vaginal disorders Flashcards
vulvovaginal candidiasis (VVC) causitive organisms?
Candida albicans
also Candida glabrata, Candida tropicalis, or Torulopsis glabrat
Who gets VVC
At least 75% of women experience 1 episode
40-45% experience > 1 episode
clinical presentation of VVC
Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation
Thick, curd-like vaginal dc
Normal vaginal pH <4.5
RF’s for vulvovaginal candidiasis (VVC)
taking abx
immunocompromise
dx for VVC
Clinical (consistent)
testing: wet prep (saline & 10% KOH) --> buds and hyphae, candida culture, normal vag. ph (<4.5)
Tx for uncomplicated VVC
short course (1–3d) of topical vaginal azole (clotrimazole OTC)
Tx for VVC in pregnancy
Topical azole x 7 days or single dose fluconazole
Tx for complicated VVC
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
should male partner be tx’d if female partner has VVC
No unless he has balanitis
in pt’s w/recurrent or difficult to tx yeast infx’s eval for…
DM, HIV
BV causative organism
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)
clinical presentation of BV
Vaginal irritation, thin white or gray discharge with strong fishy odor
RF’s for BV
New or multiple sex partners, douche, rarely affects women who have never been sexually active
Dx of BV
clinical (Amsel’s criteria)
best LAB test = gram stain
what is Amsel’s criteria?
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)
Tx for BV
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
complications of BV
Increases risk of acquiring & transmitting HIV
Increases risk of acquiring herpes, gonorrhea (GC) & chlamydia
Association with PID
Persistent/recurrent BV common
what is atrophic vaginitis?
Loss of estrogen causes epithelial thinning involving the vulva, vagina and bladder (dryness)
loss of elasticity in connective tissue
clinical presentation for atrophic vaginitis
Dyspareunia, post-coital bleeding, leukorrhea, burning, raw, dry sensation, urinary symptoms
“feels like a yeast infection”
PE for atrophic vaginitis
Vagina has loss of rugae
Pale – red coloring, petechiae
Purulent vaginal discharge, fissures or erosions
Wet mount
pH > 5
Tx for atrophic vaginitis
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)
Vaginal intraepithelial neoplasia
incidence is 35-55
assoc. w/ CIN and squamous carcinoma of vulva/cervix
RF’s for Vaginal intraepithelial neoplasia (VAIN)
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
pathogenesis for VAIN
HPV exposure
most lesions upper 1/3 of vagina
lab/studies for VAIN
detection is via pap smear (cytology)
colposcopy
VAIN 1 managment:
Observation is justified in younger women
Cytology/HPV/Colposcopy Q 6 months
VAIN 2/3 management
Surgical intervention vs. Topical chemotherapy
tx for VAIN
Vaginectomy
Laser Vaporization
when should you use topical chemotherapy for VAIN
if other tx’s options are not feasible
Vaginal cancer
MCC of invasive CA is metastasis from endometrium, ovary or cervix
vaginal cancer clinical presentation
Asymptomatic Leukorrhea Vaginal odor Post-coital bleeding Abnormal Pap smea
vaginal cancer tx
no standard tx
Combination of vaginectomy and radiation
