Vaginitis

Question 1

Common vaginitis conditions:

Answer 1

Bacterial vaginosis
vulvovaginal candidiasis
atrophic vaginitis

Question 2

Healthy vaginal flora is usually dominated by

Answer 2

Lactobacillus
especially L.crispatus

Question 3

the term for an unhealthy vaginal microbiome

Answer 3

Dysbiosis

Question 4

Amsel’s criteria for BV

Answer 4

1. presence of a thin homogenous discharge that adheres to vaginal walls
2. presence of clue cells on the normal saline prepared slide
3. pH of the vagina or vaginal discharge is 4.5 or higher
4. positive “wiff test” which signals the release of an amine “fishy” odor when vaginal discharge contacts the alkaline KOH
   look for clue cells

Question 5

Is BV inflammation or not

Answer 5

It is not an inflammation….reason it ends in osis and not itis.

Question 6

BV symptoms

Answer 6

irritation’

itching

dyspareunia

gray or white discharge
a “fishy” odor that is often most noticeable after vaginal penetration during sexual activity

Question 7

BV signs.

Answer 7

evident as a thin white/gray homogenous discharge

irritated vaginal mucosa and introitus

possibly cervicitis

Question 8

Treatment for BV

Answer 8

Flagyl

Question 9

What is complicated candida vaginitis

Answer 9

more than 4 infections per year

produces severe symptoms

occurs in women who are immunocompromised

requires more intensive tx

recurrent VVC is more likely to involve different Candida species
such as C. glabrata that may not be responsive to conventional antimycotic tx

Question 10

How does candida presents on a wet mount

Answer 10

lack of lactobacilli on saline prep

presence of hyphae and pseudohyphae with saline or KOH

they look like those long skinny structures going across the length of a slide
budding yeast looks like little shoe prints of a man’s dress shoe.

Question 11

Treatment for Candida

Answer 11

Fluconazloe (Diflucan)
oral med
side effects:
alterations in hepatic function
several drug-drug interactions

For Complicated VVC in nonpregnant women
with skin fissures
longer treatment of 7-14 days of a topical “azole” OR
2 dosees of fluconazole, 150 mg 72 hours apart

Question 12

Treatment for atrophic vaginitis

Answer 12

Estrogen
1st line
–topical estrogen administration
when used topically, estrogen does not need to be paired with progesterone in a women with a uterus
-vaginal ring
—Estring (estradiol 2 mg/ring releases 7.5 mcg/24 hr) place q 3 months PV
tablet
—Vagifem ( 10 mcg estradiol Vaginal tablet) PV

insert one 10 mcg tablet vaginally daily x 2weeks

followed by one 10 mcg insert 2x weekly or cream

—Estrace Vaginal 0.1 mg/g (0.01%)
2-4 g (marked on the applicator)

intravaginally daily x 1-2 weeks

Maintenance: 1g PV 1-3 x week