Vaginitis Flashcards
Vaginitis
Inflammation of the vaginal ______
Also referred to as —————
involving the ______ ,_____
mucosa ; Vulvovaginitis
vulva, vagina
Vaginitis
Symptoms:
abnormal ______ and additional symptoms such as an _________. _______, ________ (local irritation of external genitalia)
discharge
offensive odor or itching,
vulvitis
Introduction
The three most common causes of vaginitis
(1) __________ is caused by __________ __________
(2) __________ is caused by __________ __________ and other fungal species.
(3) __________ vaginosis is associated with a __________ microbiota.
Trichomoniasis ;Trichomonas vaginalis.
Candidiasis ; Candida albicans
Bacterial vaginosis ; complex bacterial.
Epidemiology
Trichomoniasis is a _____ transmitted condition.
Bacterial vaginosis and vulvovaginal candidiasis are __________ transmitted diseases but seldom occur in ____________ women
sexually
not classic sexually
sexually inexperienced
Trichomoniasis
Trichomoniasis is caused by the _______, Trichomonas __________.
Transmission almost always occurs through _______.
After an incubation period of a _______, patients develop a ________ discharge associated with varying degrees of vulvar _______, dysuria, and dyspareunia.
protozoan; vaginalis.
sexual contact ; few days
purulent ; irritation
Trichomonas is normally present in the vagina.
T/F
F
The organism is not normally present in the vagina.
Diagnosis of Trichomonas
Examination is notable for vulvar and vaginal _______ and a _______ vaginal discharge.
Vaginal pH is almost always ( lesser or greater?) than _____.
A positive ______ test is usual.
erythema ; purulent
greater ; 4.5
whiff
Diagnosis of Trichomonas
The vaginal wet preparation contains an abundance of _______ and (motile or non-motile?) (flagellated or non-flagellated?) trichomonads.
The organism can be cultivated by inoculating a liquid medium such as modified _______ medium or _______ TV.
After incubation, _______ of the liquid medium are examined daily for ______ _____________
leukocytes ; motile flagellated
Diamond’s medium ; InPouch TV.
aliquots
motile trichomonads.
Diagnosis of Trichomonas
________improves the diagnostic yield, especially in asymptomatic patients.
A _____ preparation diagnostic of trichomoniasis is highly specific because of the characteristic ______ of the organisms.
Culture
wet; motility
Treatment of Trichomonas
_________ and _________ are the only effective agents
Metronidazole
tinidazole
Vulvovaginal candidiasis
Candida albicans and other species of Candida can be part of the vaginal microbiota of asymptomatic women.
Symptoms are primarily vulvovaginal _______ and _______
itching and irritation.
Risk factors of vulvovaginal candidiasis
Poorly controlled _________
_________, _________ clothing
Impairment of _________ cells or of _________ immunity
Women with _________ infection develop vulvovaginal candidiasis more often than _________ women do, especially if they have ________________
diabetes mellitus
Tight, insulating
phagocytic cells ; cell-mediated immunity
HIV infection ; HIV-negative
low CD4 T-cell counts.
Clinical manifestation of vulvovaginal candidiasis
Perivaginal ________ , often with ________ discharge
________ is occasionally noted
The labia may be ________ or ________.
(Shallow or deep?) , ________, (linear or circular?) ulcerations, especially on the (anterior or posterior?) portion of the introitus, are common.
________ caused by scratching are often present
pruritus; little or no
Dysuria
pale or erythematous.
Shallow, radial, linear
posterior; Excoriations
Diagnosis of vulvovaginal candidiasis
Vaginal pH is usually ________.
There is ________ odor when the vaginal secretions are mixed with 10% ________.
Microscopic examination of vaginal material in saline or in 10% KOH may disclose ______________
In the symptomatic patient with a diagnostic ________ examination, ________ are not needed.
normal ; no odor ; KOH.
budding yeasts
microscopic examination
fungal cultures
Treatment of vulvovaginal candidiasis
——— or ——- antifungal agents are used.
