Vaginitis and vaginosis

Question 1

Opportunistic caused of vaginitis/vaginosis

Answer 1

Candida albicans and glabrata
Gardnerella vaginalis
Mobiluncus

Question 2

Disruption of what kind of normal flora promotes growth of Candida, Gardnerella, and Mobiluncus?

Answer 2

Lactobacilli, flora that help maintain and acidic pH and produce H2O2

Question 3

List some factors associated with opportunistic vaginitis/vaginosis.

Answer 3

Abx, douching, tight underwear, onset of menses, initial use of IUD, pregnancy, sex

Question 4

Besides the vagina, where else are Candida, Gardnerella, and Mobiluncus found?

Answer 4

Intestine

Question 5

Is trichomonas sexually transmitted?

Answer 5

YES! NOT part of normal flora

Question 6

What else does trich cause besides vaginitis/osis?

Answer 6

Urethritis in males

Question 7

White discharge

Answer 7

Candida or BV

Question 8

Yellow discharge

Answer 8

Trich

Question 9

Clumpy discharge

Answer 9

Candida

Question 10

Discharge uniformly coats vagina

Answer 10

BV

Question 11

Fishy smell

Answer 11

BV

Question 12

Lactobacilli predominate in microscopy

Answer 12

Normal

Question 13

Normal vaginal pH

Answer 13

4.5

Question 14

Discharge pH > 4.5

Answer 14

BV, trich

Question 15

Leukocytes in discharge

Answer 15

Candida, trich

Question 16

Clue cells

Answer 16

BV (Gardnerella coating epithelial cells)

Question 17

Scant discharge

Answer 17

Candida

Question 18

Profuse discharge

Answer 18

Trich

Question 19

Frothy discharge

Answer 19

Trich

Question 20

Dysuria

Answer 20

Candida, trich

Cystitis, pyelo, cervicitis

Question 21

Vulvar itching

Answer 21

Candida, trich

Question 22

No erythema

Answer 22

Normal, BV

Question 23

Introitus

Answer 23

Candida

Question 24

Colpitis macularis

Answer 24

“Strawberry cervix” = trich

Question 25

Vulvar fissure

Answer 25

Candida | normally open but can look closed d/t Candidiasis-induced edema

Question 26

Mycelia/pseudomycelia on microscopy

Answer 26

Candida | mass of branching hyphae

Question 27

Leukocytes in the urine

Answer 27

Cystitis

Question 28

WBC/RBC casts in the urine

Answer 28

Pyelo

Question 29

Suprapubic pain

Answer 29

Cystitis, pyelo

Question 30

Fever

Answer 30

Pyelo

Question 31

Mucopurulent discharge

Answer 31

Cervicitis

Question 32

Flank/back pain

Answer 32

Pyelo

Question 33

>10^5 bacteria in the urine

Answer 33

Cystitis. pyelo

Question 34

(T/F): BV and Candidiasis cannot be passed from a female to a male

Answer 34

False; they can be sexually transmitted but generally are d/t overgrowths

Question 35

Candidiasis vs. trichomoniasis

Answer 35

Both will have dysuria, discharge, vulvar erythema and itching, but Candida will produce scant, clumpy, white discharge with pH ~ 4.5 while trich will produce abundant, yellow, frothy discharge with pH > 4.5

Question 36

Candida vs. BV

Answer 36

Both will have white, clumpy discharge but BV D/C will be stanky with pH > 4.5; Candida will cause vulvar edema and erythema and have leukocytes on microscopy

Question 37

BV vs. trichomoniasis

Answer 37

Both will cause discharge, pH > 4.5, and can be smelly but BV will cause adherent white discharge with Clue cells while trich causes yellow, frothy discharge with leukocytes and vulvar erythema

Question 38

Clear discharge

Answer 38

Normal

Question 39

Use KOH in diagnosis

Answer 39

Candida - to isolate | BV - for whiff test

Question 40

What causes malodorous smell of BV discharge during whiff test?

Answer 40

KOH causes amine release, which has a fishy smell

Question 41

Usually the only sx of BV is:

Answer 41

Discharge

Question 42

Can be cultured

Answer 42

Candida or trich if clinical signs suggest infection but other tests are negative

Question 43

Tx candidiasis

Answer 43

Azoles

Question 44

Tx trich

Answer 44

Metronidazole

Question 45

Tx BV

Answer 45

Metronidazole or clindamycin

Question 46

Required tx of partner

Answer 46

Trich

Question 47

A patient returns to your office with persistent white vaginal discharge and vulvar itching despite stated compliance with a 7 day course of imidazole prescribed 9 days ago. What might be the problem?

Answer 47

Infection with Candida glabrata, which is associated with treatment failure "not uncommonly"