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Professional Practice > vulvovaginal candidiasis > Flashcards

vulvovaginal candidiasis Flashcards

1
Q

what is vaginitis

A

Inflammation of the vaginal tissue that may be accompanied by itching, burning, irritation, pain, odor and vaginal discharge

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2
Q

what are non infectious causs of vaginitis

A
  • causing vulvuvaginal pruritus wihtout discharge
    • poor hygiene
    • irritatnt. allergic dermatitis
    • skin disorders; PsoriasiS, Lichenplanus, Lichensclerosus,Squamous cell hyperplasia
  • causing vaginal discharge primarily
    • Desquamative inflammatory vaginitis
    • atrophic vaginitis (vag dryness, body will try to inc discharge
    • foreign bodies
    • excessive physiologic secretions
    • certain cancers
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3
Q

infectious causes of vaginitis

A
  • bacterial aginosis (#1)
  • vulvovaginal cadidiasis (VVC)
  • trichomiasis
  • other
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4
Q

describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of

bacterial vaginosis

A
  • Symptom presentation
    • vulvar pruritus + discharge
    • 50% asymptomatic
  • vaginal discahrge
    • homogeneous adherent, thin, milky white-grey, fishy smell
  • clinical findings
    • little or no inflamation
  • pH
    • >4.5
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5
Q

describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of

trichomoniasis

A
  • symptoms
    • vulvar pruritus (SUPER ITCHY)
    • disrcahge
    • dysuria
    • 64-90% asymptomatic
  • vaginal discahge
    • frothy off white yello green
    • malodorous
  • clinical finsings
    • cervical petechiae “strawberry cervix” -> dots on it
  • pH
    • >4.5
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6
Q

describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of Vulvovaginal candidiasis

A
  • symptoms
    • vulvar pruritis (itchiest one!)
    • discharge, dysuria, hysparenuia (painful sex)
    • <20% asymptomatic
  • vaginal discharge
    • thick, clumpy white, “cottage cheese”
    • no odour
  • Clinical findinds
    • erythema +/- edema of vulva and vegina
  • vaginal pH
    • <4.5 NOT CHANGED FROM NORMAL
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7
Q

causatic organism, transmission, risk factors and potential complications of

bacterial vaginosis

A
  • causative organism
    • gardnerella vaginalis, mycoplasma hominis (+)
  • transmission
    • not at STI
    • rates inc in secually active women
  • Risk factors
    • IUD, vaginal douching, absense of or dec in lactobacilli
    • mew/multiple sexual partners
    • smoking
  • Potential compications
    • pre term labour/delivery
    • premature rupture of membranes, PID, spontaneous abortion
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8
Q

causatic organism, transmission, risk factors and potential complications of

trichomoniasis

A
  • causative organism
    • trichomonas vaginalis
  • transmission
    • sexual
  • risk factors
    • history of STIs, lack of condom use, multiple sex partners
    • lower socioeconomic status, smoking
  • potential complications
    • pre term rupture of membranes & delivery
    • inc risk of HIV acquisition
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9
Q

causatic organism, transmission, risk factors and potential complications of

vulvovaginal candidiasis

A
  • causative organism
    • candidia albicans
  • transmission
    • not suually acquired sexually
  • Risk factors
    • race
    • vaginal douching
    • meds: ABX, CST, inc estogen levels
    • uncontolled DM
    • immunodeficiency
  • Potential complications
    • resistance, recurrent VVC
    • inc risk of other ifnections: vaginitis and penile candidiasis
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10
Q

treatment for bacterial vaaginosis

A
  • metronidazole 500mg BID f7d
  • metronidazole 0.75% gel: 5g intravaginally 1d f5d

clindamycin 2% cream: 5g intravaginally 1d f7d

*routine treatment of sexual partner not warranted

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11
Q

treatment for trichomoniasis

A
  • mtrionzadole 500mg BID f7d (acts for both trichomoniasis and bacterial vag)
  • metronidazole 2g single dose