Effective agents include vaginal preparations containing
– _________, __________ , _________, butoconazole, terconazole, and tioconazole.
Oral ________ in a single 150mg dose
Vaginal or oral
nystatin, miconazole, clotrimazole,
fluconazole
Treatment of vulvovaginal candidiasis
Complicated vulvovaginal candidiasis occurs in patients with underlying conditions that compromise the immune response, such as
– __________
–__________ disease
– __________
– Treatment with __________ agents.
Diabetes
– HIV disease
– Malignancy
– Treatment with immunosuppressive agents.
Bacterial vaginosis
Synergistic activity of various (aerobic or anaerobic?) organisms, including Prevotella spp., Porphyromonas spp., Bacteroides spp., Peptostreptococcus spp., Mobiluncus spp. (curved, motile rods), and ______ spp., as well as G. vaginalis, seems to contribute to the pathology of BV.
anaerobic
Mycoplasma
Bacterial vaginosis
Affected women are usually sexually (active or inactive?) and often complain of vaginal ________ , which frequently is described as “________.”
Patients also notice a mild to moderate ________.
________ discomfort is occasionally present.
Discharge is often present at the ________ and visible on the ________
active ; odor,
“fishy.” ; discharge.
Abdominal ; introitus
labia minora.
Bacterial vaginosis
On speculum examination, the vaginal walls appear (inflamed or uninflamed?).
The vagina usually contains a ______, (thin or thick?) , ____geneous discharge.
There is an increased risk for ________ and ________ among women with bacterial vaginosis .
uninflamed ; grayish
thin ; homogeneous
endometritis ; salpingitis
In bacterial vaginosis, The labia and vulva are erythematous or edematous.
T/F
F
They are not erythematous or edematous.
In bacterial vaginosis
The pH of vaginal fluid is (elevated or depressed?) (above or below?) _____ in about 90% of women with BV.
A vaginal pH of ____ or (lower or higher?) strongly suggests BV.
A whiff test is ________.
A wet mount of the vaginal fluid from patients with BV usually reveals _____ cells, which are ___________ cells studded with ____________.
elevated ; above ; 4.6
5 ; positive.
clue cells ; vaginal epithelial
tiny coccobacilli.
In bacterial vaginosis
_____ epithelial cells with edges completely ______ by sheets of ________
Cell outlines are covered by _______, which are mostly _______, but also gram _________ rods and coccobacilli
Squamous ; blurred
small bacteria; bacteria
GNB; variable
Diagnosis of bacterial vaginosis
The patient is most likely to complain of ______ and of the _______, which tends to be _______ and _______.
The odor is best described as “_______” and is caused by _______ such as _______.
These amines are more volatilile at _____eased pH, which explains the propensity of the patient to notice the odor when her secretions are more _______ (e.g., during _______, after _______).
odor ; discharge
gray ; homogeneous.
fishy ; amines
methylamine ; increased
alkaline ; menses
intercourse
In bacterial vaginosis
Odor is produced when vaginal secretions are mixed with _________ (whiff test)
Microscopic examination of vaginal secretions suspended in 0.9% _____ reveals few _______ and many ________
The bacilli tend to _____ vaginal _______ cells—the so-called ——— cells
10% KOH
NaCl ; leukocytes ; small bacilli.
coat ; epithelial ; clue cells
Criteria for the diagnosis of bacterial vaginosis
Amsel criteria: at least ______ of the ______ listed should be present for the diagnosis of BV to be made:
_____________________________________
three ; four
- homogeneous discharge
- positive whiff test,
- pH >4.6,
- clue cells
Treatment for bacterial vaginosis
The primary regimen for the treatment of BV is ____________, 500 mg twice a day for 7 days.
A single 2.0-g dose of metronidazole, such as is used to treat __________, is (more or less?) effective and is not recommended.
Vaginal preparations containing 0.75% ______________ or 2% ______________
oral metronidazole
trichomoniasis ; less
metronidazole gel
clindamycin cream
