VULVAR INFECTIONS Flashcards
Condyloma Acuminatum
Etiology
: HPV
16, 18: aneuploid,
premalignant or malignant
lesions
6, 11: benign, euploid
lesions
Condyloma Acuminatum
Clinical Features
Raised & ragged lesions cauliflower lesions
(+) pruritus
(+) grows fast
spread by skin-to-skin contact
Condyloma Acuminatum
Diagnosis
EXCISION Biopsy
PATHOGNOMONIC: Koilocytes seen on cytology
Koilocytes - cells with
perinuclear halos)
Condyloma Acuminatum
Treatment
Electrocautery - in office
Cryotherapy
Chemical cautery - if lesion is thin
SMALL LESIONS: IMIQUIMOD (topical cream for small
multiple lesions)
Condyloma Acuminatum in a pregnant patient
Deliver CS if condyloma is so prolific
Baby might incur virus (laryngeal
papilloma)
In early pregnancy: Do not use chemical cauterizing drugs;
treat mechanically via excisions,
cauterization or cryotherapy
Herpes Genitalis
Describe lesion
Vesicles
Ulcers (vesicles that have ulcerated)
(+) painful
Herpes Genitalis
what is peculiar about this disease?
Recurrent & incurable STD
• 1st recurrence usually within 6 months
• May recur 4x in first year
Herpes Genitalis
Causative agent
Herpes Simplex
Virus Type 2 – resides in
dorsal root ganglia (S2, S3,
S4)
Before appearance of herpetic vesicles, what symptoms may arise first?
Sacroneuralgia vulvar burning tenderness pruritus inguinal adenopathy --> appear hours to 5 days before vesicle formation
What vulvar lesion causes tender inguinal lymphadenopathy
HSV 2
Herpes
HSV diagnosis
- PCR - most accurate and sensitive
- Tzanck smear (+) multinucleated giat cells
- viral culture or serologic testing
HSV Treatment
ACYCLOVIR (A mukhang 4)
400 mg
3x/day for 7-10
days
Daily suppression/prophylaxis: if >6 episodes/year (Acyclovir 400mg
orally BID)
Molluscum Contagiosum
Etiologic agent
Poxvirus
Molluscum Contagiosum
Mode of transmission
Asymptomatic
Molluscum Contagiosum
Lesion description
asymptomatic
Umbilicated papule
“water wart”
Molluscum Contagiosum
Diagnosis
Giemsa stain
Confirmatory intracytoplasmic molluscum bodies
Molluscum Contagiosum
Treatment
Usually self-limiting
May be treated chemically or by
cryosurgery or electrocautery
s (Bartholin’s
Adenitis)
Etiology
Etiology: 1. Cystic dilatation of duct 2. Abscess formation 3. Mechanical obstruction (inflammation/trauma)
Soft swelling, fluctuant tissue on the vulva and
severe pain
Bartholin’s
Adenitis
Swelling of the vulva Usually unilateral, tense, non-painful and
unilocular
Bartholin’s cysts
Swelling of the vulva
Swelling, redness, tenderness, but NO mass
Bartholin’s adenitis
Erythema, acute tenderness, edema,
cellulitis, asymmetrical vulvar swelling
• Fever and difficulty in walking
Bartholin’s Abscess
Bartholin’s Abscess
Etiologic Agent
s. aureus
Treatment of Bartholin’s Abscess:
Marsupialization Development of a fistulous tract from Bartholin’s duct to vestibule, to allow continuous drainage
Drained pus sent for culture &
sensitivity
Give IV antibiotics first before
draining the abscess, to
prevent spread of infectious
emboli