*treat sexual partner -> avoid sex until therapy is compelte

*dont treat asymtpomatic pregnant patients

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12
Q

treatment for vulvovaginal cadidiasis

A
  • antifungals

*typically no need to treat sexual partner -> exception is C. balanitis, RVVC

*avoid sex until therapy is compelte

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13
Q

pathogenesis of VVC

A
  • Candida special are normal in skin and vaginal, not sonciered sexually transmited
  • symptomatic candidasis caused by overgorwth of C. albicans and other candidia species
  • distruption of normal vaginal exolocy & host immunity -> diabetes, pegnnacy or HIV
  • can also occur bc of antibiotics and douching
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14
Q

main symptoms of VVC

A
  • thick white cottage cheese discharge with NO odor
  • noraml vaginal pH
  • vulvar pruritis
  • vulvar erythema
  • +/1 vulvar edma
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15
Q

classifications of VVC

A
  • uncomplicated
    • sporadic, infrequent VVC
    • mild to moderate signs and symptoms
    • likely caused by C. albicans
    • non- immunocompromised host
  • Complicated
    • recurrent VVC
    • severe symptoms
    • non albicans species
    • compromised host
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16
Q

red falgs for VVC

A
  • pregnant
  • premenarchal
  • presents w/ vaginal symptoms for 1st time (MUST have had it before to self treat)
  • presents w/ concurrent symptoms of fever or pelvic pain
  • present w/ signs or symptoms inconsistent with VVC (coloured or malodorous discharge)
  • predisposed to VVC: DM, HIV
  • taking predisposing medications (Chemo)
  • has recurrence of VVC (> 3.year or two within past 2 months)
17
Q

when can you self treat VVC

A
  1. Vaginal symtpoms inrequent (3 less/year)
  2. one previously diagnoses VVC
  3. symptoms are mild -> consistent with VVC
  4. pH < 4.5 (if measured)

*must satifsy all

18
Q

what can be used to chekc vaginal pH

A
  • vagisense
  • just tells you if pH is above 4.5
  • if yellow pH is not above 4.5, any blue is positive

*can get a postive test but still have a yeast infection -> can get mixed infections)

  • if used corretnyl and you tested negative, dont have baterial vaginosis
19
Q

when should you avoid Vagisense usage to test pH

A
  • if pregnant (REFER)
  • < 1 day before or the day after your period
  • signs of menstruation or any vaginal bleeding
  • <12 hours after sexual intercourse or vaginal douching

< 72 hours after application of vaginal preparations

20
Q

goals of therapy for VVC

A

Rapidly relieve signs & symptoms

Eradicate causative organism

Prevent recurrence & complications-> Reestablishment of normal vaginal flora

Prevent misdiagnosis and delayed treatment of another condition

Reduce inappropriate use of anti- fungals

*single course of therapy is effective in achieving tis, if they have symptoms after need to refer

21
Q

how to prevent aginitis

A
  • Hygiene
    • keep genital area clean and dry -> wipe fron to back
    • avoid OTC feminine hygiene products and douches
    • charge sanitary pads and tampons reguarly -> practie safe sex
  • Clothing
    • choose cotton underwear (avoid synthetic, silk or nylon)
    • avoid tight or restictive clothing -> avoid thongs
    • promptly change out of wet clothes/swimsuits
  • Diet
    • balanced nutritous diet
      • dec sucrose and refined cards if poorly controled diabetc
    • drink sufficient fluids
    • eat yogurt (8 oz/day) with live lactobacillus cultures?
22
Q

first lien options to treat VVC

A
  • non pharmacologic therapy PLUS
  • non rx therapy or rx therapy
    • non rx
      • vaginal imidazole antifugals
      • oral triazole antifunal: fluconazole
    • RX
      • vaginal triazole antifuncal: terconazole
23
Q

