Vaginal Disorders

Question 1

Clinical presentation of vulvovaginal candidiasis?

Answer 1

• vulvar pruritus, external dysuria, burning, dyspareunia, swelling, redness, excoriation
• thick, curd-like discharge
• nl vag pH <4.5

Question 2

RFs for vulvovaginal candidiasis?

Answer 2

• abx

- immunocompromised

Question 3

How do you dx vulvovaginal candidiasis?

Answer 3

clinically

can do:

• wet prep (KOH- budding yeast)
• culture

Question 4

Tx of uncomplicated vulvovaginal candidiasis?

in pregnancy?

Answer 4

short course (1-3 days) topical azole
or single dose fluconazole

Pregnant:
7 days topical azole
or single dose fluconazole

Question 5

A female pt is dx w/ vulvovaginal candidiasis, do you need to treat her male partner?

Answer 5

NO- they don’t need tx unless he has balanitis

Question 6

Clinical presentation of BV?

Answer 6

• vaginal irritation

- thin white or gray discharge w/ strong fishy odor (“amine”)

Question 7

RFs of BV?

Answer 7

• new or multiple sex partners
• douche
• rare in pts who have never had sex

Question 8

Diagnostic criteria for BV

Answer 8

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)

Question 9

Bacteria that normally cause BV?

Answer 9

polymicrobial

usu. Gardnerella vaginalis & Mobiluncus

Question 10

What pts do you tx w/ BV and what do you treat w/?

Answer 10

Treat all pts w/ sx

-Metronidazole (Flagyl) oral x7 days (no EtOH)
or
-Metronidazole gel intravaginally x5 days

Question 11

In pregnant women w/ BV, what do you use to tx?

Answer 11

oral flagyl or clindamycin

Question 12

Complications of BV

Answer 12

• increased risk of STD
• association w/ PID
• persistent or recurrent BV

Question 13

What is the cause of atrophic vaginitis?

Answer 13

• loss of estrogen -> epithelial thinning of vulva, vagina, & bladder
• loss or elasticity of connective tissue -> vagina shortening/narrowing

Question 14

Clinical presentation of atrophic vaginitis

Answer 14

• dyspareunia
• post-coital bleeding
• leukorrhea
• burning, raw, dry sensation
• urinary sx

Question 15

PE findings of atrophic vaginitis

Answer 15

• loss of rugae
• pale
• purulent vag discharge
• ph > 5

Question 16

Tx of atrophic vaginitis

Answer 16

1st line= OTC vaginal moisturizer

• mechanical tx
• Vaginal estrogens
• vaginal prasterone (DHEA)
• Ospemifene (SERM)

Question 17

What has to be present in order to develop VAIN?

Answer 17

HPV!

Question 18

RFs of VAIN?

Answer 18

SAME AS CIN
(smoking, multiple sex partners, early sexual activity)
-hx of CIN III

Question 19

Is frequency and progression to invasive CA from VaIN more or less high compared to CIN?

Answer 19

Less

Question 20

What are the classifications of VaIN?

Answer 20

1: benign viral proliferation
2: intermediate risk
3: true precursor to vaginal CA

Question 21

What dx studies are done for VaIN?

Answer 21

• detection w/ Pap

- Colposcopy

Question 22

Management for VaIN 1

Answer 22

• Obs is ok in younger women

- cytology/HPV/colposcopy every 6 mo

Question 23

Tx for VaIN 2/3?

Answer 23

• surgical intervention (Vaginectomy, Laser vaporization)

- topical chemotherapy

Question 24

Is invasive cancer from metastasis from endometrium, ovary, or cervix considered vaginal cancer?

Answer 24

NO. Primary site off growth has to be from vagina

Question 25

Clinical presentation of vaginal CA

Answer 25

• asymptomatic
• leukorrhea
• vaginal odor
• post-coital bleeding
• abnormal Pap smear

Question 26

MC type of vaginal CA?

Answer 26

squamous cell

Question 27

MC age of vaginal CA?

Answer 27

> 50