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Gen Med: Ob/gyn > Vaginal Disorders and STDs > Flashcards

Vaginal Disorders and STDs Flashcards

1
Q

what are the general characteristics of vaginitis

A
  1. Vaginal sx’s (abn. discharge, unpleasant odor, itching, & burning) common reasons for GYN eval
  2. Typically lead to Dx of:
    A. Bacterial vaginosis (BV)
    B. Parasitic vaginitis (trichomoniasis)
    C. Yeast vaginitis (vulvovaginal candidiasis; VVC)
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2
Q

What is the most common etiology of vaginitis?

A

Bacterial vaginosis (BV)

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3
Q

What is the ddx for vaginitis

A
  1. Candidiasis (VVC)
  2. Bacterial vaginosis
  3. Trichomoniasis
  4. Atrophic vaginitis
  5. Chemical (allergens)
  6. Foreign body
  7. Uterine abnormalities
  8. STDs
  9. Cervicitis
  10. Douching
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4
Q

What is vulvovaginal candidiasis?

A

Overgrowth of candida albicans (80-90% of cases)

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5
Q

What are the common sxs of vulvovaginal candidiasis?

A
  1. Vaginal burning & pruritus
  2. Vulvar erythema (fire engine red w/ satellite lesions)
  3. Contact dysuria (during urination)
  4. Thick, white cottage cheese like vaginal discharge
  5. Labia may be erythematous & edematous
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6
Q

How is vulvovaginal candidiasis dxed?

A
  1. Wet prep of NS (-) & KOH
  2. KOH -> (+) hyphae & buds (spores)
  3. Normal pH 4.5 (litmus paper remains yellow)
  4. Gold standard: vaginal culture; now have triple screen for yeast, BV, trich
    A. Affirm is a Nucleic acid (DNA) probe assay
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7
Q

How is vulvovaginal candidiasis treated?

A
  1. Imidazoles: fungal agents that interfere w/ production of cell wall
    A. Oral: Diflucan 150mg x 2 pills; stat & 3 days later prn
    B. Creams: Monistat, Terazol, Gyne-Lotrimin, etc.
    -1,3,7 day treatments
    C. Suppositories: as per creams
    -1,3,7 day treatments
    D. Rx & OTC
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8
Q

How is vulvovaginal candidiasis prevented?

A
  1. Cotton underwear helpful, loose fitting clothing;
    A. Synthetic or tight material holds moisture
  2. Keep vulva area as dry as possible
  3. Control underlying illness: DM, HIV, Obesity
  4. Low sugar diet
  5. If frequent VVC, think about changing OCP
  6. Prophylactic antifungals after Abx
  7. NO douching
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9
Q

What may chronic vulvovaginal candidiasis indicate?

A 
1. If frequently recurrent, R/O chronic disease:
A. DM
B. HIV
C. Urinary problems
D. Obesity
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10
Q

Define bacterial vaginosis

A
  1. Non-sexually-transmitted disorder
  2. Overgrowth of bacteria
  3. Most common cause of vaginitis sx’s in women of child bearing age
  4. No specific guidelines for prevention: may be same as candida guidelines
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11
Q

What bacteria can cause bacterial vaginosis?

A 
1. Many pathogens:
A. Mobiluncus sp
B. Gardnerella vaginalis
C. Anaerobic bacteria
D. Gm (-) bacteria
E. Peptostreptococcus sp
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12
Q

What are the sxs of BV?

A
  1. Thin white or gray vaginal discharge that is fishy or malodorous
  2. Minimal inflammation
  3. Usually non-irritating, can have itching & burning
  4. Recurrence is common
    A. May have 2° vaginal infection
    B. Use management strategies
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13
Q

How is BV tested for?

A
  1. Pap smear
  2. DNA probe (Affirm)
  3. Check pH
  4. NS wet prep
  5. KOH wet prep
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14
Q

How is BV dxed?

A
  1. Thin vaginal discharge
  2. (+) Whiff test –amine (“fishy”) w/ KOH prep
  3. (+) Clue cells: epithelial cells w/ borders obscured by the presence of excessive bacteria) on wet mount or PAP
  4. ↑ vaginal pH >4.5
  5. (+) Affirm probe
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15
Q

How is BV treated?

A
  1. Clindamycin Vaginal Cream 1 applicator PV hs x 3 or 7 days
  2. MetroGel Vaginal 1 applicator PV hs x 5 days (bid x 7 days )
  3. Metronidazole 500mg po bid x 7-10 days
  4. Clindamycin 300mg po bid x 7 days
  5. Tindemax (timidazole)
    2 gm po x 2 days (? CA)
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16
Q

What are the management/prevention strategies for BV?

