Vaginal disorders

Question 1

VulvoVaginal Candidiasis (VVC) causative organism

Answer 1

Candida albicans

Question 2

VulvoVaginal Candidiasis Clinical presentation

Answer 2

1. Vulvar pruritis, external dysuria, burning
2. Thick, curd-like vaginal discharge
3. Normal vaginal pH <4.5

Question 3

VulvoVaginal Candidiasis Risk Factors

Answer 3

1. Abx

2. Immunocompromised

Question 4

VulvoVaginal Candidiasis testing

Answer 4

Wet prep: Saline & 10% KOH- Budding yeast and Hyphae

Question 5

VulvoVaginal Candidiasis treatment

Answer 5

1. Short course (1-3 days) Topical Vaginal Azole: Clotrimazole
2. Fluconazole (Diflucan)-1x

Question 6

VulvoVaginal Candidiasis treatment in pregnancy

Answer 6

Topical azole x 7 days or single dose fluconazole

Question 7

When would you treat the male partner in a yeast infection?

Answer 7

Balanitis: inflammation of the skin covering the glans of the penis

Question 8

Bacterial Vaginosis causative organism

Answer 8

Polymicrobial: Gardnerella vaginalis & Mobiluncus

Question 9

BV clinical presentation

Answer 9

1. Vaginal irritation
2. Thin white or gray discharge
3. Strong fishy odor

Question 10

BV Risk Factors

Answer 10

1. New or multiple sex partners
2. Douche
3. Rarely affects women who have never been sexually active

Question 11

BV clinical criteria

Answer 11

Amsel’s Criteria: 3 of 4

1. Thin white homogenous discharge
2. Clue cells on microscopy
3. Vaginal fluid pH > 4.5
4. Release of fishy odor when adding KOH solution (+ whiff test)

Question 12

What is the Gold standard test in BV?

Answer 12

Gram stain: Positive Gram anaerobes

Question 13

BV Treatment

Answer 13

Treat ALL pt’s with sx’s

Metronidazole (Flagyl)

Question 14

What does BV increase the risk of ?

Answer 14

1. Acquiring & transmitting HIV
2. Acquiring herpes, gonorrhea (GC) & chlamydia
3. Associated with PID

Question 15

Atrophic Vaginitis pathophysiology

Answer 15

1. Loss of estrogen causes:
   Epithelial thinning of vulva/vagina/bladder
2. Loss of elasticity in connective tissue

Question 16

Atrophic Vaginitis Clinical presentation

Answer 16

1. Dyspareunia
2. Post-coital bleeding
3. Leukorrhea
4. Burning, raw, dry sensation: “feels like a yeast infection”

Question 17

Atrophic Vaginitis Physical exam findings

Answer 17

1. Loss of rug in vagina

2. Pale: Red coloring, petechiae

Question 18

Wet mount findings in Atrophic Vaginitis

Answer 18

Parabasal cells

Decreased/absent lactobacilli

Question 19

Atrophic Vaginitis Treatment

Answer 19

1. OTC vaginal moisturizer
2. Vaginal Estrogens: Premarin or Estrace
3. Vaginal prasterone (DHEA)
4. Ospemifene (Osphena

Question 20

What has to be present in order to develop Vaginal Intraepithelial Neoplasia (VAIN)?

Answer 20

HPV

Question 21

VAIN Risk Factors

Answer 21

Same as CIN:

1. Smoking
2. Multiple sexual partners
3. Early onset of sexual activity

Question 22

VAIN 1 classification

Answer 22

Benign Viral Proliferation

Question 23

VAIN 2 classification

Answer 23

Intermediate risk

Question 24

VAIN 3 classification

Answer 24

True precursor to vaginal cancer

Question 25

VAIN labs/studies

Answer 25

1. Cytology: Pap smear

2. Colposcopy

Question 26

VAIN 1 treatment

Answer 26

1. Observation is justified in younger women

2. Cytology/HPV/Colposcopy Q 6 months

Question 27

VAIN 2/3 treatment

Answer 27

1. Surgical intervention: Vaginectomy, Laser Vaporization

2. Topical chemotherapy