VAGINAL INFECTIONS Flashcards
Normal vaginal ph
pH 3.8 to 4.5 is normal
Anything that disrupts the normal vaginal pH will lead to
infections of the genital tract!
o Alkaline pH (>4.5) will favor BACTERIAL VAGINOSIS and
TRICHOMONAS
o Acidic pH (<3.8) will favor fungi growth
CANDIDA
Describe the normal secretion of the vagina
white, floccular, odorless
Discharge: Gray-white
• Usually noted after
intercourse
Bacterial
Vaginitis
Discharge: Yellow-green bubbly
Trichomonas
Discharge: White, curd-like
Candida
Vaginitis
Discharge: Fishy
Bacterial
Vaginitis
What is the treatment for Bacterial Vaginosis?
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
Give the precautions of Metronidazole
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)
Significance of having bacterial vaginosis in pregnant women
o Risk factor for PPROM
o Preterm labor
Bacterial Vaginosis
Etiology
Gardnerella
vaginalis
GIVE THE 4 CRITERIA in Diagnosis of BACTERIAL VAGINOSIS
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
Diagnostics for Bacterial Vaginosis
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
Why does bacterial vaginosis occur?
Occurs when anaerobic
bacteria predominate over
lactobacilli in the vagina
Etiology of Trichomoniasis
Trichomonas vaginalis
Cause of trichomoniasis
Anything that alters acidic
vaginal environment: >4.5 Alkaline
menstruation, semen
What condition creates “punctate hemorrhages” on the cervix?
Strawberry cervix (punctate hemorrhages), dysuria
What is seen on the wet smear of Trichomoniasis
Wet smear: flagellated, pearshaped protozoa
T or F. You must treat the male partner in Trichomoniasis
T
T or F. You must treat the male partner in Bacterial Vaginosis
F
Risk factors of developing Mycotic Vaginitis aka Candidiasis
• Prolonged antibiotic intake (depress normal flora of the vagina) • OCP intake • Diabetes Mellitus • Immunocompromised
Besides White, curd like discharge,
cottage cheese how would you describe Candidiasis?
The discharge is non-foul
smelling, sticks to walls of
vagina
Beefy, red vulva
Candidiasis
Discharge irritates vulva
causing pruritus vulvae
Diagnosis for Candidasis
KOH smear: simplest diagnostic
test (see mycelia/hyphae)
Fungal culture - sobaraud’s or nickerson’s medium
Diabetes screening (esp. if patient is obese): Hba1c