A
  1. Condoms
  2. Longer Tx periods
  3. Aci-Jel (acid jelly) after Tx
  4. Immune system stimulators:
    A.Vit. C, Zinc, Echinacea qd
  5. Oral probiotics
  6. Monogamous relationship
  7. RePhresh lubricant
  8. Cotton underwear
  9. Loose fitting clothing
  10. Ice packs prn
  11. Sitz baths
  12. Good hygiene
  13. No douching
  14. No FB in vagina
  15. Estrogen supp for atrophic vaginitis
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17
Q

What are the sxs of chlamydia trachomatis?

A
  1. Most women w/ chlamydial infection have minimal or no symptoms
  2. +/- odorless, mucoid vaginal discharge, typically w/out external pruritus
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18
Q

How is chlamydia trachomatis dxed?

A

Diagnosed with GC/Chlamydia Cx

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19
Q

What are the complications of chlamydia?

A
  1. STD infects cervix & can cause conjunctivitis & PID
    A. May infect fetus (eyes) at birth
    B. Starts as cervical infection, but can ascend reproductive tract to endometrium & fallopian tubes -> PID & salpingitis
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20
Q

What are the complications of neisseria gonorrhea?

A
  1. Similar to Chlamydia, Neisseria gonorrhea can colonize at cervix & ascend to cause PID & salpingitis
  2. Can cause neonatal conjunctivitis
    A. Ophth. Erythromycin prophylaxis
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21
Q

How is neisseria gonorrhea dxed?

A
  1. Diagnosed with GC/Chlamydia Cx
  2. Gram stain
    A. Gonorrhea -> coffee bean shaped gm (-) intracellular diplococci
22
Q

How is GC/chlamydia treated?

A
  1. Treat partner
  2. Treat for both pathogens
    A. Ceftriaxone 250 mg IM
    +
    B. Azithromycin 1 gm po x 1 dose
    OR
    C. Doxycycline 100 mg po bid x 7 days
23
Q

Define Pelvic inflammatory disease

A

Due to infection that starts in cervix or vagina & ascends to endometrium or fallopian tubes leads to endometritis & salpingitis

24
Q

What are the most common causative organisms of PID?

A
  1. Neisseria gonorrhoeae 2. Chlamydia trachomatis
25
Q

What are the sxs of PID?

A 
1. Major criteria
A. lower abdominal pain
B. Lower abdominal tenderness
C. Cervical motion tenderness
D. Adenexal tenderness
E. Mucopurulent cervical discharge
2. Minor criteria
A. Fever over 38
B. Positive culture for GC or chlamydia
C. WBC over 10,000
D. Elevated CRP or ESR
26
Q

What are the potential sequelae of PID?

A
  1. Infertility
  2. Chronic pelvic pain
  3. Ectopic pregnancy
  4. Recurrent salpingitis
27
Q

What is the chandelier sign?

A

Sever cervical motion tenderness seen in PID

28
Q

How is PID treated?

A
  1. Ceftriaxone 250 mg IM

2. Doxycycline 100 mg PO bid x 14d

29
Q

How is trichomonas transmitted?

A
  1. STD
  2. Most common non-viral STD worldwide
  3. Enhances transmission of HIV infection
30
Q

What are the sxs of trichomonas?

A
  1. Can be asymptomatic up to 4 weeks
  2. Symptoms
    A. Vulvovaginal pruritus
    B. Dyspareunia
    C. Dysuria
    D. Pelvic discomfort
    E. pH >5.0
    F. Profuse frothy yellow or green discharge
    G. +/- malodorous
    H. Vaginal/cervical erythema w/ “strawberry spots” (punctate hemorrhages)
    I. Labial edema & tenderness
31
Q

How is trichomonas dxed?

A
  1. N/S wet smear: see mobile protozoa
  2. Affirm DNA probe
  3. OSOM Trichomonas rapid test (OSOM Trich)
    A. OTC
  4. Pap smear
  5. Obtain GC/chlamydia Cx & screen for viral STD’s
32
Q

How is trichomonas treated?

A
  1. Partner must be treated
  2. Tindemax (timidazole)
    A. 2 gm po x 1 dose
  3. Flagyl (metronidazole)
    A. 2 gm po x 1 dose
    B. 500mg po bid x 7 days
33
Q

What is chemical vaginitis caused by?

A
  1. Topical hygiene products: sanitary items/perfumed pads & tampons, spermacides, soaps, body washes, creams, detergents, clothing
  2. Allergens: cream bases for meds, latex
34
Q

What are the main sxs of chemical vaginitis?

