Vaginal Disorders Flashcards
Vagina dryness and dyspareunia in 55 yo women. PE shows pale friable skin. DX? Tx?
Atrophic vaginitis
Topical estrogen cream/lubricants/moisturizers
White to transparent thick odorless vaginal discharge. Quantity increases with ovulation, pregnancy, and oral contraceptives. pH: 4-.45
Normal Vaginal Discharge
5 Causes of Candida vulvovaginitis?
recent ABX, DM, Increased estrogen levels (from pregnancy, OCP, estrogen therapy), Immunocomprimised irritants
Pt presents with pruritus, swelling of the vulva, and dysuria. PE shows erythema and edema of the vulva and thick white”cottage cheese” discharge. How do you dx? Tx?
Wet Mount with KOH prep shows budding yeast with hyphae = Candida Vulvovaginitis
Tx = 1 x dose fluconazole 150 mg PO or Intravaginal anti fungal both OTC and Rx, or Boric Acid 600 mg intravaginally x 21 days
What do you need to check for in cases of recurrent vulvovaginitis? (>4x / year)
DM + HIV, lower estrogen OCP, Tx: Flucanazole 150mg q week x 6 months
pH >4.5 and wet mount shows clue cells. What other sx do you expect to see? Tx?
+ Whiff test = Fishy odor w/ KOH = BV
Tx: Metrogel BID x 5 days or Cleocin Gel x 7 days or PO Metronidazole 500 BID x 7 days
What serious DI must you council your pts on when prescribing PO Metronidazole for BV?
Avoid ETOH! will cause nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath
Tx for recurrent BV? ( >3x/year)
Metronidazole 500 BID x 7 days AND Boric Acid 600 mg intravaginally x 21 days. Retest, if + add Metrogel 2x/week for 6 months
Pruritis, dysuria, dyspareunia. Strawberry cervix on PE. What other sx do you expect to see? How do you DX? Tx?
Sx = Copious purulent discharge, may be green and frothy Dx = Wet mount w/ saline shows motile trichomonads = Trichomonas Vaginalis Tx = No sex until all partners treated. Metronidazole 500 mg 4 tabs (2g) x 1 (no ETOH for 24 hr after tx)
How do you dx and TX Vaginal Intraepithelial Neoplasia?
DX = Colposcopy and bx Tx = excision, ablation, topical chemo, radiation of lesions
60 yo women w/ post menopausal bleeding? most common cause?
Vaginal Cancer until proven otherwise, metastatic dz = most common cause
Most common cause of dysuria
Lower UTI
UTI Tx? 3 options? What is a complicated UTI and how do you tx?
1) TMP-SMX
2) Fluroquinolone (Cipro)
3) Nitrofurantoin (Macrobid)
Floroquinolone x 7-14 days for complicated UTI: DM, elderly, Immunocomp, catheter, or reccurance
A 25-year-old woman with a recent history of antibiotic use presents to your office with a complaint of vaginal discomfort. For the past week she has been experiencing intense vaginal pruritus and has noticed a white discharge. What is the most appropriate next step in her management?
A single dose of 150 mg fluconazole
A 58-year-old woman with no significant medical history presents for an annual wellness physical. She says it has been 16 months since she had any menstrual bleeding and notes moderate vaginal discomfort that makes coitus difficult for her. Which of the following recommendations would be most appropriate for this patient?
Avoidance of vaginal intercourse
Prescribe a vaginal ring containing estradiol
Prescribe an oral conjugated estrogen preparation
Prescribe gabapentin taken nightly
Prescribe a vaginal ring containing estradiol
