Vaginal/Vulval conditions

Question 1

vaginal atrophy

Answer 1

Topical oestrogen (estradiol pessaries & vaginal rings), & estriol pessaries, cream, gel.
~ treat symptoms of vaginal atrophy related to oestrogen deficiency in postmenopausal women.
~ Systemic effects of oestrogen minimised by using lowest effective dose to control symptoms;
~ Treatment continued for as long as needed to relieve symptoms & reviewed initially at 3 months, then at least annually.

Question 2

Genital thrush tx

Answer 2

~ oral azole drug (fluconazole /itraconazole), or with intravaginal imidazole pessary or cream (e.g. clotrimazole or econazole)
~ add on topical antifungal cream for vulvitis and to treat other superficial sites of infection. Local irritation may occur on application of intravaginal imidazole drug preparations and may be mistaken for treatment failure.

Intravaginal imidazole drugs effective against candida in short courses of 1 to 14 days according to preparation used. Treatment can be repeated if initial course fails to control symptoms or if symptoms recur after 7 days.

Question 3

Genital thrush in pregnancy

Answer 3

intravaginal application of imidazole (clotrimazole).
~ need longer duration of tx, usually ~7 days.
~ limited systemic absorption of imidazole from vagina. Treatment with oral azole drug avoided during pregnancy !!
~ if recurrent = 6 moths tx

Question 4

Bacterial vaginosis tx

Answer 4

Metronidazole 2g single dose

Question 5

Vaginal trichomoniasis

Answer 5

Metronidazole 2g single dose

Question 6

Candidal vulvitis tx

Answer 6

external imidazole creams e.g. miconazole, clotrimazole

Question 7

Vaginal candida

Answer 7

imidazole pessary/internal cream e.g. clotrimazole
ORAL tx = fluconazole or Itraconazole