Vaginitis

Question 1

Normal vaginal ph?

Answer 1

3.8-4.2

Question 2

Main bacteria in vagina?

Answer 2

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

Question 3

Why are lactobacilli helpful?

Answer 3

Produce hydrogen peroxide which inhibit infectious causes of vagninosis

Question 4

Normal vaginal discharge?

Answer 4

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

Question 5

Predispoing factors to candidiasis

Answer 5

Pregnancy, DM, antibiotics, and immune supression

Question 6

Causes for candidiasis

Answer 6

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

Question 7

Risk factors for for candidiasis?

Answer 7

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

Question 8

Symptoms of Candidiasis?

Answer 8

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

Question 9

Assessment findings of candidiasis?

Answer 9

Musty, dry mucous membranes, satellite lesions, fissures

Question 10

Uncomplicated candidiasis?

Answer 10

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

Question 11

Complicated candidiasis?

Answer 11

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

Question 12

What should you do for complicated?

Answer 12

Cultures

10-20% are glabrata- no pseudo hyphae

Question 13

1 day treatment of candidiasis?

Answer 13

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

Question 14

3 day treatment for candidiasis?

Answer 14

Monistat, Butoconazole

Question 15

7 day treatment for candidiasis?

Answer 15

Monistat, clotrimazole

Question 16

Treatment for complicated yeast?

Answer 16

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

Question 17

Other ways of treating candidiasis

Answer 17

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

Question 18

Clinical presentation of trichomoniasis?

Answer 18

Strawberry cervix, frothy discharge

Question 19

Lab tests for trich?

Answer 19

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

Question 20

Treatment for BV?

Answer 20

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

Question 21

What to do if you suspect resistance?

Answer 21

Contact CDC for resistance treatment

Question 22

Common bacteria in BV?

Answer 22

Mycoplasma hominis, curved rods

Question 23

Presentation of BV?

Answer 23

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

Question 24

Requirements for BV diagnosis?

Answer 24

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

Question 25

treatment for BV?

Answer 25

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

Question 26

Alternative treatment for BV?

Answer 26

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

Question 27

Treatment of BV for pregnant women

Answer 27

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

Question 28

Recurrence of BV factors?

Answer 28

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

Question 29

Characteristic of cytolytic vaginosis?

Answer 29

transformation in length of lactobacilli, frequently confused sith candidiasis

Question 30

Presentation of cytolytic vaginosis?

Answer 30

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

Question 31

Clinical features of cytolytic vaginosis?

Answer 31

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

Question 32

Diagnosis of cytolytic vaginosis

Answer 32

pap smear

Question 33

Treatment of cytolytic vaginosis?

Answer 33

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

Question 34

What to check for with lichen plans?

Answer 34

hepatitis C