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Pharm 129 > 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

One of the most common reasons women seek medical care

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2
Q

What are non-infectious causes of vaginitis

A

Causing vulvovaginal pruritus without discharge (itching)

Causing vaginal discharge primarily (no/less itch)

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3
Q

what are the causes of vulvovaginal pruritus

A 
• Poor hygiene
• Irritant or allergic dermatitis
• Skin disorders: 
– Psoriasis
– Lichen planus
– Lichen sclerosus
– Squamous cell hyperplasia
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4
Q

what are the causes of vaginal discharge (without itch)

A
  • Desquamative inflammatory vaginitis
  • Atrophic vaginitis
  • Foreign bodies
  • Excessive physiologic secretions (stress, pregnant, ovulation)
  • Certain cancers
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5
Q

what are infectious causes of vaginitis

A

Bacterial Vaginosis (BV) - most common
Vulvovaginal Candidiasis (VVC) - yeast infection
Trichomoniasis
Other (chlamydia, gonorrhoea, etc)

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6
Q

Which type of vaginitis:

  • little itching
  • homogenous, white-grey discharge, malodorous “foul fishy”
  • ph >4.5 (5-6)
A

bacterial vaginosis

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7
Q

Which type of vaginitis:

  • some itching
  • frothy, yellow-green discharge, malodorous
  • dysuria
  • strawberry cervix
  • ph >4.5 (6)
A

Trichomoniasis

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8
Q

Which type of vaginitis:

  • LOTS of itching
  • cottage cheese discharge, no odour
  • dysuria and dyspareunia
  • redness and/or swelling
  • pH <4.5 (normal pH)
A

VVC

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9
Q

What organism causes bacterial vaginosis

A

Gardnerella vaginalis

Mycoplasma hominis +

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10
Q

What organism causes trichomoniasis

A

Trichomonas vaginalis

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11
Q

What organism causes VVC

A

Candida albicans

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12
Q

Which type of vaginitis is sexually transmitted

A

trichomoniasis

not an STI in bacterial vaginosis but rates > in sexually active women

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13
Q

What are risk factors for bacterial vaginosis

A 
IUD use
Vaginal Douching 
Absence of or decrease in lactobacilli 
New/multiple sexual partners
smoking
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14
Q

Risk factors for trichomoniasis

A 
History of STIs
Lack of condom use 
Multiple sex partners
Lower socioeconomic status
smoking
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15
Q

Risk factors for VVC

A 
Race (more likely for african americans)
Vaginal Douching 
Meds: ABX, CST
increased Estrogen Levels 
Uncontrolled DM 
Immunodeficiency
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16
Q

Treatment for bacterial vaginosis

A

Preferred treatment:
• Metronidazole 500mg BID x 7 days

  • Metronidazole 0.75% gel: 5g intravaginally once a day x 5 days
  • Clindamycin 2% cream: 5g intravaginally once a day x 7 days
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17
Q

Partner management for bacterial vaginosis

A

treatment of partner not warranted

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18
Q

Treatment of trichomoniasis

A
  • Metronidazole 500mg BID x 7 days (can be used if no swab test is done bc will treat BV or trichomoniasis)
  • Metronidazole 2g single dose
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19
Q

Partner management for trichomoniasis

A

Treat partner
Avoid sex
- dont treat/defer asymptomatic pregnant patients

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20
Q

Partner management for VVC?

A

Typically NO need to treat sexual partner (unless uncircumcised)
Exception: C. balanitis, RVVC

Avoid sex until therapy complete

21
Q

How does VVC occur?

A
  • candida is a normal part of the vagina flora
  • symptomatic candidiasis is caused by overgrowth (usually due to changes in host environment)
  • disruption of vaginal ecology can occur with diabetes, pregnancy, or HIV disease. In some women, disruption can occur with the use of antibiotics and douching
22
Q

What are the 2 classes of VVC

A

Uncomplicated (can be treated by RPh) and complicated (refer)

23
Q

What is uncomplicated VVC

A
  • Sporadic, Infrequent VVC
  • Mild-to-moderate signs and symptoms
  • Likely caused by C. albicans
  • Non-immunocompromised host
24
Q

What is complicated VVC

A
  • Recurrent VVC (RVVC)
  • Severe symptoms
  • Non-albicans species
  • Compromised host
25
Q

Red flags of VVC

A
  • Is pregnant
  • Is premenarchal
  • Presents w/ vaginal symptoms for the 1st time
  • Presents w/ concurrent symptoms of fever or pelvic pain
  • Presents w/ signs or symptoms inconsistent with VVC
  • Coloured or malodorous discharge
  • Is predisposed to VVC: DM, HIV
  • Is taking predisposing medications
  • Has a recurrence of VVC (>3/year or 2 within past 2 months)
26
Q

What are the criteria for self treating VVC?

