Vaginal/Dysuria Flashcards
Etiology of candida
C. albicans (90%)
C. garbralta
C. tropicalis
White, curdy DC that adheres to vaginal walls
Candida
Tx for candida
Fluconazole or any vaginal azole (3-7 d)
Tx for recurrent candida
Inductions with vaginal azole (4-7d)
or fluconazole PO (1,3,7)
Maintenance: fluconazole weekly or clotrimazole intravag weekly
Tx for severe candida
nductions with vaginal azole (4-7d)
or fluconazole PO (1,3,7)
Maintenance: fluconazole weekly or clotrimazole intravag weekly
+ low potency topical steroid
Tx for non albicans candida
Nonfluconazole azole (posaconazole)
NS: 5-10 WBC/HPF + Lactobacilli
KOH: Pseudohyphae/ yeast buds
Candida
Tx for desquamative inflammatory vaginitis
2% clindamycin intravag
10% hydrocortisone
(4-6 weeks)
Bacterial Vaginosis
G. Vaginalis **
Prevotella
Mobiluncus
M. hominis
grey/white, thin, homogenous, fishy smell
Bacterial Vaginosis
NS: 1-3 WBC/HPF , decreased lacto, increased bacteria, clue cells
pH >4.5
Bacterial Vaginosis
Tx for bacterial vaginosis
Metronidazole oral/gel or
Clindamycin cream
green/yellow, thin, frothy, malodorous
Trichomonas
NS: >10 WBC/HPF , Trichomonads, decreased lacto
Trichomonas
Diagnostics for Trichomonas
PCR assay
Affirm VPII
OSOM rapid trichomonas test
Diagnostic for Bacterial Vaginosis
Culture of no value.
Affirm VP III
OSOM blue BV test
Tx of Trichomonas
Metronidazole PO
Tindazole PO
NS: >10 WBC/HPF , intracellular diplococci (GC)
Gonorrhea Chlamydia
Diagnostics for gonorrhea Chlamydia
CT/GC NAAT (nucleic acid amplification test)
Tx for Chlamydia
Azithromycin
or Doxycycline
Tx for Gonorrhea
Ceftriaxone IM AND Azithromycin PO
Cefixime PO or Azithromycin PO (test for cute 7 d)
Partner Treatment
Trichomonas
Gonorrhea
Chlamydia
Etiology of UTI
E. Coli
Klebsiella
Proteus
S. Saphro
vaginal fluid is bactericidal at pH
4.5
Tx of UTI
- Trimethoprim and sulfamethoxazole (Septra) PO
- Nitrofurantoin (microbic, Macrodantin)
- Fosftomycin (Moonurol)
- Fluroquinolones (Ciprofloxacin and Levofloxacin) - resistance/allergy
Tx of UTI for children
Cefixime (Supra) -daily Cefdinir (Omnicef) - daily Ceftibuten - daily x10 with fever x3-5 without fever
Symptom relief for UTI
Phenazopyridine (Pyridium) AZO
Recurrent UTI
Nitrofurantoin
TMP-SMX DS
Cephalexin
Ciprofloxacin
Tx of pyelonephritis
Fluroquinolones (Ciprofloxacin/Levofloxacin)
Cytoscopy
assess presence of bladder glomerulations or bladder wall hunter’s ulcers
Medications for IC/BPS
Amitriptyline (Elavil)
Pentosan polysufate sodium (Elmira)
Hydrazine (Atarax)
Lactobacilli
Metabolizes glycogen substrates into lactic acid
Lactic acid
Maintains vaginal pH between 3.5 -4.5 restricting overgrowth
Estrogen
Induces formation of mature squamous epithelium rich in glycogen