Vaginitis/Vaginosis

Question 1

Candida albicans, C. flabrata, and Gardnerella vaginalis, Mobiluncus spp and other anaerobes are all what?

Answer 1

Opportunistic microorganisms and agents of bacterial vaginosis (BV)

Question 2

Are the BV organisms sexually transmitted?

Answer 2

For the most part they are not

Question 3

Where are the BV organisms found?

Answer 3

In the normal flora of the vagina at any given time, but are normally present in low and harmless numbers

Question 4

What is the key factor allowing overgrowth of Candida and the agents of BV?

Answer 4

Disturbance of normal flora, especially the gram positive lactobacilli but also normal flora that help maintain a low Ph and produce hydrogen peroxide

Question 5

What is T. vaginalis?

Answer 5

A single cell protozoan, not a bacterium, it is considered a frank pathogen rather than a part of normal flora (it is sexually transmitted)

Question 6

Does a single agent cause BV?

Answer 6

No

Question 7

What are the agents of BV we should know?

Answer 7

Gardnerella vaginalis, Mobiluncus, anaerobes

Question 8

What causes Candidiasis?

Answer 8

Candida albicans, C. glabrata: fungi not bacteria

Question 9

What causes Trichomoniasis?

Answer 9

Trichomonas Vaginalis, a protozoan

Question 10

What main symptoms are seen with Candidiasis, Trichomonal, and BV?

Answer 10

Discharge (all 3), Dysuria and itching (for C and T)

Question 11

What is the discharge seen in Candidiasis?

Answer 11

Scant, white, clumped adherent plaques

Question 12

What is the discharge seen in Trichomoniasis?

Answer 12

Profuse, yellow, homogenous or frothy

Question 13

What is the discharge seen in BV?

Answer 13

Moderate, white or grey, adherent, homogeneous discharge that uniformly coats vagina

Question 14

Does BV have inflammation?

Answer 14

No, Candidiasis and Trichomoniasis do

Question 15

Do Candidiasis and Trichomoniasis have Leukocytes?

Answer 15

Yes, BV does not

Question 16

What is cystitis characterized by?

Answer 16

Dysuria, suprapubic pain, polys in urine, significant numbers of bacteria in the urine

Question 17

What is pyelonephritis characterized by?

Answer 17

Signs and symptoms of cystitis, significant fever, flank/back pain

Question 18

What is Cervicitis characterized by?

Answer 18

Dysuria, mucopurulent discharge

Question 19

Are BV, candidiasis, and trichomoniasis common?

Answer 19

Yes, very

Question 20

How is BV diagnosed?

Answer 20

Foul odor (add KOH = whiff test), discharge typical a dirty white/gray, pH > 4.5 of discharge, presence of clue cells

Question 21

How is Candidiasis diagnosed?

Answer 21

Vaginal itching, discharge: patchy white adherent clumps, discharge may have pungent but not foul smelling odor, pH 4.5 or below, yeasts and branching hyphae seen on wet mount w/ KOH

Question 22

How is Trichomonas diagnoses?

Answer 22

Discharge: yellow-green/yellow, homogeneous and may be copious and frothy, pH > 4.5; Wet mount microscopic exam of discharge: trichomonads (size of PMNs) with twitching motility, presence of PMNs

Question 23

How do you treat Trichomonas?

Answer 23

Oral metronidazole

Question 24

How do you treat Candidiasis?

Answer 24

Topical and oral azoles

Question 25

How do you treat BV?

Answer 25

Oral metronidazole

Question 26

Do you treat sexual partners of Trich?

Answer 26

Yes, Metronidazole (not in BV or Candidiasis)