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Foundations III-Women's Health > vaginal disorders > Flashcards

vaginal disorders Flashcards

1
Q

vulvovaginal candidiasis (VVC) causitive organisms?

A

Candida albicans

also Candida glabrata, Candida tropicalis, or Torulopsis glabrat

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2
Q

Who gets VVC

A

At least 75% of women experience 1 episode

40-45% experience > 1 episode

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3
Q

clinical presentation of VVC

A

Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation

Thick, curd-like vaginal dc

Normal vaginal pH <4.5

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4
Q

RF’s for vulvovaginal candidiasis (VVC)

A

taking abx

immunocompromise

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5
Q

dx for VVC

A

Clinical (consistent)

testing: 
wet prep (saline &amp; 10% KOH) --> buds and hyphae, candida culture, normal vag. ph (<4.5)
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6
Q

Tx for uncomplicated VVC

A

short course (1–3d) of topical vaginal azole (clotrimazole OTC)

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7
Q

Tx for VVC in pregnancy

A

Topical azole x 7 days or single dose fluconazole

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8
Q

Tx for complicated VVC

A

Recurrent (> 4 episodes in 1 yr), Severe, Non-albicans, Patient has uncontrolled DM or immune compromise

Tx w/ longer duration (7-14 days) topical azole or oral fluconazole (Diflucan)

If Non-albicans, avoid fluconazole

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9
Q

should male partner be tx’d if female partner has VVC

A

No unless he has balanitis

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10
Q

in pt’s w/recurrent or difficult to tx yeast infx’s eval for…

A

DM, HIV

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11
Q

BV causative organism

A

Results from disruption of usual, “healthy” vaginal microflora (Lactobacillus sp) - allows overgrowth of bacteria

Cause is usu. polymicrobial - often assoc. with Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)

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12
Q

clinical presentation of BV

A

Vaginal irritation, thin white or gray discharge with strong fishy odor

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13
Q

RF’s for BV

A

New or multiple sex partners, douche, rarely affects women who have never been sexually active

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14
Q

Dx of BV

A

clinical (Amsel’s criteria)

best LAB test = gram stain

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15
Q

what is Amsel’s criteria?

A

3 of 4:

Thin white homogenous discharge that smoothly coats vaginal walls

Clue cells on microscopy

Vaginal fluid pH > 4.5

Release of fishy odor when adding KOH solution (+ whiff test)

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16
Q

Tx for BV

A

tx all pt’s w/sx’s
Metronidazole (Flagyl) orally for 7 days*

Metronidazole gel intravaginally x5d

Clindaymycin orally or intravaginally

pregnant - use oral meds

17
Q

complications of BV

A

Increases risk of acquiring & transmitting HIV

Increases risk of acquiring herpes, gonorrhea (GC) & chlamydia

Association with PID

Persistent/recurrent BV common

18
Q

what is atrophic vaginitis?

A

Loss of estrogen causes epithelial thinning involving the vulva, vagina and bladder (dryness)

loss of elasticity in connective tissue

19
Q

clinical presentation for atrophic vaginitis

A

Dyspareunia, post-coital bleeding, leukorrhea, burning, raw, dry sensation, urinary symptoms

“feels like a yeast infection”

20
Q

PE for atrophic vaginitis

A

Vagina has loss of rugae
Pale – red coloring, petechiae
Purulent vaginal discharge, fissures or erosions

Wet mount

pH > 5

21
Q

Tx for atrophic vaginitis

A

OTC vaginal moisturizer
(Replens) if CI’s to estrogen

Mechanical tx (stretch tissue)

vaginal estrogens (premarin or estrace vag cream, vagifem, estring)

Vaginal prasterone (DHEA)

Ospemifene (SERM)

22
Q

Vaginal intraepithelial neoplasia

A

incidence is 35-55

assoc. w/ CIN and squamous carcinoma of vulva/cervix

23
Q

RF’s for Vaginal intraepithelial neoplasia (VAIN)

A

Same as CIN:
Smoking, multiple sexual partners and early onset of sexual activity

Some women with 1 degree vaginal CA have NO h/o CIN III or cervical cancer

24
Q

pathogenesis for VAIN

A

HPV exposure

most lesions upper 1/3 of vagina

25
Q

lab/studies for VAIN

A

detection is via pap smear (cytology)

colposcopy

26
Q

VAIN 1 managment:

A

Observation is justified in younger women

Cytology/HPV/Colposcopy Q 6 months

27
Q

VAIN 2/3 management

A

Surgical intervention vs. Topical chemotherapy

28
Q

tx for VAIN

A

Vaginectomy

Laser Vaporization

29
Q

when should you use topical chemotherapy for VAIN

A

if other tx’s options are not feasible

30
Q

Vaginal cancer

A

MCC of invasive CA is metastasis from endometrium, ovary or cervix

31
Q

vaginal cancer clinical presentation

A 
Asymptomatic
Leukorrhea
Vaginal odor
Post-coital bleeding
Abnormal Pap smea
32
Q

vaginal cancer tx

A

no standard tx

Combination of vaginectomy and radiation

Foundations III-Women's Health (13 decks)

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