Vaginitis 1A Flashcards
what is vaginitis
• inflammation of the vagina
what is the leading cause
• bacteria vaginosis
other common infectious causes
trichomoniasis and candidiasis
what percentage of vagninitis is atrophic
10%
how does bacteria vaginosis occur
• bacterial vaginosis is due to altered flora ↑ Gardnerella vaginalis, mobiluncus, mycoplasma and ↓lactobacillae
risk factor for bacteria vaginosis
sexually active, new partner, other STIs, vaginal douching, smoking, copper IUD
what is the utility of COC in bacterial vaginosis
combined pill is protective & oestrogen boost lactobacillae (good bacteria)
what is the 2nd most common cause
• Vulvo-vaginal candidiasis (thrush)
yeast infection can include?
candida albicans (95%) or candida glabrata (5%)
is yeast infection sexually transmitted
No
RF for yeast infections
antibiotic use and immunosuppression
what is Trichomoniasis
protozoan infection by Trichomonas vaginalis
is Trichomoniasis sexually transmitted
yes
signs and symptoms of bacteria vagnosis
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
signs and symptoms of thrush
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
signs and symptoms of trichomoniasis
Frothy, yellow/green fishy discharge
Itchy, soreness
Superficial dysuria and dyspareunia
asymptomatic in 50%
ddx
STI (e.g. chlamydia, gonorrhoea), inoffensive discharge due to physiological causes e.g. (pregnancy, arousal, puberty, the pill), due to tampon (foul smelling)
investigation
speculum examination plus vaginal swab + analysis
what is the pH in BV or trichomoniasis
vaginal pH>4.5
what is seen on wet mount test
clue cells and absent/ reduced lactobacillae in BV
what is seen in candida
• Normal (acidic) pH + itch + no odour
in a primary care setting a raised pH and malodorous discharge =
BV
a positive Amine Whiff test is indicative of
BV
what investigations is done in patient with ↑STI risk, bloody discharge, ambiguous symptoms, recent/current pregnancy or termination, investigate as follows:
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
• Treat BV with
metronidazole PO/PV or clindamycin
• Treat thrush with
clotrimazole PV or fluconazole PO
• Treat trichomoniasis with
metronidazole PO and treat partners
• BV & trichomoniasis can lead to the following complications
↑STI susceptibility, pregnancy complications e.g. rupture of membranes, preterm labour, low birth weight
• BV can lead to miscarriage
