vaginal disorders Flashcards
vaginal cancer epidemiology?
Rare → 1% of gyn malignancies → Usually secondary to another cancer
peak incidence of vag ca
60-65 yo
types of vag ca
Squamous Cell → 95%
Clear cell if DES exposure in utero
DES (Diethylstilbestro: estrogen)
s/sx of vag ca
Asymptomatic
Changes in menstrual period
Abnormal vaginal bleeding
Vaginal discharge
tx of vag ca
radiation
vulvar ca types
90% squamous
rf for vulvar ca
HPV 16, 18, 31
linked to DES exposure
when is peak incidence of vulvar cancer
50 yo
s/sx of vulvar ca
Pruritus → Most Common Presentation → Vaginal itching, irritation
Asymptomatic (20%)
Post-coital bleeding
Vaginal discharge
dx of vulvar ca
Red/White ulcerative, crusted lesions → Biopsy
tx of vulvar ca
Surgical Excision, radiation therapy, chemotherapy (Ex: 5FU)
types of infection vaginitis
Bacterial vaginosis, Trichomoniasis, Candida, Cytolytic
types of atrophic vaginitis
postmenopausal, allergic rxn
bacterial vaginosis PP
Decreased Lactobacillus acidophilus → Normally maintains vaginal pH → Overgrowth of normal flora such as GARDNERELLA VAGINALIS, anaerobes (Mobiluncus, Peptostreptococcus)
Most Common cause of vaginitis
bacterial
s/sx of bacterial vag
Vaginal odor worse after sex
+ Pruritus
> 50% asymptomat
vag d/c in bacterial vag
Copious discharge
Thin, homogenous, watery
→ GREY-WHITE with “FISH ROTTEN” smell
vag pH in bacter vag
> 5
whiff test results in bac vag?
Positive → Fishy Odor
10% KOH Prep
microscopic results ofBV
clue cells, few WBC, few lactobacili
what are clue cells?
epithelial cells covered by bacteria
tx of BV
METRONIDAZOLE (Flagyl) x 7 days → Gel or PO
Safe in pregnancy
CLINDAMYCIN → Gel or PO
preventing BV
Avoid douching → Promotes loss of Lactobacilli
Treating partner unnecessary → Unclear if sexually transmitted but reduced recurrence if male uses condom
complications of BV
Pregnancy → PROM, PTL, chorioamnionitis
trichomoniasis PP?
TRICHOMONAS VAGINALIS → Pear shaped flagellated protozoa
Sexually transmitted
s/ sx of trich
Vulvar pruritus,
erythema,
dysuria
Dyspareunia
trich d/c?
Copious malodorous discharge
FROTHY YELLOW GREEN DISCHARGE
Worse with menses
what does the cervix look like in trich?
strawberry cervix!!
cervical petechiae
vag pH in trich?
> 5
whiff test in trich
+/- positive
what would you see microscopically in a trch infxn?
mobile protozoa on wet mount
wbc
tx of ttrick
METRONIDAZOLE (Flagyl)
2g oral dose x 1 dose
OR
500mg BID oral x 7 days
Safe in pregnancy
Oral preferredprevent trich
Spermicidal Agents → Ex: Nonoxynol 9 reduces transmission
MUST TREAT PARTNER
complications of trich
Perinatal complications
↑HIV transmission
candida PP
Candida albicans overgrowth → Part of normal flora due to change in normal vaginal environment (ex: use of abx)
what are RF for candida?
↑ with DM, steroid, pregnancy
s/sx of candida
Vaginal & vulvar erythema, swelling, burning, pruritus,
Burning when urine touches skin
Dysuria
Dyspareunia
candida d/c?
THICK CURD-LIKE/COTTAGE CHEESE DISCHARGE
vag pH in candida
normal (3.8-4.2)
what will you see microscopically with candida?
hypae, yeast, and posrts on KOH wet prep
tx of candida?
FLUCONAZOLE (PO x 1 dose)
what are types of intravaginal antifungals
Clotrimazole, Nystatin
Butoconazole
Miconazole
prevention of candida
Keep vagina dry, 100% cotton underwear, avoid tight-fitting clothes, avoid use of feminine deodorants & bubble baths
what is cytolytic vaginitis
Overgrowth of LACTOBACILLI
s/sx of vaginitis
Vaginal or vulvar pruritus & burning
Dysuria
cytolyitc vaginitis d/c?
non-odorous d/x white to opaque
cytolytic vaginitis ph?
normal
what will you see microcoscopically in cytolytic vag?
copious lactobacili
large # of epithelial cells
