VAGINITIS

Question 1

General considerations of vaginitis

1. Definition
2. Causes
3. History should include

Answer 1

(1) Inflammation and infection of the vagina (common)
(2) Results from
(a) Pathogens
(b) Allergic reactions to vaginal contraceptives or other products
(c) Vaginal atrophy
(d) Friction during coitus
(3) History should include
(a) LMP
(b) Recent sexual activity and use of any latex products or lubricants
(c) Use of contraceptives, tampons, or douches
(d) Recent changes in medications or use of antibiotics

Question 2

Pertinent anatomy of vaginitis

Answer 2

(1) Vagina
(2) Vulva
(3) Cervix

Question 3

Signs and symptoms of vaginitis

Answer 3

(1) Vaginal irritation or pruritus
(2) Pain
(3) Unusual or malodorous discharge
(4) Bimanual exam may show
(a) Pelvic inflammation
(b) Cervical motion tenderness
(c) Adnexal tenderness

Question 4

Differential diagnosis of vaginitis

Answer 4

(1) Vulvovaginal Candidiasis
(a) Pregnancy, diabetes, and use of broad spectrum antibiotics or
corticosteroids predispose patients to Candida infections.
(b) Heat, moisture, and occlusive clothing also contribute to the risk.
(c) Pruritus, vulvovaginal erythema, and a white curd-like discharge that
is NOT malodorous.
(2) Trichomonas Vaginalis Vaginitis
(a) sexually transmitted protozoal flagellate
(b) infects the vagina, Skene ducts, and lower urinary tract in women
(c) infects the lower genitourinary tract in men
(d) Pruritus and a malodorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema
(e) Strawberry cervix- red macular lesions on the cervix in severe cases
(3) Bacterial Vaginosis (BV)
(a) polymicrobial disease that is NOT sexually transmitted
(b) an overgrowth of Gardnerella and other anaerobes
(c) increased malodorous discharge without obvious vulvitis or vaginitis
(4) Chlamydia
(5) Gonorrhea
(6) Contact dermatitis
(7) Chemical irritation

Question 5

Laboratory findings of vaginitis

Answer 5

(1) No labs operationally
(2) KOH
(a) Branched hyphae and budding yeast in Candidiasis
(b) Positive whiff test with BV (amine or fishy odor)
(3) Wet prep
(a) Motile flagella in T. vaginalis
(b) Clue cells in BV
(4) NAAT urine testing for chlamydia and gonorrhea
(5) Vaginal pH
(a) Frequently greater than 4.5 in T. vaginalis or BV

Question 6

Imaging of vaginitis

Answer 6

None

Question 7

Treatment of vaginitis

(1) Vulvovaginal Candidiasis
(2) Trichmonas vaginalis Vaginitis
(3) Bacterial Vaginosis
(4) Chlamydia
(5) Gonorrhea

Answer 7

(1) Vulvovaginal Candidiasis
(a) Fluconazole (Diflucan) is an anti fungal
(2) Trichmonas vaginalis Vaginitis
(a) Treatment of both partners is recommended
(b) Metronidazole (Flagyl) - is an antibiotic with cytotoxic effects towards anaerobic organisms
(3) Bacterial Vaginosis
(a) Metronidazole (Flagyl) 500 mg BID x7 days
(b) Clindamycin vaginal cream (Clindagel, Cleocin T lotion) – Lincosamide antibiotic
(c) Metronidazole gel (0.75%, 5g vaginal twice daily for 5 days)
(4) Chlamydia
(a) Azithromycin (Zithromax) - Macrolide antibiotic
(5) Gonorrhea
(a) Ceftriaxone (Rocephin) - 3rd gen Cephalosporin antibiotic

Question 8

Patient education of vaginitis

Answer 8

(a) Avoid nonabsorbent undergarments
(b) Avoid douching
(c) Delay sexual intercourse until treatment is complete and symptoms resolve

Question 9

Complications of vaginitis

Answer 9

(1) Resistance to treatment
(2) Reoccurrence
(3) Concurrent infection with other sexually transmitted diseases

Question 10

Follow up of vaginitis

Answer 10

None necessary unless symptoms persist