drop of 10% KOH to
vaginal secretions smeared on glass slide
Amine or ‘whiff’ test
Most newborn girls have some mucoid white vaginal
discharge. This is normal and usually disappears by
________
3 months of age.
_________ is the most common gynaecological
disorder of childhood, the most common cause being
a non-specific bacterial infection
Vulvovaginitis
Tx of vulvovaginitis
local oestrogen cream or tablet (e.g. Vagifem).
The tablet is preferred as it is less messy
or
zinc and castor oil soothing cream
Vaginal candidaiasis
with the widespread use
of over-the-counter antifungals, resistant nonalbicans
species, such as________, ______ and ______ are becoming more
common
C. glabrata (in particular),
C. parapsilosis and C. tropicalis
SSx of Vaginal candidaiasis
- Intense vaginal and vulval pruritus
- Vulval soreness
- Vulvovaginal erythema (brick red)
- Vaginal excoriation and oedema
- White, curd-like discharge (see FIG. 106.3 )
- Discomfort with coitus
- Dysuria
Factors predisposing to vaginal
candidiasis
Endogenous 1 2 3 4
- Diabetes mellitus
- AIDS syndrome
- Pregnancy
- Debilitating diseases
For the first attack of candidiasis it is appropriate
to select one of the range of vaginal azoles therapies
(clotrimazole, butoconazole, miconazole) for_____
1–7 days
________ is best reserved for recurrent cases or
if there is local reaction to the azoles
Nystatin
______ (0.5% aqueous solution) is useful
for rapid relief, if available
Gentian violet
Recommended initial regimen for vaginal candida
clotrimazole 500 mg vaginal tablet as a single
dose or 100 mg for 6 nights
±
clotrimazole 2% cream applied to vulvovaginal
and perineal areas 8–12 hourly (for symptomatic
relief)
An alternative regimen, especially for recurrent
infections with vaginal candida
nystatin pessaries twice daily for 7 days
and/or
nystatin vaginal cream (100 000 U per 5 g) twice
daily for 7 days
If patient intolerant of vaginal therapy, use
_______
fluconazole 150 mg (o) as a single dose
Recalcitrant cases (proven by microscopy and if not pregnant) or recurrent and chronic cases
fluconazole 50 mg (o) once daily
or
itraconazole 100 mg (o) once daily
The time to achieve remission for vaginal candidiasis varies from _______
2 weeks to 6 months
T or F
vaginal candida
A male sexual partner does not usually
require treatment
T
How to Tx male partner if with candida
If symptomatic (usually balanitis
in an uncircumcised male), treat with clotrimazole
1% + hydrocortisone 1% topically, 12 hourly until
2 weeks after symptoms resolve
________ is the commonest non-albicans
species, which exhibit reduced susceptibility to
azoles.
Toruloposis glabrata
In preparing for the antifungal preparation,
use_______
1–3% acetic acid or sodium bicarbonate
solution (1 tablespoon to 1 litre of water).
This flagellated protozoan, which is thought to originate
in the bowel, infects the vagina, Skene’s ducts and lower
urinary tract in women and the lower genitourinary tract
in men
Trichomonas vaginalis
Ssx of trichomonas vaginalis
Profuse, thin discharge (grey to yellow–green in
colour)
• Small bubbles may be seen in 20–30%
• Pruritus
Appearance of cervix in trichomonas
- Diffuse erythema of cervix and vaginal walls
* Characteristic punctate appearance on cervix
Tx of trichomonas?
oral metronidazole 2 g as a single dose
(preferable) or 400 mg bd for 5 days (if relapse)
or
tinidazole 2 g as a single dose
Tx of Trichomonas
T or F
• The sexual partner, whether male or female,
must be treated simultaneously
T
Tx of Trichomonas
For resistant infections a ______ course of either
metronidazole or tinidazole may be necessary
3–5 day
_______ is a clinical entity of mixed
aetiology characterised by the replacement of the
normal vaginal microflora (chiefly Lactobacillus )
with a mixed flora consisting of Gardnerella vaginalis,
other anaerobes such as Mobiluncus species, and
Mycoplasma hominis. This accounts for the alkalinity
of the vaginal pH.
Bacterial vaginosis
Findings on Amine Whiff Test for BV
• Liberates an amine-like, fishy odour on
admixture of 10% KOH (the amine whiff test)
• Clue cells
Tx of BV
metronidazole 400 mg (o) bd for 7 days
(or 2 g stat)
or
0.75% vaginal gel applied at bedtime for 5 days
____________ can be used for resistant infections
or during pregnancy
Clindamycin 300 mg (o) bd for 7 days or 2%
clindamycin cream
__________ is a commensal
in up to 40% of healthy humans. It is a problem
if detected in the pregnant woman because of
serious infection in the neonate
Group B Streptococcus ( S. agalactiae )
GBS
Tx In certain at-risk circumstances, such as premature rupture of the membranes or a previous infected neonate
benzylpenicillin 1.2 g IV stat, then 600 mg IV
4 hourly until delivery
GBS
In the non-pregnant woman give amoxycillin
____________ if there is significant
pyogenic infection
500 mg (o) tds for 7 days
________which may be impacted and cannot
be removed by the patient, is usually associated with
an extremely offensive vaginal discharge
A retained tampon,
This rare, dramatic condition is caused by the
production of staphylococcal exotoxin associated
with tampon use for menstrual protection. The
syndrome usually begins within 5 days of the onset
of the period
Tampon toxic shock syndrome:
staphylococcal infection
SSx of Tampon toxic shock syndrome:
staphylococcal infection
The clinical features include sudden onset fever,
vomiting and diarrhoea, muscle aches and pains, skin
erythema, hypotension progressing to confusion,
stupor and sometimes death
