VAGINAL INFECTIONS

Question 1

Normal vaginal ph

Answer 1

pH 3.8 to 4.5 is normal

Question 2

Anything that disrupts the normal vaginal pH will lead to

infections of the genital tract!

Answer 2

o Alkaline pH (>4.5) will favor BACTERIAL VAGINOSIS and
TRICHOMONAS

o Acidic pH (<3.8) will favor fungi growth
CANDIDA

Question 3

Describe the normal secretion of the vagina

Answer 3

white, floccular, odorless

Question 4

Discharge: Gray-white

• Usually noted after
intercourse

Answer 4

Bacterial

Vaginitis

Question 5

Discharge: Yellow-green bubbly

Answer 5

Trichomonas

Question 6

Discharge: White, curd-like

Answer 6

Candida

Vaginitis

Question 7

Discharge: Fishy

Answer 7

Bacterial

Vaginitis

Question 8

What is the treatment for Bacterial Vaginosis?

Answer 8

Nonpregnant women: 500 mg BID x 7 days OR 2 g orally single dose

Pregnant women: 500 mg PO BID x 7 days OR 250 mg PO
TID x 7 days

Alternative: Tinidazole

Question 9

Give the precautions of Metronidazole

Answer 9

do not take alcohol with
metronidazole to prevent the disulfiram-like reaction (nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort, and general hangover-like symptoms among others)

Question 10

Significance of having bacterial vaginosis in pregnant women

Answer 10

o Risk factor for PPROM

o Preterm labor

Question 11

Bacterial Vaginosis

Etiology

Answer 11

Gardnerella

vaginalis

Question 12

GIVE THE 4 CRITERIA in Diagnosis of BACTERIAL VAGINOSIS

Answer 12

Criteria for diagnosis:
1. Homogenous vaginal discharge
2. Discharge pH >4.5
3. Whiff test (+) – amine like odor
4. Clue cells > 20% of normal
vaginal epithelial cells on wet smear

Question 13

Diagnostics for Bacterial Vaginosis

Answer 13

WET SMEAR - clue cells (vaginal
epithelial cells with clusters of
bacteria adherent to the external
surfaces)

(+) Whiff test with KOH –> Amine like odor is observed

Question 14

Why does bacterial vaginosis occur?

Answer 14

Occurs when anaerobic
bacteria predominate over
lactobacilli in the vagina

Question 15

Etiology of Trichomoniasis

Answer 15

Trichomonas vaginalis

Question 16

Cause of trichomoniasis

Answer 16

Anything that alters acidic
vaginal environment: >4.5 Alkaline
menstruation, semen

Question 17

What condition creates “punctate hemorrhages” on the cervix?

Answer 17

Strawberry cervix (punctate
hemorrhages), dysuria

Question 18

What is seen on the wet smear of Trichomoniasis

Answer 18

Wet smear: flagellated, pearshaped protozoa

Question 19

T or F. You must treat the male partner in Trichomoniasis

Answer 19

T

Question 20

T or F. You must treat the male partner in Bacterial Vaginosis

Answer 20

F

Question 21

Risk factors of developing Mycotic Vaginitis aka Candidiasis

Answer 21

• Prolonged antibiotic intake
(depress normal flora of
the vagina)
• OCP intake
• Diabetes Mellitus
• Immunocompromised

Question 22

Besides White, curd like discharge,

cottage cheese how would you describe Candidiasis?

Answer 22

The discharge is non-foul
smelling, sticks to walls of
vagina

Question 23

Beefy, red vulva

Answer 23

Candidiasis

Discharge irritates vulva
causing pruritus vulvae

Question 24

Diagnosis for Candidasis

Answer 24

KOH smear: simplest diagnostic
test (see mycelia/hyphae)

Fungal culture - sobaraud’s or nickerson’s medium

Diabetes screening (esp. if
patient is obese): Hba1c

Question 25

Treatment for Candidasis

Answer 25

AZOLES
Fluconazole (oral)  150 mg single dose - SINGLE ORAL DOSE

If complicated:
a 2nd dose of Fluconazole (150 mg)
given 72 hours after 1st dose is recommended