Vaginal Infections Lecture Powerpoint Flashcards
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Pathogen most often responsible for bacterial vaginosis
Gardnerella vaginalis
KOH wet mount
Lab technique to view sample of discharge removed of skin cells but not fungus
Vaginal pH
> 5 indicates bacterial vaginosis or trichomonas infection
<4.5 indicates physiologic discharge or fungal infection
Atrophic vaginitis
Inflammation of vagina and outer urinary tract due to thinning of tissues due to lack of estrogen
Atrophic vaginitis symptoms
Dryness, itching, soreness, painful intercourse, sores and cracks, painful urination but no wbc in urine dip, incontinece
Atrophic vaginitis treatment
Vaginally administered estrogens
Lichen planus/psoriasis of vagina
Inflammatory, autoimmune disorder of skin and mucus membranes
Lichen planus/psoriasis of vagina symptoms
Glassy, bright red erosions and ulceration involving vulva and vagina
Lichen planus/psoriasis of vagina treatment
Corticosteroid ointment fluocinonide or clobetasol, or topical macrolide such as tacrolimus and pimecrolimus
Vulvovaginal candidiasis
Yeast of infection that affects all women from menarche to menopause, 40% of vulvovaginitis is caused by candida
Vulvovaginal candidiasis symptoms
- Intense vulvar itching
- Thick curd vaginal discharge
- erythema of vulva
- thick white patches
Intertrigonal candida infection
The spreading of a candida infection into the folds of skin creating a rash like appearance often under the breasts or in the thighs
1 cause of recurrent candida infections
Diabetes mellitus
Candida differential diagnosis (4)
- Trichomonas vaginalis
- Gonorrheal vaginalis
- Pinworm vaginitis
- contact dermatitis
Candida Lab studies
- KOH
- Culture
- Vaginal pH <4.5
Fluconazole (diflucan)
150 mg po once, preferred treatment for candida, works on C. albicans
Miconazole nitrate (monistat)
1 suppository at night x3, or cream at night x7, treatment for C. albicans
Butoconazole nitrate (femstat)
vaginal cream at night x3, treaetment for C. albicans
Terconazole (terazol)
1 suppository or vaginal cream at night x3, used for C. tropicalis
Nystatin
Used to treat C. glabrata
3 candida species and how they appear on wet mount
C. albicans - hyphae and buds
C. tropicalis - hyphae
C. glabrata - buds
Topical gentian violet
An aqueous solution painted onto the vagina weekly to treat candida infection and prevent their recurrence over a year by applying over 2-3 weeks but will shed purple into underwear
Watery, bad smelling discharge is characteristic of ____, while frothy, bubbling discharge is characteristic of ____
BV, trich
BV often co-occurs with…
yeast infections
BV signs and symtpoms
Unpleasant vaginal odor, thick grey white vaginal discharge
BV differential (6)
- N. gonorrhea
- Chlamydia
- Trichomonas
- e. coli
- staph
- fungal
Amsel’s diagnostic criteria for BV (3/4 of em)
- thin homogenous discharge
- fishy odor
- clue cells present on microscopy
- vaginal pH greater than 4.5
BV treatment (3)
- Metronidazole
- Clindamycin
- Metrogel
On azole treatment for BV, educate patients on…
…cannot drink alcohol on an azole
BV possible complications
- don’t treat in first trimester of pregnancy
- PID
- intrauterine infections
Trichomoniasis epidemiology
-often in young and middle aged adults, rare until onset of sexual activity
Trichomoniasis sypmtoms female
- strawberry cervix
- vaginal frothy discharge
- odor
Trichomoniasis symptoms male
- many asymptomatic
- urethral discharge
Trich risk factors
- multiple sex partners
- hot tubs
Trich differential
- vaginal candidiasis
- BV
- chlamydia urethritis
Trich labs
- Wet prep
- Vaginal pH >4.5
Trich DOC
metronidazole