A

intense itching, burning, inflammation, thin milky vag d/c, possibly hives

35
Q

How is chemical vaginitis treated?

A
  1. Remove offending agents
  2. Antihistamines
  3. Sitz baths
    A. Aveeno oatmeal soaks, sea salt
  4. Topical steroids or oral steroids
  5. Ice packs prn
  6. NSAIDs as directed prn
36
Q

Who most commonly gets atrophic vaginitis? why?

A
  1. Most common in menopausal women
  2. Low-estrogen state
    A. Thinning of vaginal mucosa
    B. Decreased vaginal lubrication
37
Q

What are common sxs of atrophic vaginitis?

A

Vaginal discomfort & dyspareunia

38
Q

What are common etiologies of atrophic vaginitis?

A
  1. Prepubertal
  2. Lactation
  3. Postmenopausal
  4. Chemotherapy
  5. Meds for breast cancer (anti-estrogen)
  6. Surgical menopause
39
Q

What are the pe results for atrophic vaginitis?

A
  1. Pelvic exam → pale mucosa & ↓ size of introitus & cervix
  2. Thin, dry tissue, w/ few rugae
    A. Easily traumatized
    B. Microtears, infections
  3. pH 5.0-7.0
  4. Wet mount shows no pathology
40
Q

How is atrophic vaginitis treated?

A
  1. Estrogen therapy
    A. Cream (Premarin, Estrace) nightly dose x 2 weeks, then 2-3 times per week x 2 weeks, then weekly
    B. Vaginal estrogen ring (Estring)-Insert 1 vaginal ring q three mo; change q 3 mo
    C. Vaginal tablet: (Vagifem): 1 tab PV hs x 2 weeks, then weekly thereafter
41
Q

When is estrogen therapy contraindicated?

A
  1. GYN cancers
  2. Breast cancer
  3. Thromboembolic Dz
42
Q

How is atrophic vaginitis managed?

A
  1. Vaginal lubricants w/ intercourse
  2. Vaginal moisturizers q 3-4 days:
    A. Replens, RePhresh, Luvena
  3. Avoid peripads or change frequently (urine can irritate issue)
  4. Be wary of chemicals/soaps in vulva area
  5. Cotton underwear
  6. Good hygiene w/water only: if odor, seek medical attention
  7. May take many months to improve; reassurance
  8. May need oral estrogen therapy for improvement
43
Q

What are common FB in the vagina?

A

Condom, tampon, pessary

44
Q

What are the sxs of a fb?

A
  1. Very malodorous vaginal d/c with color: greenish, brownish, reddish
  2. Intermenstrual spotting
  3. Will have regular periods
  4. Can have microulcerations
45
Q

What can a fb lead to if left in too long?

A

If present for a long period of time, can erode bladder or rectum

46
Q

How is a fb managed?

A
  1. Remove FB-method explanation
  2. Cultures if deemed appropriate
  3. Swab vagina with betadine if not allergic
47
Q

What meds may be needed after fb removal?

A
  1. Flagyl
  2. AVC cream
  3. Acid Jelly
  4. RePhresh
48
Q

Define Toxic shock syndrome

A
  1. Rare
  2. Clinical diagnosis
  3. Organism: Staph aureus
  4. Consider in women menstrating & using super absorbant tampons (withdrawn from market) or vaginal diaphragms
  5. Toxins gain access to circulatory system via vaginal microtears or ulcerations; retrograde menstruation
49
Q

What are the sxs of TSS?

A
  1. H/A
  2. High fever
  3. Hypotension
  4. Flu-like symptoms
  5. Strawberry tongue
    First 48 hours, diffuse sunburn-like rash then ↓ urine output, confusion, agitation then multisystem organ failure
    Can develop DIC (disseminated intravascular coagulation)
50
Q

How is TSS diagnosed?

A
  1. Clinical diagnosis
  2. Remove tampon first!
  3. Culture vagina
  4. CMP
  5. CBC
    A. Leukocytosis w/ left shift
    B. Thrombocytopenia
    C. Anemia
    D. +/- coag abnormailities
    E. Death usually in a few days from septic shock
51
Q

How is TSS treated?

A
  1. Admit to ICU
  2. IV antibiotics
  3. 3rd gen cephalosporins + ampicillin + vancomycin.
    A. Adding clindamycin or gentamicin ↓ toxin production & mortality
    B. Tissue debridement may be needed for necrotizing fasciitis
  4. Avoid highly absorbant or super/super plus tampons

Gen Med: Ob/gyn (13 decks)

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