Vaginitis Flashcards
Vulvo-vaginal candidiasis:
Another name more commonly known?
Is it an STI?
Risk factors?
Thrush
No - it is not sexually transmitted
Antibiotics
Immunosuppression
Vulvo-vaginal candidiasis:
Discharge:
- Colour?
- How is it described?
- Is it offensive?
Vulva and vagina:
- Colour
- What might the patient complain of that would be uncomfortable?
What might the patient have pain doing?
What else might you find at other parts of the body?
Non-offensive
White - cheese curd
Red
Fissured, itchy and sore
Dysuria
Dyspareunia
Candida infections
Bacterial Vaginosis (BV):
Why is this important?
It is not an STI but why is it important to ask about sex?
Risk factors?
What might women do excessively to clean down there, which in turn increases the risk?
What contraception is protective?
Most common infectious vaginitis
Commoner in sexually active women
Sexually active New partner Other STIs Smoking Copper IUD
Vaginal douching
COCP - oestrogen boots lactobacillae
Bacterial Vaginosis (BV):
Discharge:
- Colour - 2
- Consistency
- Smell
- What does the discharge adhere to?
Why does the smell get worse after sex?
What is absent which can be used to differentiate against other causes of vaginitis?
White/grey
Thin
Fishy
Vaginal mucosa
Due to alkaline semen
No inflammation or itch
Trichomoniasis:
Is it an STI or not?
Discharge:
- Colour - 2
- Consistency
Other symptoms
What might the patient have pain doing?
Yes so partners may be affected
Yellow/green
Frothy
Itch
Soreness
Dysuria
Dyspareunia
DDx:
STI - 2
Physiological inoffensive discharge causes?
What foreign body might cause foul smell?
Chlamydia
Gonorrhoea
Pregnancy
Arousal
Puberty
Pill
Tampon
Investigations:
What is done first?
Speculum exam + vaginal wall swab
Investigations:
Vaginal pH >4.5 - what 2 causes does that indicate?
What can be done to the discharge collected in the vaginal wall swab?
BV and Trichomoniasis
Wet mount microscopy
Investigations:
What is an Amine whiff test?
What does a +ve result suggest?
What type of clinic are most investigations done except for testing pH?
A whiff test is performed by adding several drops of 10% potassium hydroxide to a sample of vaginal discharge.
A strong fishy odour is indicative of a positive test result.
GUM clinic - genitourinary medicine
Sexual Health Clinic
Practical Approach in Primary Care:
In those with low STI risk, the following clinical diagnoses can be made:
> What does a raised pH (>4.5) and an unpleasant discharge suggest?
> What does normal (acidic) pH, itch and no unpleasant smell suggest?
BV
Candida - thrush
Management:
BV - antibiotics - 2
Thrush - antibiotics - 2
Trichomoniasis - antibiotics - 1
Metronidazole PO/PV or clindamycin
Clotrimazole PV or fluconazole PO
Metronidazole PO and treat partners
Complications:
What does BV and trichomoniasis increase the risk of:
- Outside pregnancy
- During pregnancy
STI susceptibility
Preterm labour
Preterm rupture of membranes
LBW
Miscarriage
