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Ambulatory Care of Women > Vaginitis > Flashcards

Vaginitis Flashcards

1
Q

Normal vaginal ph?

A

3.8-4.2

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2
Q

Main bacteria in vagina?

A

Lactobacilli- increase as a response from estrogen causing increased glycogen synthesis in vaginal epithelial cells

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3
Q

Why are lactobacilli helpful?

A

Produce hydrogen peroxide which inhibit infectious causes of vagninosis

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4
Q

Normal vaginal discharge?

A

clear or white, flocculent
No burning or itching
Average of 1.6 g of discharge every 8 hours.

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5
Q

Predispoing factors to candidiasis

A

Pregnancy, DM, antibiotics, and immune supression

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6
Q

Causes for candidiasis

A

antibiotics (most common), clothing, chemicals, hormones, and intercourse

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7
Q

Risk factors for for candidiasis?

A

Childbearing, OCP, pre-menarchial or post menopausal, DM, Sex

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8
Q

Symptoms of Candidiasis?

A

90% have pruritis,
20% have vaginal redness
20% of non pregnant patients
70% of pregnant patients

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9
Q

Assessment findings of candidiasis?

A

Musty, dry mucous membranes, satellite lesions, fissures

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10
Q

Uncomplicated candidiasis?

A

Sporadic and infrequent, mild to moderate, likely to be albicans, not in immunocompromised

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11
Q

Complicated candidiasis?

A

Recurrent VVC >4/year, Severe, non albicans, DM, debilitation, immunosuprression

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12
Q

What should you do for complicated?

A

Cultures

10-20% are glabrata- no pseudo hyphae

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13
Q

1 day treatment of candidiasis?

A

Monistat
Miconazole 1200 suppository
Ticonazole 5 g intravaginally
Fluconazole 150 mg tab

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14
Q

3 day treatment for candidiasis?

A

Monistat, Butoconazole

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15
Q

7 day treatment for candidiasis?

A

Monistat, clotrimazole

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16
Q

Treatment for complicated yeast?

A

Tompicals 7-14 days
Fluconazole x 3 every third day
Ketoconazole 100 mg/day x 6 months
Oral fluconazole weekly

17
Q

Other ways of treating candidiasis

A

Gentian violet, acetic acid, hydrogen peroxide, 600 mg boric acid intravaginally daily for 2 weeks.

18
Q

Clinical presentation of trichomoniasis?

A

Strawberry cervix, frothy discharge

19
Q

Lab tests for trich?

A

Wet prep- 50-60% specificity
Culture- 85 and 100 S&S
RNA probe, affirm, and OSOM

20
Q

Treatment for BV?

A

Metronidazole 2 g x 1
Metronidazole 500 mg BID x 7 days
Tinidazole 2 g orally in a single
DONT USE FLAGYL GEL

21
Q

What to do if you suspect resistance?

A

Contact CDC for resistance treatment

22
Q

Common bacteria in BV?

A

Mycoplasma hominis, curved rods

23
Q

Presentation of BV?

A

Increased discharge, pruritus not common, thin gray white homogenous discharge, fishy odor worse after blood and semen (because of increased alkalinity)

24
Q

Requirements for BV diagnosis?

A 
Homogenous discharge
Clue cells
pH >4.5
Fishy odor after KOH
Gram stains not appropriate
25
Q

treatment for BV?

A

Flagyl oral 7 days
Flagyl gel 5 days
Clindamycin cream 7 days

26
Q

Alternative treatment for BV?

A

Tinidazole 2 g QD x 2 days
Tinidazole 1 g QD x 5 days
Clindamycin 300mg BID x 7 days
Clindamycin 100 mg ovals once at bedtime for 3 days

27
Q

Treatment of BV for pregnant women

A

Flagyl 500 mg PO BID x 7 days
Flagyl 250 mg PO TID x 7 days
Clindamycin 300 mg BID x 7 days

28
Q

Recurrence of BV factors?

A

Probiotics, VIT D, folate, Vit A and calcium, stop smoking

29
Q

Characteristic of cytolytic vaginosis?

A

transformation in length of lactobacilli, frequently confused sith candidiasis

30
Q

Presentation of cytolytic vaginosis?

A

Tick or thin white cheesy vaginal discharge, pruritus, dysparenurina, vulvar dysuria, cyclic symptoms increased in luteal phase

31
Q

Clinical features of cytolytic vaginosis?

A

Normal vulva or slightly erythematous and edema, 3.5-4.5, lots of white blood cells, false clue cells

32
Q

Diagnosis of cytolytic vaginosis

A

pap smear

33
Q

Treatment of cytolytic vaginosis?

A

increase pH with sodium bicarb or sit bath. Don’t touch if there’s concern for PID, just do sitz bath.

34
Q

What to check for with lichen plans?

A

hepatitis C

Ambulatory Care of Women (8 decks)

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