Vaginitis Flashcards
Describe normal vaginal secretions.
slight or no odour
clear to white (consistency of egg whites)
viscous and homogeneous
1-4ml secreted daily
acidic (pH 3.8-4.2)
5-10 bacterial species that can usually be cultured
-lactobacillus predominate
What can impact secretions throughout the cycle?
stress
diet
medications
sexual activity
What are all the different colours of vaginal discharge? What do they mean?
white: healthy discharge, yeast infection
clear: healthy discharge, pregnancy, ovulation, hormonal
imbalances
gray: bacterial vaginosis
pink: cervical bleeding, vaginal irritation, implantation bleeding
red: menstruation, cervical infection, cervical polyp,
endometrial or cervical cancer
yellow-green: sexually transmitted infection
In regards to colour-coded vaginal discharge, what are some variations to keep in mind?
cycle
lifestyle
environment
each individual serves as their own best baseline
What is vaginitis?
inflammation of the vulva (outside), vagina (inside) or both
-with or without vaginal discharge
What are the causes of vaginitis?
majority of the time due to an infection:
-bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis,
or STI
may also be noninfectious:
-atrophy during peri-menopause
-physiologic (change in normal flora, mid-cycle cervical fluid)
-retention of foreign body (tampon)
-allergy
True or false: viral genital infections generally cause vaginitis
false
What are the four types of vaginitis?
vulvovaginal candidiasis
bacterial vaginosis
atrophy
trichomoniasis
Describe vulvovaginal candidiasis.
severe pruritis of vulva and vaginal areas
stinging/burning
“cottage cheese” discharge
odourless
pH<4.5
Describe bacterial vaginosis.
fishy odour
creamy discharge (grey)
pH 5-6
Describe atrophy.
vaginal discharge
spotting
soreness and burning
pH 7
Describe trichomoniasis.
frothy wet discharge
pruritis possible
malodourous
pH>6
Which types of vaginitis do we refer to an MD?
bacterial vaginosis
trichomoniasis
List off things that can alter the normal vaginal flora.
puberty
menstruation
estrogen or OCP therapy
pregnancy
post-menopause
antibiotics
vaginal surgery
What are risk factors for infection?
uncontrolled diabetes
broad spectrum antibiotics
immunosuppression
medications
diet
stress
pregnancy
menses
chemical irritants
synthetic, non-breathable undergarments and clothing
What is the pathogenesis of vaginitis?
an overgrowth of yeast cells Candida albicans that is already present in vulvovaginal area
the overgrowth can be initiated by risk factors
Differentiate between complicated and uncomplicated vulvovaginal candidiasis.
uncomplicated: sporadic, easily treated, caused by Candida
albicans
complicated: recurrent, severe disease, not caused by C.
albicans, or abnormal host factors
When does vulvovaginal candidiasis peak in women?
30-40 years of age
risk increases in 20s and is rare before puberty
What are the signs and symptoms of vulvovaginal candidiasis?
itching, soreness and/or burning discomfort
dysuria
dyspareunia
heavy white vaginal discharge (odourless)
bright red rash affecting inner and outer parts of the vulva
When do we refer vulvovaginal candidiasis to a doctor?
symptoms for 1st time
discharge has colour, coloured or profuse
presence of other symptoms
pregnant
pre-pubertal (<12)
diabetes or other underlying chronic illness
recurrence within 2 months
immunosuppressed
at risk of STI (unprotected sex, multiple partners)
How does the vaginal infection screening test work?
it tests pH, higher pH turns green/blue meaning it is likely not a yeast infection
bacterial vaginosis and trichomoniasis show elevated pH
True or false: there are no long-term consequences of vulvovaginal candidiasis to fertility that we know of
true
True or false: bacterial vaginosis has no associated increased risk of getting an STI
false
risk of getting an STI increases and passing an STI
When is OTC treatment appropriate for vulvovaginal candidiasis?
uncomplicated infection
VVC previously diagnosed
Describe clotrimazole treatment for VVC.
Oral
-500mg vaginal tab x 1 dose
-or 200mg vaginal tablet x 3 nights
1% topical cream
-1 applicatorful of vaginal cream PV at bedtime x 7 days
-2% cream x 3 days, 10% cream x 1 day
-apply externally to vulva daily-bid prn for itch
Describe miconazole treatment for VVC.
Oral
-100mg vaginal ovule HS for 7 days
-or 400mg HS x 3 nights
-or 1200mg HS x 1 dose
2% topical cream
-1 applicatorful of vaginal cream PV at bedtime x 7 days
-4% cream x 3 days
-apply externally to vulva daily-bid prn
What are some side effects of miconzaole and clotrimazole?
very uncommon, maybe an allergy or irritation
Describe oral fluconazole treatment.
1 dose 150mg
do not use in girls <12 years
can be used with azole topical external cream
results within 3-7 days
What are side effects of oral fluconazole treatment?
nausea
abdominal pain
headaches
diarrhea
dyspepsia
What must you do if you recommend oral fluconazole?
check for drug interactions
Describe boric acid treatment.
600mg in 1 gelatin capsule
1 capsule inserted PV OD or BID x 14-28 days
not to be taken orally
What can a patient expect with treatment of vaginal yeast infections?
adverse effects are uncommon
allergies are possible
irritation can be dose related
successful therapy will resolve within 7 days
short course therapy does not achieve results faster than long course therapy
What is some information to tell a patient about treatment of vaginal yeast infections?
how to use, duration, side effects
continue until course finished
nighttime is a good time to use
condom or diapragm efficacy reduced
continue through menstrual period (do not use tampons)
generally arent sexually transmitted to partner
intercourse not recommended during therapy
What is a natural treatment for vaginal yeast infections?
plain yogurt with no sweeteners
How can vaginitis be prevented?
control risk factors
general hygiene
probiotics
What are prescription treatments for vaginal yeast infections? When are these products used?
terconazole 0.4% cream PV x 7 days
topical nystatin
-used in suspected resistant infections, pregnant women, drug
coverage
When do we suspect that vaginal yeast infections are recurrent?
4 or more infections within a year
the infections have caused symptoms
infections were not related to the use of antibiotics
What is the treatment for recurrent vaginal yeast infections?
fluconazole 150mg PO once every 3 days for 3 doses
boric acid 300-600mg cap placed in the vagina OD for 14 days
What are the treatments of vaginal yeast infections in pregnancy?
oral fluconazole (but recommended to avoid)
topical or vaginal azole for 7 days
topical nystatin
What is vaginal douching?
instilling fluid into the vagina in a flushing manner
not a necessary part of vaginal cleanliness and can be harmful
warm water, vinegar and water, sodium bicarbonate and water, various commercial products
What are the disadvantages of vaginal douching?
disruption of normal flora
vaginal irritation
possibly increase the risk of ascending infection
What are the treatments for bacterial vaginosis?
metronidazole 500mg PO BID for 7 days
metronidazole gel 0.75%, one applicator (5g) OD vaginally for 5 days
clindamycin cream 2%, one applicator (5g) OD vaginally for 7 days
CanesBalance
What are the signs and symptoms of trichomoniasis?
malodourous
discharge is purulent (thin/frothy, green/yellow)
burning
dyspepsia
frequent urination
dyspareunia
What are the treatments for trichomoniasis?
metronidazole 2g PO in a single dose
metronidazole 500mg PO BID for 7 days
How long does resolution take with miconazole or clotrimazole treatment for VVC?
7 days
even if its the 1 or 3 day treatment
