vulvovaginal candidiasis Flashcards
what is vaginitis
Inflammation of the vaginal tissue that may be accompanied by itching, burning, irritation, pain, odor and vaginal discharge
what are non infectious causs of vaginitis
- 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
infectious causes of vaginitis
- bacterial aginosis (#1)
- vulvovaginal cadidiasis (VVC)
- trichomiasis
- other
describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of
bacterial vaginosis
- 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
describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of
trichomoniasis
- 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
describe symptom presentation, vaginal discharnge, cinlical findgins and vaginal pH of Vulvovaginal candidiasis
- 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
causatic organism, transmission, risk factors and potential complications of
bacterial vaginosis
- 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
causatic organism, transmission, risk factors and potential complications of
trichomoniasis
- 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
causatic organism, transmission, risk factors and potential complications of
vulvovaginal candidiasis
- 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
treatment for bacterial vaaginosis
- 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
treatment for trichomoniasis
- 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
treatment for vulvovaginal cadidiasis
- antifungals
*typically no need to treat sexual partner -> exception is C. balanitis, RVVC
*avoid sex until therapy is compelte
pathogenesis of VVC
- 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
main symptoms of VVC
- thick white cottage cheese discharge with NO odor
- noraml vaginal pH
- vulvar pruritis
- vulvar erythema
- +/1 vulvar edma
classifications of VVC
- 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
red falgs for VVC
- 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)
when can you self treat VVC
- Vaginal symtpoms inrequent (3 less/year)
- one previously diagnoses VVC
- symptoms are mild -> consistent with VVC
- pH < 4.5 (if measured)
*must satifsy all
what can be used to chekc vaginal pH
- 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
when should you avoid Vagisense usage to test pH
- 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
goals of therapy for VVC
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
how to prevent aginitis
- 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?
- balanced nutritous diet
first lien options to treat VVC
- non pharmacologic therapy PLUS
- non rx therapy or rx therapy
- non rx
- vaginal imidazole antifugals
- oral triazole antifunal: fluconazole
- RX
- vaginal triazole antifuncal: terconazole
- non rx
what is second line treatment for VVC
- polyene antifungal: nystatin
*2nf line bs longer duration for use and adverse effects
do case and questions at end
