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PHAR 153 > Vaginitis > Flashcards

Vaginitis Flashcards

1
Q

What do normal vaginal secretions look like?

A

Slight or no odour
Clear to white - consistency of egg whites
Viscous and homogenous
1-4 ml secreted daily
It is acidic (3.8 to 4.2) (normal for underwear bleaching)
Lactobacillus predominate and create lactic acid

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2
Q

What do the different colours of vaginal secretions mean?

A

White or Clear: Normal

Grey: bacterial vaginosis

Pink and Red: depending on timing, it could be due to menstruation, cervical bleeding, cervical polyp

Yellow-green: a potential sign of an STI

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3
Q

Who is affected by vaginitis?

A

Peri-menopausal women: 15%

Post-menopausal women: 29-57%

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4
Q

What is vaginitis?

A

Inflammation of the vulva (outside), vagina (inside) or both

Most of the time, vaginitis is caused by an infection, but some cases are noninfectious (vaginal tissue atrophy during menopause)

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5
Q

What are the different causes of vaginitis?

A

Vulvovaginal Candidiasis:
Severe itching of vulva and vagina
“Cottage cheese” discharge

Atrophy:
Vaginal Discharge
Soreness and burning

Bacterial Vaginosis:
Fishy odour
Creamy discharge

Trichomoniasis:
Frothy wet discharge (more bubbly and water-y)
Malodourous

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6
Q

What are some factors that can alter normal vaginal flora?

A

Puberty

Menstruation

Estrogen therapy

Pregnancy

Post-menopausal vaginal tissue atrophy

Vaginal surgery (hysterectomy or abortion)

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7
Q

What are some risk factors for vaginitis?

A

Uncontrolled diabetes (increased sugar=food for bacteria/fungi)

Broad spectrum antibiotics

Immunosuppression

Diet

Stress

Pregnancy

Menstruation

Chemical irritants

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8
Q

What are some complications of bacterial vaginitis?

A

Bacterial vaginitis can increase the risk of getting an STI and passing an STI. There is evidence that STIs can cause damage to fertility and vaginal tissues

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9
Q

Describe vulvovaginal candidiasis?

A

Caused by an overgrowth of Candida albicans

Uncomplicated cases: sporadic, easily treated, caused by C. albicans (92% of cases)

Complicated cases: recurrent, severe disease, not caused by C. albicans (need to refer to physicians)

Signs and Symptoms:
Itching, soreness, and/burning in the vagina or vulva

Painful urination and intercourse

Heavy white vaginal discharge (cottage cheese)

Bright red rash affecting inner and outer parts of the vulva

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10
Q

When to refer vulvovaginal candidiasis cases to physicians?

A

First infection

Odorous or coloured discharge

Presence of systemic symptoms

Pregnant

A young girl who has not had their first menstruation episode

Diabetes

Recurrent infections

Immunosuppressed

At risk of STI (unprotected sex, multiple partners)

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11
Q

What are some complications of vulvovaginal candidiasis?

A

If left untreated, symptoms would likely get more severe and uncomfortable until treatment sought out

There are no long-term consequences of vulvovaginal candidiasis on fertility or tissue scarring

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12
Q

How many women get vulvovaginal candidiasis?

A

Affects 70-75% of women at least once during their lives, but 5-8% of women will experience more than 4 episodes/year

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13
Q

What is the treatment for vulvovaginal candidiasis?

A

The goal of therapy is to cure the infection and prevent recurrence

Antifungals like clotrimazole, miconazole, terconazole and nystatin are all effective agents (80-90%)

Range from 1-14 day treatments, but the infections still take at least 1 week to recover completely

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14
Q

If a woman has external candidiasis, what is the best formulation for antifungal agents?

A

An external cream is the best option as it will provide relief the fastest, but suggest a product that the woman will be comfortable using

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15
Q

If a woman has external and internal candidiasis, what is the best formulation for antifungal agents?

A

An external cream works great for candidiasis on the vulva, but use a different formulation for vaginal (internal) infection. Go with a vaginal tablet or cream for internal infection

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16
Q

How to administer vaginal tablets, ovules, and creams?

