Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DipGUM > Vulvovaginal candidiasis > Flashcards

Vulvovaginal candidiasis Flashcards

1
Q

What is the primary laboratory investigation for acute vulvovaginal candidiasis?

A

Microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is culture recommended in management of vulvovaginal candidiasis? Why?

A

Recurrent presentations

Speciation and sensitivity testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of recurrent vulvovaginal candidiasis?

A

4 episodes per year with 2 episodes confirmed by microscopy or culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of organism is Candida?

A

Yeast
Eukaryotic, unicellular microorganisms
able to develop multicellular characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the multicellular characteristics of Candida?

A

Form pseudohyphae and biofilms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is candidiasis?

A

Fungal infection caused by yeasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common candida species that causes infection?

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What proportion of vulvovaginal candidiasis is caused by Candida albicans?

A

80-89%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are species have been known to cause vulvovaginal candidiasis?

A 
C. glabrata
C. tropicalis
C. krusei
C. parapsilosis
Saccharomyces cerevisiae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What proportion of women will have at least one episode of vulvovaginal candidiasis?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the host factors that lead to recurrent vulvovaginal candidiasis?

A 
persistence of Candida on PCR
poorly controlled diabetes mellitus
immunosupression
endogenous or exogenous oestrogen (pregnancy, COCP, HRT)
recent antibiotic use (<3 months)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathophysiology that correlates with symptomatic vulvovaginal candidiasis?

A

fungal burden

neutrophil infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What signs may be identified in vulvovaginal candidiasis?

A 
erythema
fissuring
swelling/oedema
vaginal discharge (typically non-offensive and curdy but may be thin or absent)
satellite lesions and excoriation marks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the differential diagnoses for vulvovaginal candidiasis?

A 
dermatitis/eczema
lichensclerosus
other infections (HSV, trichomonas vaginalis)
vulvodynia
aerobic vaginitis
cytolytic vaginosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should aerobic vaginitis be considered over vulvovaginal candidiasis?

A

primary complaint - purulent non-offensive discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When might you consider Cytolytic vaginosis over vulvovaginal candidiasis?

A

very similar clinical features:
curdy discharge
pruritus
microscopy and fungal cultures are negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sampling technique should be used to diagnose vulvovaginal candidiasis?

A

high vaginal swab (HVS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What may be seen on microscopy that confirms high vaginal swab (HVS)?

A

blastospores
pseudohyphae
neutrophils

19
Q

If you see blastosphores and neutrophils only, what might this suggest infection with?

A

Candida glabrata

20
Q

If there are no neutrophils but evidence of candida on microscopy what does this suggest?

A

colonisation with Candida not infection

21
Q

At what pH is in vitro susceptibility testing performed for Candida?

A

pH 7.0

22
Q

What is the typical vaginal pH in vulvovaginal candidiasis?

A

pH 4 - 4.5

23
Q

What are the practical implications of susceptibility testing performed for Candida at higher pH?

A

standard treatment may not work despite being designated as susceptible

24
Q

What general advice should be given to women with symptoms of vulvovaginal candidiasis?

A

avoiding the use of local irritants
emollient for personal hygiene as a soap substitute, moisturiser and a barrier cream
Sex can continue
Women may wish to avoid sex until symptoms have improved particularly if there is fissuring of the skin

25
Q

What genital hygiene practices have been linked with recurrent vulvovaginal candidiasis?

A

washing hair in bath
excessive cleaning
wearing incorrectly fitted clothing made from non-breathable fabric
using intermenstrual or daily panty liners
vaginal douching

26
Q

What additional investigations should be considered in recurrent vulvovaginal candidiasis?

A

urinalysis, random blood glucose or HbA1c for diabetes

full blood count or serum ferritin for iron-deficiency anaemia

27
Q

When should screening for mannose binding lectin (MBL) deficiency be considered in vulvovaginal candidiasis?

A

Recurrent infection
history of recurrent upper respiratory tract infections
otitis media
autoimmune conditions

28
Q

What is the recommended treatment for vulvovaginal candidiasis? Oral? Topical?

A

Oral:
Fluconazole 150mg STAT
Topical:
Clotrimazole 500mg STAT intravaginal

29
Q

How effective are intravaginal and oral treatments for vulvovaginal candidiasis?

A

> 80% clinical and mycological cure rate in acute VVC All intravaginal imidazoles and oral azoles

30
Q

When should oral fluconazole be avoided?

A

pregnancy
risk of pregnancy
breastfeeding

31
Q

What is the risk with intravaginal/topical treatments for vulvovaginal candidiasis?

A

damage latex condoms and diaphragms

risk of unplanned pregnancies

32
Q

Fluconazole is a moderate inhibitor of cytochrome P450 (CYP) isoenzyme 2C9 and a moderate inhibitor of CYP3A4 - how long does this effect last?

A

4-5days

due to the long half-life

33
Q

What cardiac risk is associated with azaleas including fluconazole?

A

prolongation of the QT interval

34
Q

What signs may be present in severe VVC?

A

extensive vulval erythema
oedema
excoriation
fissure formation

35
Q

What is the treatment for severe VVC?

A

Fluconazole 150mg orally on day 1 and 4

Vaginal pessary - clotrimazole or miconazole - alternative

36
Q

What other treatment may accelerate symptomatic relief of VVC?

A

Low-potency corticosteroid creams

37
Q

What is the treatment for recurrent VVC? induction? Maintenance?

A

Induction:
fluconazole 150mg orally every 72 hours x 3 doses
Maintenance:
fluconazole 150mg orally once a week for 6 months

38
Q

When should an antihistamine be considered in the treatment of VVC?

A

Relapse between suppressive therapy doses

history of allergy ie atopy

39
Q

Why is ketoconazole NO longer used as treatment for fungal infections?

A

risk of hepatotoxicity outweighs the potential benefits

40
Q

What treatments may be considered for non-albicans candida or azole resistance?

A

Nystatin pessaries
Boric acid vaginal suppositories
Amphotercin B vaginal suppositories
Flucytosine pessary

41
Q

How long should treatment be given for azole resistant Candida?

A

2 weeks

42
Q

When might a higher dose and increased frequency of fluconazole be used for VVC?

A

isolates with an elevated MIC but still designated susceptible

43
Q

What is the difference in cure rate of VVC in pregnancy between 4 day and 7 day course?

A

4 days topical imidazole: >50%

7 days: >90%

DipGUM (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions