Vaginal Disorders Flashcards
causative organism for vulvovaginal candidiasis (VVC)
Usu. Candida albicans
Can be caused by other Candida sp. or yeasts: Candida glabrata, Candida tropicalis, or Torulopsis glabrata
Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation
Thick, curd-like vaginal discharge
Normal vaginal pH <4.5
what dz?
VVC
risk factors of VVC
abx
immunocompromised
dx of VVC
consistent clinical px
VVC testing
Wet prep (saline & 10% KOH) with microscope visualization of budding yeast and hyphae
Candida culture
Normal vaginal pH (<4.5)
uncomplicated VVC tx
Short course (1-3 days) of topical (vaginal) azole, eg. clotrimazole (OTC)
what characterizes complicated VVC?
Recurrent (> 4 episodes in 1 yr),
OR
Severe, Non-albicans, Patient has uncontrolled DM or immune compromise
complicated VCC tx
7-14 days topical azole or oral fluconazole
If Non-albicans, avoid fluconazole
VVC during pregnancy tx
topical azole x 7 days
OR
single dose fluconazole
does the male partner need tx if pt has VVC?
Male partner doesn’t need treatment unless he has balanitis (inflammation of the skin covering the glans of the penis)
for what do you evaluate pts who have recurrent VVC or are difficult to tx?
DM
HIV
bacterial vaginosis causative organism
polymicrobial - often assoc. with Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)
Vaginal irritation, thin white or gray discharge with strong fishy odor
clinical px of what?
bacterial vaginosis
risk factors for bacterial vaginosis
New or multiple sex partners
Douche
Rarely affects women who have never been sexually active
bacterial vaginosis dx
3/4 Amsel’s criteria must be present
- 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)
Gram stain: Shows anaerobes known to cause BV & lack of Lactobacilli
Gold standard but not generally used clinically
bacterial vaginosis tx
Treat all pts with symptoms*
Metronidazole x 7 days*
Metronidazole gel intravaginally for 5 days
Clindamycin orally or intravaginally
Pregnant patients: Use oral medication
Sex partners: Routine treatment of male partners not recommended
May spread between female sex partners
what should you avoid when taking metronidazole?
alcohol
complications of bacterial vaginosis
Increases risk of acquiring & transmitting HIV
Increases risk of acquiring herpes, gonorrhea (GC) & chlamydia
Association with PID (?independent risk factor)
Persistent or recurrent BV is common
Loss of estrogen causes epithelial thinning involving the vulva, vagina and bladder
Symptoms of dryness
Loss of elasticity in connective tissue
Vagina shortening/narrowing
Pathophys of what condition?
atrophic vaginitis
Dyspareunia
Post-coital bleeding
Leukorrhea
Burning, raw, dry sensation
“feels like a yeast infection”
Urinary symptoms
clinical px of what?
Atrophoic vaginitis
physical exam of atrophic vaginitis
Vagina has loss of rugae
Pale – red coloring, petechiae
Purulent vaginal discharge, fissures or erosions
Wet mount: parabasal cells, decreased/absent lactobacilli
pH > 5
atrophic vaginitis tx
OTC vaginal moisturizer: Replens, etc, Contraindications to estrogen
Mechanical treatment
Vaginal Estrogens: Premarin or Estrace vaginal cream, Vagifem 10mcg twice weekly, Estring q 90 days
Vaginal prasterone (DHEA)
Ospemifene (Osphena) 60mg daily: SERM (Potential for thrombotic events)
Risk Factors of vaginal intraepihelial nepplasia (VAIN)
Same as CIN: Smoking, multiple sexual partners and early onset of sexual activity
History of CIN III: Unclear how CIN migrates to vagina
T/F: Some women with primary vaginal cancer have NO history of CIN III or cervical cancer
TRUE
HPV exposure
Development of VaIN following HPV exposure requires greater period of time
Frequency of VaIN is not as high as CIN since vaginal epithelium is different than cervical
VaIN progression to invasive cancer is lower than CIN to cervical cancer
Most lesions are located in the upper 1/3 of vagina
Patho of what?
VAIN
VAIN classification
benign viral proliferation
VAIN 2 classification
intermediate risk
VAIN 3 classification
true precursor to vaginal cancer
VAIN Dx
pap smear (cytology) for detection
colposcopy
VAIN 1 mgmt
Observation is justified in younger women
Cytology/HPV/Colposcopy Q 6 months
VAIN 2/3 mgmt
Surgical intervention vs. Topical chemotherapy
when is vaginectomy preferred for VAIN
Invasion suspected, women > 40ys, cytology and colposcopy differ and if extended sampling needed
Removes upper 1/3 of vagina
S/E’s: vaginal shortening, blood loss, need for skin graft and adverse sexual functioning
90% success rate
disadvantages of laser vaporization for VAIN
Inability to access lesions extending into vault or lesions within surgical scar from TAH and operator-dependent
VAIN mgmt
Topical chemotherapy / 5FU: Insert 2g PV x 5-7 nights: Apply zinc oxide in AM at introitus and vulva prior to application
Causes sloughing of vaginal epithelium
side effects of topical chemotherapy/5FU
S/E’s:
Dyspareunia, vaginal burning/ulceration/irritation
¡Only used if other treatment options are not feasible
¡Not FDA approved for this indication
what is the MCC of invasive vagina CA?
metastasis from endometrium, ovary or cervix
FIGO definition of vaginal CA
FIGO states only when the primary site of growth is from the vagina can it be called vaginal cancer
T/F: Squamous cell is the most common type of vaginal CA
True
Asymptomatic
Leukorrhea
Vaginal odor
Post-coital bleeding
Abnormal Pap smear
Colposcopy demonstrates acetowhite changes, punctation or mosaicism
Clinical px of what?
vaginal cancer
vaginal CA tx
Combination of vaginectomy and radiation
