Vaginal Infections Flashcards
What is the main type of candida vaginitis infection?
Albicans
What is the main classification of vaginal infections?
Bacterial vaginosis
What are predisposing factors to candidiasis?
Antibiotic therapy Corticosteroid therapy Diabetes Oral contraceptives Pregnancy Immunodeficiency disorder Use of vaginal oils
Clinical manifestations of candidiasis:
Pruritus Erythema Edema Satellite pustules White, curd-like discharge
Candidiasis diagnosis:
Normal vaginal ph
Koh prep. (Standard office procedure)
Culture- only for patients who have been refractory to treatment (in reproduction of yeast look for budding and mycelia formation)
What are preventative measures for candidiasis?
Avoid bubble baths Avoid douching Avoid use of vaginal oils Wear cotton undergarments (better aeration) Careful hygiene (corn starch to avoid moisture)
What is the treatment for candidiasis?
Topical antifuncal agents
- miconazole-OTC
- clotrimazole- OTC
- terconazole-prescription
Oral anti-fungal agents
-fluconazole (2 tablets, 1 initially then wait)
What is the treatment for recurrent candidiasis infections?
use of topical or oral agent monthly
use oral medication weekly x 12 weeks
use oral medication daily
Trichomoniasis
STD
Incubation period is 4-28 days
highly contagious (75% chance)
What are the clinical manifestations of trichomoniasis?
Frequency Dysuria Dyspareunia Erythema Pruritus YELLOW-GREEN FROTHY DISCHARGE Punctate cervical hemorrhages Vaginal pH >4.5 Strawberry cervix
How do you diagnose trichomoniasis?
Pap smear
Saline prep- only thing moving besides sperm
Culture- rarely used in clinic
What is the treatment for trichomoniasis?
drug of choice is metronidazole
single 2 gm dose (4 tablets, 500mg)
-250 mg TID x 7 days
-500 mg BID x 7 days
Sexual partner is treated too
CONSIDER CONDOMS UNTIL PARTNER IS TREATED
Does trichomoniasis affect infertility?
no
What is the most common vaginal infection?
BV, multiple organisms
What is the most common bacterial vaginosis?
anaerobes
What is the pathophysiology of bacterial vaginosis?
results from a disruption of normal lacto bacilli dominant flora- elevation of pH and overgrowth of anaerobes
What are causes of bacterial vaginosis?
menses douching use of lubricants intercourse antibiotic exposure
What are the clinical manifestations of bacterial vaginosis?
Thin gray discharge
PROMINENT VAGINAL ODOR
minimal inflammation
no pruritus
How do we diagnose bacterial vaginosis?
Vaginal pH > 4.5
Positive amine test- whiff test, KOH on secretions and smell
Positive saline microscopy
What do we look for in the saline microscopy for bacterial vaginosis?
the studding of the epithelial surface by multiple organisms
What are complications of bacterial vaginosis?
PID PPROM- premature rupture of the membrane Post operative infection Preterm delivery Chorioamnionitis Endomertiosis
Why do we have to be cautious of bacterial vaginosis?
It can cause serious systemic problems
How do we treat bacterial vaginosis?
Topical metronidazole - once daily x 5 days at bed time
- more expensive
- less likely to prevent systemic complications of BV
- **ORAL METRONIDAZOLE - 500 mg twice daily for 7 days
- less expensive
What can you not do while on metronidazole?
drink
What are the clinical manifestations of a bartholins gland cyst?
pain
swelling
palpable mass
What are the clinical manifestations of a bartholins gland abscess?
fever pain swelling erythema fluctulant mass purulent drainage
What are the dominant oragnisms that form bartholins gland abscesses?
gonorrhe
chlamydia
coliforms
anaerobes
What are the clinical manifestations of a bartholins gland tumor?
swelling
firm, indurated mass
What is the most likely bartholins gland tumor?
adenocarcinoma, uncommon if younger than 50
How do we diagnose a bartholins gland cyst?
drainage and sitz baths, marsupialization
How do we diagnose a bartholins gland adscess?
drainage, abx, sitz bath
marsupialization
How do we diagnose a bartholins gland tumor?
biopsy
excision
What is the technique for drainage of a bartholins gland mass?
using a words catheter
What antibiotics do we use to treat a bartholin’s gland abscess?
Doxycycline (100mg BID) PLUS metronidazole (500mg BID)
Amoxicillin PLUS clavulanic acid (875 mg BID)
