Vaginosis

Question 1

Characteristics of nl vaginal milieu

Answer 1

• Organisms: lactobacilli, other aerobic and anaerobic bacteria, candida
• There is a mix of protective and pathogenic bacteria, w/ protective bacteria (lactobacilli producing H2O2) being dominant
• Many factors can affect the ecosystem: ABx, hormones, douching, foreign bodies/spermicides, intercourse/semen, menses
• A healthy vagina reduces STI risk
• There may be more than 1 infection

Question 2

Vulvovaginal candidiasis

Answer 2

• Present as itching/burning (could also be trichomonas), white fluffly/curdy discharge, no odor
• Pruritus may be cycling (worse in last 1/2 of cycle): due to progesterone release after ovulation-> glycogen secretion and proliferation of candida
• Predisposing factors: diabetes, pregnancy, steroids, ABx, immunosuppression
• Vaginal pH is 4-4.5, around nl (nl = 3.8-4.5)
• Discharge may be described as cottage cheese
• Amine test (bad odor after mixing vaginal fluid w/ alkaline fluid, such as semen or KOH) is negative
• Microscopic (collection from vaginal wall): mycelia, budding yeast, pseudohyphae, +/- WBCs

Question 3

Vaginal trichomoniasis

Answer 3

• Only vaginosis that is sexually transmitted, caused by protozoan
• Up to 1/3rd of women are ASx, most men are ASx
• Presentation: frothy discharge, bad odor, pruritus, dysuria
• Vaginal pH is variable but usually >4.5
• Discharge (increased): frothy grey, yellow-green, flocculent and adherent
• Amine odor often present
• Micro: trichomonads (large round cells w/ tail), +/- WBCs

Question 4

Bacterial vaginosis

Answer 4

• Most prevalent vaginal infection, associated w/ sex but not sexually transmitted
• 50% of women are ASx
• Predisposing factors: presence or Hx of STI, sexual activity, douching, new sex partner, decreased lactobacilli
• Presentation: discharge, malodorous, +/- pruritus
• Discharge: thin, homogenous, white/grey, adherent, often increased
• Amine odor present
• Micro: clue cells (epithelial cells w/ coat- obscured edges) +/- rods