vaginal disorders Flashcards
Common causes of vaginitis
-bacterial vaginosis
-vulvovaginal candidiasis
-trichomoniasis
vulvovaginal candidiasis symptoms
pruritis, discomfort, dysuria, thick discharge(thick, clumpy), no change in pH
vulvovaginal candidiasis(VVC) microbiology
-disruption of host vaginal enviorment
-excessive yeast growth
vulvovaginal candidiasis(VVC) predisposing factors
-pregnancy
-high dose oral contraceptives
-estrogen therapy
-history of diabetes
-antibiotics
-immunosuppressed
Self screening kits
-used to identify elevations in pH
-NOT a diagnostic tool
-elevated pH>4.5 needs referral
-pretty accurate
Limitations of self screening kits
-must wait72 hours after using any vaginal preparation(spermacide, antifungal)
-must wait 48 hours after sexual intercourse
-must wait 5 days after menstrual period
uncomplicated VVC
-sporadic/infrequent
-mild to moderate symptoms
-likely to be C. albicans
-non-immunocomprimised
-Responds to short course treatment
Complicated VVC
-recurrent(>3 episodes/year)
-severe symptoms
-non-albicans candidiasis
-VVC in pregnant women, uncontrolled diabetes, immunosuppressed
-Should be evaluated by PCP. May need longer course of treatment/systemic treatment
Exclusions for self care of VVC
-pregnancy
-<12
-concurrent fever or pain in pelvis
-medications such as corticosteroids and antineoplastics
medical disorders(diabetes, HIV)
-recurrent VVC
-first episode
-bacterial vaginosis or trichomoniasis
OTC treatments of VVC
-vaginal antifungals(clotrimazole, miconazole, tioconazole): comes as cream, suppositories, tablets
Vaginal antifungal MOA
Alter fungi membrane permeability through decreased synthesis of
the fungal sterol ergosterol
duration of treatment for VVC
1, 3, or 7 days depending on treatment
Adverse effects of antifungals
-uncommon and generally mild
-burning, itching, irritation
-penile irritation and allergic reactions
-abdominal cramps
-headache
True or false: Cream and suppository antifungals strengthen latex condoms and diaphragms.
False. These medications are oil based and will weaken the material. Do not use for up to 3 days after therapy
Antifungal drug interactions
-limited systemic absorption
-possible interactions between miconazole suppositories and warfarin
Which antifungals should be used during lactation?
miconazole or clotrimazole
Application of vaginal antifungals
1) Lay down to reduce leakage
2)Wash vaginal area with mild soap and water, completly dry
3)vaginal cream: unscrew cap, attach to end of tube. Push down to break seal. Twist clockwise to move product into applicator.
4)Insert applicator as far as it will go comfortably.
5)Administer medication
Follow up recommendation for VVC
-symptoms persist >1 week after treatment
-symptoms recur within 2 months
-symptoms worsen or change
Antifungal pharmacodynamics
-relief within 3-7 days
-must complete full course
How long to wait before using tampon after antifungal treatment
Wait 3 days after treatment
Can antifungals still be used during a menstual period
yes. Continue as normal
Is it ok to have sex while using a vaginal medication?
No. wait 3 days
Non pharmacologic VVC
-sodium bicarb sitz bath
-prevention: yougurt(1 cup/day of live culture), decrease dietary sugars and refined carbs
Sodium bicarb sitz bath
-quick, temporary relief of vulvar irritation
-1 tsp of NA bicarb to 1 pint water
-Add 2-4 T. to 2 inches of bath water
-sit in bath for 15 min.
Why is the used of benzocaine and hydrocortisone products generally not recommended for VVC?
-may provide itching relief but does not treat underlying cause
-Generally not recommended
given benefits of imidazole
antifungals
Complementary therapies for VVC
1)lactobacillus preparations: limited evidence, might use for prevention
2)Tea tree oil: not effective
3)Gentian violet: sometimes used for resistant candida infections
4)Boric acid suppository: non-C. albicans infections, avoid in pregnancy
What is genitourinary syndrome of menopause(GSM)?
-vaginal atrophy: decreased lubrication and thinning of epithelium
-changes to genital, sexual, and urinary symptoms
Symptoms of GSM
-vaginal: dryness, dyspareunia, irritation, itching, tenderness, bleeding/spotting during intercourse
-Urinary: dysuria, urgency, frequency, nocturia, incontinence, Recurrent UTI’s
do not self treat GSM
-severe symptoms
-not localized
-dryness is not relieved by treatment
Treatments for GSM
-vaginal moisturizers and lubricants
