Vaginitis

Question 1

Vaginitis

Inflammation of the vaginal ______

Also referred to as —————

involving the ______ ,_____

Answer 1

mucosa ; Vulvovaginitis

vulva, vagina

Question 2

Vaginitis

Symptoms:

abnormal ______ and additional symptoms such as an _________. _______, ________ (local irritation of external genitalia)

Answer 2

discharge

offensive odor or itching,

vulvitis

Question 3

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.

Answer 3

Trichomoniasis ;Trichomonas vaginalis.

Candidiasis ; Candida albicans

Bacterial vaginosis ; complex bacterial.

Question 4

Epidemiology

Trichomoniasis is a _____ transmitted condition.

Bacterial vaginosis and vulvovaginal candidiasis are __________ transmitted diseases but seldom occur in ____________ women

Answer 4

sexually

not classic sexually

sexually inexperienced

Question 5

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.

Answer 5

protozoan; vaginalis.

sexual contact ; few days

purulent ; irritation

Question 6

Trichomonas is normally present in the vagina.

T/F

Answer 6

F

The organism is not normally present in the vagina.

Question 7

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.

Answer 7

erythema ; purulent

greater ; 4.5

whiff

Question 8

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 ______ _____________

Answer 8

leukocytes ; motile flagellated

Diamond’s medium ; InPouch TV.

aliquots

motile trichomonads.

Question 9

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.

Answer 9

Culture

wet; motility

Question 10

Treatment of Trichomonas

_________ and _________ are the only effective agents

Answer 10

Metronidazole

tinidazole

Question 11

Vulvovaginal candidiasis

Candida albicans and other species of Candida can be part of the vaginal microbiota of asymptomatic women.
Symptoms are primarily vulvovaginal _______ and _______

Answer 11

itching and irritation.

Question 12

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 ________________

Answer 12

diabetes mellitus

Tight, insulating

phagocytic cells ; cell-mediated immunity

HIV infection ; HIV-negative

low CD4 T-cell counts.

Question 13

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

Answer 13

pruritus; little or no

Dysuria

pale or erythematous.

Shallow, radial, linear

posterior; Excoriations

Question 14

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.

Answer 14

normal ; no odor ; KOH.

budding yeasts

microscopic examination

fungal cultures

Question 15

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

Answer 15

Vaginal or oral

nystatin, miconazole, clotrimazole,

fluconazole

Question 16

Treatment of vulvovaginal candidiasis

Complicated vulvovaginal candidiasis occurs in patients with underlying conditions that compromise the immune response, such as
– __________
–__________ disease
– __________
– Treatment with __________ agents.

Answer 16

Diabetes
– HIV disease
– Malignancy
– Treatment with immunosuppressive agents.

Question 17

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.

Answer 17

anaerobic

Mycoplasma

Question 18

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 ________

Answer 18

active ; odor,

“fishy.” ; discharge.

Abdominal ; introitus

labia minora.

Question 19

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 .

Answer 19

uninflamed ; grayish

thin ; homogeneous

endometritis ; salpingitis

Question 20

In bacterial vaginosis, The labia and vulva are erythematous or edematous.

T/F

Answer 20

F

They are not erythematous or edematous.

Question 21

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 ____________.

Answer 21

elevated ; above ; 4.6

5 ; positive.

clue cells ; vaginal epithelial

tiny coccobacilli.

Question 22

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

Answer 22

Squamous ; blurred

small bacteria; bacteria

GNB; variable

Question 23

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 _______).

Answer 23

odor ; discharge

gray ; homogeneous.

fishy ; amines

methylamine ; increased

alkaline ; menses

intercourse

Question 24

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

Answer 24

10% KOH

NaCl ; leukocytes ; small bacilli.

coat ; epithelial ; clue cells

Question 25

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:

_____________________________________

Answer 25

three ; four

• homogeneous discharge
• positive whiff test,
• pH >4.6,
• clue cells

Question 26

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% ______________

Answer 26

oral metronidazole

trichomoniasis ; less

metronidazole gel

clindamycin cream