Vaginitis 1A

Question 1

what is vaginitis

Answer 1

• inflammation of the vagina

Question 2

what is the leading cause

Answer 2

• bacteria vaginosis

Question 3

other common infectious causes

Answer 3

trichomoniasis and candidiasis

Question 4

what percentage of vagninitis is atrophic

Answer 4

10%

Question 5

how does bacteria vaginosis occur

Answer 5

• bacterial vaginosis is due to altered flora  ↑ Gardnerella vaginalis, mobiluncus, mycoplasma and ↓lactobacillae

Question 6

risk factor for bacteria vaginosis

Answer 6

sexually active, new partner, other STIs, vaginal douching, smoking, copper IUD

Question 7

what is the utility of COC in bacterial vaginosis

Answer 7

combined pill is protective & oestrogen boost lactobacillae (good bacteria)

Question 8

what is the 2nd most common cause

Answer 8

• Vulvo-vaginal candidiasis (thrush)

Question 9

yeast infection can include?

Answer 9

candida albicans (95%) or candida glabrata (5%)

Question 10

is yeast infection sexually transmitted

Answer 10

No

Question 11

RF for yeast infections

Answer 11

antibiotic use and immunosuppression

Question 12

what is Trichomoniasis

Answer 12

protozoan infection by Trichomonas vaginalis

Question 13

is Trichomoniasis sexually transmitted

Answer 13

yes

Question 14

signs and symptoms of bacteria vagnosis

Answer 14

 25% = asymptomatic
 Thin, white/grey fishy discharge adherent to vaginal mucosa
 Smell may be worse after unprotected sex due to exacerbation by alkaline semen
 No inflammation or itch

Question 15

signs and symptoms of thrush

Answer 15

 Non-offensive, white ‘cheese curd’ discharge
 Vulva and vagina are red, fissured, itchy and sore
 superficial dysuria and dyspareunia
 there might be candida infection elsewhere e.g. tongue

Question 16

signs and symptoms of trichomoniasis

Answer 16

 Frothy, yellow/green fishy discharge
 Itchy, soreness
 Superficial dysuria and dyspareunia
 asymptomatic in 50%

Question 17

ddx

Answer 17

STI (e.g. chlamydia, gonorrhoea), inoffensive discharge due to physiological causes e.g. (pregnancy, arousal, puberty, the pill), due to tampon (foul smelling)

Question 18

investigation

Answer 18

speculum examination plus vaginal swab + analysis

Question 19

what is the pH in BV or trichomoniasis

Answer 19

vaginal pH>4.5

Question 20

what is seen on wet mount test

Answer 20

clue cells and absent/ reduced lactobacillae in BV

Question 21

what is seen in candida

Answer 21

• Normal (acidic) pH + itch + no odour

Question 22

in a primary care setting a raised pH and malodorous discharge =

Answer 22

BV

Question 23

a positive Amine Whiff test is indicative of

Answer 23

BV

Question 24

what investigations is done in patient with ↑STI risk, bloody discharge, ambiguous symptoms, recent/current pregnancy or termination, investigate as follows:

Answer 24

 vaginal pH
 endocervical swab for chlamydia and gonorrhoea nucleic acid amplification test
 consider high vaginal swab for trichomoniasis
 rule out pregnancy and UTI
 consider GUM referral if ??trichomoniasis

Question 25

• Treat BV with

Answer 25

metronidazole PO/PV or clindamycin

Question 26

• Treat thrush with

Answer 26

clotrimazole PV or fluconazole PO

Question 27

• Treat trichomoniasis with

Answer 27

metronidazole PO and treat partners

Question 28

• BV & trichomoniasis can lead to the following complications

Answer 28

↑STI susceptibility, pregnancy complications e.g. rupture of membranes, preterm labour, low birth weight
• BV can lead to miscarriage