Vulvar and Vaginal Disease Flashcards
What is the most common cause of vaginal infection?
bacterial vaginosis
What are the 4 Amsel criteria for diagnosis of BV that needs 3 for diagnosis?
1) thin, gray homogenous vaginal discharge
2) positive whiff test from KOH releasing amines
3) presence of clue cells on saline microscopy
4) elevated vaginal pH>4.5
What is treatment of BV?
500mg metronidazole BID x7 days or vaginal metronidazole .75% gel QHS for five days
What is lichen sclerosis and how does it present?
chronic inflammatory skin condition most commonly affects Caucasian premenarchal girls and postmenopausal women; presents with extreme vulvar pruritis and may also present with vulvar burning, pain and introital dyspareunia; ultimately, introital stenosis, resorption of clitoris(phimosis) and labia minora may occur; 5% risk of developing SCC
What is treatment for lichen sclerosis?
high potency topical steroids
How can vulvovaginal candidiasis be diagnosed?
in a women with signs and symptoms of vaginitis with either a)wet prep or gram stain of vaginal discharge demonstrates yeast or pseudohyphae or b)a vaginal culture or other test yields positive yeast; microscopy might be negative in up to 50% of confirmed cases
How is uncomplicated vulvovaginal candidiasis treated?
short course of topical Azole formulations
What is lichen planus?
chronic dermatologic disorder involving the hair bearing skin and scalp, nails, oral mucous membranes and vulva
What is vestibulodynia syndrome?
severe pain on vestibular touch or attempted vaginal entry, tenderness to pressure and erythema of various degrees
How is vestibulodynia syndrome treated?
TCAs to block sympathetic afferent pain loops, pelvic floor rehabilitation, biofeedback and topical anesthetics; surgery with vestibulecotmy is reserved for patients who do not respond to standard therapies and are unable to tolerate intercourse
What is lichen simplex chronicus?
vulvar non-neoplastic disorder that results from chronic scratching and rubbing, which damages the skin and leads to loss of its protective barrier
what are symptoms of lichen simplex chronicus?
severe vulvar pruritus, which can be worse at night. thick, lichenified, enlarged and rugose labia giving labia a leather like appearance with or without edema
What are etiologies of lichen simplex chronicus?
environmental factors such as excessive heat and feminine hygiene products, and conditions such as yeast infections or lichen sclerosis
How is lichen simplex chronicus diagnosed and treated?
based on clinical history and findings, as well as vulvar biopsy and cultures to determine underlying cause; treatment involves short course of high potency topical corticosteroids and antihistamines
How is muculopurulent cervicitis treated?
therapy should include coverage for both organisms, such as azithromycin or doxycycline for chlamydia and cephalosporin or quinolone for gonorrhea; ceftriaxone 125mg in a single dose
