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ACOG Practice Bulletins > Vaginitis > Flashcards

Vaginitis Flashcards

1
Q

Differential diagnosis

A
  • Candidiasis
  • Bacterial vaginosis
  • Trichomoniasis
  • Atrophic vaginitis
  • Vulvar dermatologic conditions
  • Vulvodynia
  • UTI
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2
Q

Prepubertal/postmenopausal vagina vs. reproductive-aged vagina

A

Thinned vaginal epithelium, pH of 4.7 or greater

Estrogenation of the vagina: increased glycogen content of vaginal epithelium, colonization of the vagina by lactobacilli

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3
Q

Normal vaginal flora

A

Gardernella vaginalis, E. coli, group B strep, genital mycoplasma, Candida albicans

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4
Q

Vaginitis HPI questions

A
  • Change in discharge, odor, itching, irritation, burning, swelling, dyspareunia, dysuria
  • Location of symptoms
  • Duration
  • Relationship to menses
  • Response to prior treatment
  • Self-treatment and douching
  • Sexual history
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5
Q

Vaginitis PE and testing

A

Visual exam of vulva, speculum exam, vaginal pH, amine whiff test, wet mount, KOH microscopy

Optional vaginal cxs, PCR for yeast and Trich, enzyme tests for BV and Trich, DNA testing

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6
Q

Vulvovaginal candidiasis diagnosis

A

Either 1. Visualization of blastospores or pseudohyphae on saline or KOH microscopy or 2. + cxs in a symptomatic woman

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7
Q

Uncomplicated vulvovaginal candidiasis

A

sporadic or infrequent episodes, mild to moderate sxs, suspected Candida albicans, nonpregnant woman w/o medical problems

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8
Q

Complicated vulvovaginal candidiasis

A

4+ episodes/yr, severe sxs, suspected or proved non-Candida albicans, women with diabetes, severe medical illness, immunosuppression, or other vulvovaginal conditions, pregnancy

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9
Q

Side effects of oral antifungals

A

GI intolerance, headache, elevated liver tests

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10
Q

Treatment of vulvovaginal candidiasis

A

clotrimazole or fluconazole

For complicated cases of Candida albicans, intensive initial therapy for 7-14 days followed by prolonged treatment with 150 mg weekly for 6 months successfully controls 90% of cases and has a protective effect long-term for 50% of cases

Clotrimazole 500 mg weekly or 200 mg twice weekly is also an option

Vaginal boric acid (600 mg) can be used in azole failures

In pregnancy: high-dose fluconazole is associated with birth defects so topical imidazoles are used for 7 days

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11
Q

Bacterial vaginosis

A

Polymicrobial infection due to lack of lactobacilli with an overgrowth of facultative anaerobic organisms

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12
Q

Anaerobes found in BV

A

G vaginalis, Mycoplasma hominis, Bacteriodes, Peptosteptococcus, Fusobacterium, Prevotella, Atopobium vaginae

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13
Q

Diagnosis of BV

A

3/4 of Ansel’s criteria: 1) grayish discharge, 2) positive amine test, 3) pH >4.5, and 4) > than 20% clue cells

Nugent’s score is used in research settings

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14
Q

Treatment of BV

A

Oral metronidazole
- Should treat before hysterectomy or abortion

In pregnancy: same - no known teratogenic effects

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15
Q

Side effects of metronidazole

A
  • GI sxs, disulfiram reactions (stay away from alcohol for 24 hr)
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16
Q

BV associations during pregnancy

A

low birth weight, PROM, and prematurity

-Should screen for in women with prior preterm deliveries

17
Q

Symptoms of trichomoniasis

A

abnormal discharge, itching, burning, and postcoital bleeding

18
Q

Diagnosis of trichomoniasis

A

visualization of motile trichomonads on saline microscopy (50-60% sensitivity), cxs (90%), OSOM Trichomonas rapid test (antigens)

19
Q

Treatment of BV

A

metronidazole (desensitization for allergic women)

- Send resistant cases to labs for testing

20
Q

Atrophic vaginitis diagnosis and treatment

A

elevated vaginal pH and parabasal and intermediate cells on microscopy

water based moisturizers and topical or systemic estrogen

21
Q

Desquamative inflammatory vaginitis

A

occurs most often in peri/postmenopausal women

sxs: burning, dyspareunia, and green/yellow discharge

  • common to find strep B, but not caused by this
  • Possibly a vaginal erosive lichen planus
  • similar to Trich, w/o motile organisms and negative cxs
22
Q

Treatment of desquamative inflammatory vaginitis

A

clindamycin gel, but relapse is common

23
Q

When should cultures be considered for vaginitis

A

Negative microscopy but symptoms of candidiasis or trich

  • No use in BV
24
Q

When is it appropriate to provide treatment for vaginitis w/o an exam

A

in known compliant patient with multiple confirmed prior diagnsoses with same sxs

25
Q

How should patients be evaluated in the absence of a microscope?

A

check for elevated pH to test for BV and Trich

Tests: pH, amine, G vaginales proline aminopeptidase activity, and vaginal sialidases

26
Q

How to manage BV or Trich on a cytology report

A

follow with culture

27
Q

Causes of vaginitis in pediatric patients

A

dermatologic, group A strep and Haemophalus organisms, pinworms, STDs
- rarely Candadiasis

ACOG Practice Bulletins (10 decks)

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