what is second line treatment for VVC

A
  • polyene antifungal: nystatin

*2nf line bs longer duration for use and adverse effects

24
Q

do case and questions at end

A
25
Q

non pharm therapy for VVC

A
  • temporary symptomatic treatment of irritated vulva -> sodium bicarbonate sitx bath
  • add 1 tsp of sodium bicarbonate to 1 pint of water

add 2-4 tbsp of solution to 2 inces of bath water

  • sit in it for 15 min as needed for symptoms control
26
Q

vaginal imidazoles for treatment of VVC

A

*first line

  • otc options:
    • Clotrimazole (canesten): 1,3 and 6 day products (1 day has lots of side effects)
    • miconazole (monistat): 1,2, and 7 day products
      • interacts with warfarin!
  • ADR
    • well tolerated
    • if v hgih dose get local burning, ittitarion and itching
27
Q

forms of products of VVC

A

cream and ovules

  • cream use HS -> maximized contract time

ovule can be used any time of day

*comfort tab is an ovule

28
Q

treatment of VVC with fluconazole

A

ex: canesORAL, diflucanONE, monicure
- dose: 150mg PO i dose
adr: headache, GI efects, rish, inc LFT
- CIs/precautiosn: hypersensitivity, renal/liver disease, pregnancy

*fluconazoel in high dose linked to brith defects in 1st trimester -> avoid if trying to precome preg or preg

29
Q

triazoles for treatment of VVC

A

terconazole

  • dose: vaginal cream 0.4%: 1 application intravaginally qhs f7d
  • ADRs: headache, vaginal discomfort

*RX therapy

30
Q

when would you use just oral therapy vs combo for oral and cream

A
  • if super itchy do the combo bc get quicker relief
  • oral takes a day to treat itch
31
Q

sex during vaginal antifungal treatment

A
  • refrain
  • vaginal lubricatns and spermicides should NOT be used concurrently
  • do not use latex condoms & diaphragms during therapy for 3 days agter (has mineral oil that makes cnodoms less effective)
32
Q

monitoring VVC

A
  • symptoms should improve in 2-3 days of initiation of therapy & resolve in 7 days

*refer is > 7 days

  • educate patient: resolution time, adverse effects of treatment

*if presistent symptoms or new onset uncharacteristic of VVC REFER

  • follow up phone call after 3 days to dicuss: treatment effectiveness and importance of adherence
33
Q

DO PRACTICE QUESTIONS AND CASE STUDY

A
34
Q

how to treat VVC in pregnanct comen

A
  • **Clotrimazole
    • 1% cream, 100mg vaginal tab 1d f7d or 100mg tab 2d f3d, 500 mg vag tab in single app
  • **miconazole
    • 2% vaginal cream 5g intravag f7d
    • 100 mg vag sup 1d f7d, 200 mg vag sup 1d f3d
  • Nystatin
    • 100,000 unit vag tab 1d f14d (less effective than topical axoles)
  • Terconazole
    • 0.4% cream: 5f intravag f7d *
    • 0.8% cream 5g intravag f3d
    • 80mg vag sup daily f3d

* = preferred treatment

35
Q

what VVC meds should be avoided in pregnant women

A

– fluconazole

boric acid

36
Q

treatment of VVC when breastfeeding

A
  • topical azole = best option: any tpoical clotrimazole or miconazole
  • nystatin: does not enter breast milk
    fluconaozle: excreted in milk but AAP compatible
37
Q

products to avoid when have VVC

A

VaginalDouches
• VaginalAnti-ItchCreams

  • NaturalHealthProducts
  • Personal/GenitalHygieneproducts
38
Q

patient counseling: how to aply vaginal cream

A
  • insert the antifungal at bedtime to minimize leakage from the vagina
  • Significant symptom relief expected within 24-48 hours
  • Continue therapy for the recommended length of time, even if symptom-free or menstruating
  • Do not use tampons or douche while using a vaginal antifungal product & for 3 days after
  • Refrain from sexual intercourse for 1week

– Do not use latex condoms & diaphragms

Professional Practice (23 decks)

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