A

These dosage forms all use an applicator. Insert the dose into the applicator and place it into the vagina. Depress the plunger on the applicator, this should release the dose into the vagina

17
Q

What is the dosing for azole agents in vulvovaginal candidiasis?

A

Clotrimazole:
500mg vaginal tab x 1 dose*
1% topical cream (1 applicatorful of cream HS for 7 days)*

Miconazole:
100mg vaginal HS for 7 days*
Miconazole 2% topical cream (1 applicatorful of cream HS for 7 days)*

If the patient has an allergy or resistance to azole agents, Boric Acid 600mg gelatin capsule BID for 2-4 weeks is a good second-line option

*adjust duration of treatment depending on agent strength

Full recovery with azole agents still takes 1 week regardless of how long the treatment lasts

18
Q

What are some warnings or precautions for Canesten (clotrimazole)?

A

Sexual activity (need to rule out STIs)

Caution if this is your first infection

Infection is not getting better after 3 days or it hasn’t gone away in 7 days, see physician

See a physician if you have recurrent infections.

Do not use agent if pregnant

Do not use if you have never menstruated

19
Q

What are some things a pharmacist should tell someone with vulvovaginal candidiasis?

A

How to use duration of therapy, side effects

Use agent until the course is finished.

Nighttime is a good time because agents may make secretions watery, which could result in leakage if standing upright

Continue treatment through the menstrual period and do not use a tampon

Intercourse not recommended during treatment

20
Q

Are natural treatments effective for vulvovaginal candidiasis?

A

Not really, but give tips that prevent more harm if patient is really adamant.

Don’t use yogurt with honey, honey is a energy source for fungi. Yogurt on its own is fine

We don’t know what specific probiotic is relevant to vulvovaginal candidiasis

21
Q

What practices can help prevent vulvovaginal candidiasis?

A

General hygiene
Avoid perfumed or irritating products
Avoid douches
Loose-fitting cotton underwear

22
Q

What are some prescription agents for vulvovaginal candidiasis?

A

OTC products are just as good, prescription agents are meant for people who have resistant infections, pregnant women, or need drug coverage

Terconazole 0.4% cream for 7 days

Nystatin 100,000 units intravaginally for 2 weeks

23
Q

What is an effective agent for recurrent vulvovaginal candidiasis?

A

Refer to physician

Flucanazole 150 mg PO once daily for 3 days

Boric Acid: 600mg once daily for 14 days

First treatment is followed by at least 6 months of maintenance therapy

24
Q

How is vulvovaginal candidiasis treated in pregnant women?

A

Topical or vaginal -azole agents for 7 days (systemic absorption is minimal posing little risk to baby)

Topical nystatin 100,000 units intravaginally daily for 14 days

Oral fluconazole 150 mg (AVOID THIS DRUG DUE TO RISK FOR MISCARRIAGE OR FETAL DEATH)

25
Q

What are the disadvantages of vaginal douching?

A

Disruption of normal flora

Vaginal irritation

Possibly increase the risk of an ascending infection

Proper technique is important to help prevent complications

26
Q

What is the difference between bacterial vaginosis and vulvovaginal candidiasis?

A

Bacterial vaginosis has an unpleasant fish-like odour, vulvovaginal candidiasis is odourless.

Bacterial vaginosis produces thin, watery, white or grey discharge, vulvovaginal candidiasis produces thick, white discharge similar to cottage cheese.

27
Q

What other issues besides vulvovaginal candidiasis cause itchy or dry vaginal tissue?

A

Chemical irritation
Peri/post-menopausal related drying and itching due to reduced estrogen

use Vagisil or other lubricants for relief

28
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole 500mg PO BID for 7 days
or
Metronidazole gel 0.75% 5mg once daily for 7 days

29
Q

Describe the signs and symptoms of trichomoniasis?

A

Trichomoniasis can sometimes be an STI

Malodourous

Green/yellow discharge is purulent (thin/frothy)

Burning

Painful urination and intercourse

30
Q

What is the treatment for trichomoniasis?

A

Metronidazole 2g PO in a single dose
or
Metronidazole 500mg PO BID for 7 days

PHAR 153 (20 decks)

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