Vaginitis Flashcards
Describe normal vaginal discharge in reproductive age women
1 to 4 mL fluid (per 24 hours). white or transparent, thick or thin, and mostly odorless
often presents with marked inflammatory symptoms (pruritus and soreness), but scant discharge (thick, white, odorless, and curd-like)
Candida vulvovaginitis
associated with only minimal inflammation and minimal irritative symptoms, but thin, gray or yellow, ‘fishy’ discharge
bacterial vaginosis
characterized by purulent, malodorous, thin discharge, which may be accompanied by burning, pruritus, dysuria, frequency, and/or dyspareunia
Trichomoniasis
common features of atrophic vaginitis
Vaginal dryness and dyspareunia
underlying cause of atrophic vaginal changes
hypoestrogenemia
single most important finding that drives the diagnostic process and should always be determined for suspected vaginitis
Measurement of vaginal pH
elevated pH in a premenopausal woman excludes what diagnosis?
candida vulvovaginitis (pH 4 to 4.5)
What is the pH of the normal vaginal secretions in premenopausal women due to high estrogen levels
4.0 to 4.5
why are pH levels less useful in premenarchal and postmenopausal women in whom estrogen levels are low?
their pH is >4.7 due to less glycogen in epithelial cells, reduced colonization of lactobacilli, and reduced lactic acid production
helpful for identifying hyphae and budding yeast for the diagnosis of candidal vaginitis
addition of 10 percent potassium hydroxide (KOH) to the wet mount of vaginal discharge
Smelling (“whiffing”) the slide immediately after applying KOH is useful for detecting what?
the fishy (amine) odor of bacterial vaginosis
Population at increased risk for bacterial vaginosis?
women who have sex with women
What class of medications predisposes to candidal vaginitis?
antibiotics
What class of medications predisposes to candidal vaginitis?
antibiotics
most common cause of vaginal discharge in women of childbearing age
bacterial vaginosis
key player in the pathogenesis of BV
Gardnerella vaginalis
Recommended treatment of bacterial vaginosis?
metronidazole (gel preferred to oral, but either work). clindamycin second choice. same for pregnant pts
Recommended treatment of bacterial vaginosis?
metronidazole (gel preferred to oral, but either work)
Treatment for candida vulvovaginitis in nonpregnant women
any azole topical or oral (uptodate picks fluconazole (Diflucan))
Treatment for candida vulvovaginitis
any azole topical or oral (uptodate picks fluconazole (Diflucan))
Treatment for candida vulvovaginitis in pregnant women
topical imidazole (clotrimazole or miconazole)
Treatment of trichomonas
single 2 gram oral dose of either tinidazole or metronidazole (ie, four 500 mg tablets)
drug of choice for treatment of symptomatic trichomoniasis in pregnancy
metronidazole