A
  1. vaginal symptoms infrequent
  2. > 1 previous diagnosed episode
  3. current symptoms are mild-moderate and consistent with VVC
  4. vaginal pH <4.5 (if measured)
27
Q

What is vagisense

A
  • tells you if pH >4.5 (turns blue)
  • detects BV or trichomoniasis infections
  • do not use around menses (pH naturally elevated)
28
Q

When to avoid using vagisense

A
  • In pregnancy
  • <1 day before or the day after your period
  • there are signs of menstruation or any vaginal bleeding
  • <12 hours after sexual intercourse or vaginal douching
  • <72 hours after the application of vaginal preparations
29
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

30
Q

Vaginitis prevention: Hygiene measures

A
  • Keep genital area CLEAN and DRY; wipe from front to back.
  • Avoid OTC feminine hygiene products & douches.
  • Change sanitary pads & tampons regularly; Practice safe sex
31
Q

Vaginitis prevention: Clothing measures

A
  • Choose COTTON underwear (avoid synthetic, silk, or nylon)
  • Avoid tight or restrictive synthetic clothing; avoid thongs
  • Promptly change out of wet clothes/swimsuits
32
Q

Vaginitis prevention: diet measures

A
  • Balanced, nutritious diet
  • Decrease sucrose and refined carbs if poorly controlled diabetic
  • Drink sufficient fluids
  • Eat yogurt (8 oz/day) with live lactobacillus cultures
33
Q

How to treat uncomplicated VVC

A

Non pharm therapy +

nonRX (Vaginal Imidazole Antifungals or Oral Triazole Antifungal: Fluconazole)

or RX (Vaginal Triazole Antifungal: Terconazole)

34
Q

Nonpharm therapy

A

Sodium bicarbonate sitz bath
– Add 1 teaspoon sodium bicarbonate to 1 pint of water
– Add 2-4 tablespoons of the solution to 2 inches of bath water
– Sit in the sitz bath or bathtub for 15 minutes as needed for symptom control

Consume yogurt?

35
Q

What are OTC Vaginal Imidazoles available

A
  • clotrimazole (canestan)
  • 1/3/6 days
  • miconazole (monistat)
  • 1/3/7 days
  • CI: warfarin

strength increases as days decrease

36
Q

What type of product is recommended for bedtime

A

Creams

37
Q

What type of product is recommended for anytime of day

A

ovule

38
Q

What OTC oral triazoles are available?

A

Fluconazole (CanesOral, DiflucanONE, Monicure)
150 mg PO x 1 dose

  • do not use if pregnant or trying
39
Q

What RX vaginal triazole is available?

A

Terconazole (terazol 7, taro-terconazole)

Vaginal Cream 0.4%: 1 applicatorful intravaginally qhs x 7 days

40
Q

Do multi-day treatments work the same as single-dose?

A
  • equal efficacy

- faster rates of symptom relief

41
Q

What to do if nonRx therapy is ineffective?

A

refer

42
Q

what should sexual partner do in RVVC cases?

A
  • use antifungal cream x 7 days while woman is receiving treatment
43
Q

How long should symptoms improve by

A

within 2-3 days, resolve within 7

refer if >7 days

44
Q

When to follow up?

A

3 days

45
Q

What treatments are recommended for pregnancy

A
  • longer duration is better
  • clotrimazole 1% cream 5 g intravaginally per day x 7–14 days
  • clotrimazole 100 mg vaginal tablet once daily x 7 days
  • miconazole 2% cream 5 g intravaginally per day x 7 days
  • miconazole 100 mg vaginal suppository once daily x 7 days
  • terconazole 0.4% cream 5 g intravaginally x 7 days
46
Q

What to avoid using when pregnant

A

fluconazole

boric acid

47
Q

What is the best treatment option for breastfeeding women

A

Any topical Clotrimazole or Miconazole formulation

Others:

  • nystatin does not enter breastmilk
  • fluconazole is excreted in milk but compatible
48
Q

Products to avoid

A
  • Vaginal Douches
  • Vaginal Anti-Itch Creams
  • Natural Health Products (need antifungal)
  • Personal/Genital Hygiene products

Pharm 129 (14 decks)

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