Vaginitis

Question 1

vaginitis

Answer 1

inflammation of the vagina, often caused by infxn

Question 2

sx of vaginitis

Answer 2

discharge, itching, odor, dyspareunia, dysuria, urinary frequency

Question 3

what are the 3 tx most associated w/ discharge?

Answer 3

bacterial vaginosis, trichomoniasis (STD), vulvovaginal candidiasis

Question 4

signs and sx of BV

Answer 4

thin, grey, white mucus,

• fishy odor, esp after sex or menses
• pH >4.5

Question 5

dx of BV

Answer 5

+ whiff test (gross)

clue cells, no WBC

Question 6

what causes the stinkiness of BV?

Answer 6

anaerobes

Question 7

tx of BV

Answer 7

metronidazole

2) clindamycin
3) tinidazole

Question 8

trichomoniasis s/sx

Answer 8

severe pruritis
-discharge, often malodorous
-dysruia
-dyspareunia (painful sex)
-greenish-yellow, frothy dischage
-

Question 9

hallmark signs of tric.?

Answer 9

• petechiea or “strawberry markings” on the cervix

- motile flagellated protozoans on wet prep (*warming slide makes them easier to see)

Question 10

tx of Tric

Answer 10

1) metronidazole 2 gm po
2) tinidazole

**treat partners and go back and look for other STis

Question 11

ADR of metronidazole

Answer 11

NVD, metallic taste, dark red-brown urine

serious: sz, neruopathies, leukopenia, SJS, TEN

Question 12

vulvovag. candidiasis (VVC)

Answer 12

NOT an STD

Question 13

VVC s/sx

Answer 13

• pruritis, burning
• cottage cheese discharge
• dyspareunia
• erythema
• curdy, white discharge
• not malodorous (**normal PH)

Question 14

what will you see on a wet prep of VVC?

Answer 14

spores, hypahea, KOH, culture

*pseudohyphea or budding yeast

Question 15

what can lead to VVC?

Answer 15

•	Hormonal changes
(Pregnancy, OCPs, menopause)
•	Oral corticosteroid treatment
•	Oral antibiotics
•	Nylon underwear, exercise clothing, tight pantyhose, tight jeans, hot weather 
•	Obesity

Question 16

if recurrent or multiple VVC? think ?

Answer 16

• Hyperglycemia, diabetes

* Immunocompromised state (HIV)

Question 17

what are some OTC tx?

Answer 17

imidazoles (but increasing reisistance is seen)

oral fluconazole

Question 18

rx VVC tx?

Answer 18

• butoconazole
• nystatin
• terconazole
• clotrimazole
• terconazole,
• miconazole

Question 19

Atrophic vaginitis?

Answer 19

not an ifxn, but need to rule it out

-atrophic mucosa is vulnerable to infxn

Question 20

who may get this atrophic vaginitis?

Answer 20

amenorrheic women (bc decreased estrogen)

• alos, postmenopasal, lactating, extreme exercise
• progesterone tx w/o estrogen

Question 21

s/sx of AV?

Answer 21

• Pruritus, burning
• Vaginal dryness
• Dyspareunia
• Possibly spotting
• Not associated with odor unless concomitant infection
• Pale, thin vaginal mucosa
• Absence of discharge
• Loss of vaginal rugation (no wrinkles)
• Wet prep negative

Question 22

how to tx AV?

Answer 22

estrogen replacement, systemic or topical