Vaginal Disorders Flashcards
Clinical presentation of vulvovaginal candidiasis?
- vulvar pruritus, external dysuria, burning, dyspareunia, swelling, redness, excoriation
- thick, curd-like discharge
- nl vag pH <4.5
RFs for vulvovaginal candidiasis?
- abx
- immunocompromised
How do you dx vulvovaginal candidiasis?
clinically
can do:
- wet prep (KOH- budding yeast)
- culture
Tx of uncomplicated vulvovaginal candidiasis?
in pregnancy?
short course (1-3 days) topical azole or single dose fluconazole
Pregnant:
7 days topical azole
or single dose fluconazole
A female pt is dx w/ vulvovaginal candidiasis, do you need to treat her male partner?
NO- they don’t need tx unless he has balanitis
Clinical presentation of BV?
- vaginal irritation
- thin white or gray discharge w/ strong fishy odor (“amine”)
RFs of BV?
- new or multiple sex partners
- douche
- rare in pts who have never had sex
Diagnostic criteria for BV
Amsel’s criteria: at least 3 of the 4 present
- thin white homogenous discharge that coats vag walls
- Clue cells on microscopy
- vaginal fluid pH > 4.5
- release of fishy odor when adding KOH solution (+whiff test)
Bacteria that normally cause BV?
polymicrobial
usu. Gardnerella vaginalis & Mobiluncus
What pts do you tx w/ BV and what do you treat w/?
Treat all pts w/ sx
-Metronidazole (Flagyl) oral x7 days (no EtOH)
or
-Metronidazole gel intravaginally x5 days
In pregnant women w/ BV, what do you use to tx?
oral flagyl or clindamycin
Complications of BV
- increased risk of STD
- association w/ PID
- persistent or recurrent BV
What is the cause of atrophic vaginitis?
- loss of estrogen -> epithelial thinning of vulva, vagina, & bladder
- loss or elasticity of connective tissue -> vagina shortening/narrowing
Clinical presentation of atrophic vaginitis
- dyspareunia
- post-coital bleeding
- leukorrhea
- burning, raw, dry sensation
- urinary sx
PE findings of atrophic vaginitis
- loss of rugae
- pale
- purulent vag discharge
- ph > 5
Tx of atrophic vaginitis
1st line= OTC vaginal moisturizer
- mechanical tx
- Vaginal estrogens
- vaginal prasterone (DHEA)
- Ospemifene (SERM)
What has to be present in order to develop VAIN?
HPV!
RFs of VAIN?
SAME AS CIN
(smoking, multiple sex partners, early sexual activity)
-hx of CIN III
Is frequency and progression to invasive CA from VaIN more or less high compared to CIN?
Less
What are the classifications of VaIN?
1: benign viral proliferation
2: intermediate risk
3: true precursor to vaginal CA
What dx studies are done for VaIN?
- detection w/ Pap
- Colposcopy
Management for VaIN 1
- Obs is ok in younger women
- cytology/HPV/colposcopy every 6 mo
Tx for VaIN 2/3?
- surgical intervention (Vaginectomy, Laser vaporization)
- topical chemotherapy
Is invasive cancer from metastasis from endometrium, ovary, or cervix considered vaginal cancer?
NO. Primary site off growth has to be from vagina
Clinical presentation of vaginal CA
- asymptomatic
- leukorrhea
- vaginal odor
- post-coital bleeding
- abnormal Pap smear
MC type of vaginal CA?
squamous cell
MC age of vaginal CA?
> 50
