Vulvovaginal Disorders Flashcards
Infections such as bacterial vaginosis and trichomoniasis have been linked to what health problems
PID, UTIs, cervicitis, endometriosis, preterm labor, tubal infertility, inc susceptibility
to HIV transmission
estrogen role
presence increases glycogen content of vaginal epithelial cells which enourages colonization of lactobacilli which produces lactic acid –> pH 4-4.5
normal leukorrhea production
1.5g/day
a vaginal pH test of >4.5 means
BV or Trich
Trich needs referral to Dr
Vulvovaginal Candidiasis (VVC, yeast infection) risks
ABX, immunosuppressnats, estrogen containing contraceptives, estrogen replacement therapy, systemic steroids, SGLT2i
VVC, pregnant, asx
treat?
no
VVC clinical presentation? discharge? sx? microscopy? pH?
white curdlike discharge, no odor
itching, pain, swelling, fissures, external dysuria, redness, scratches/abrasions
c. albicans, c. tropicalis, c. galbrata or saccharomyces spp.
normal pH
non pharm tx VVC
diet: dec foods with sucrose and carbs, d/c med if caused VVC, probiotics not rec
pharm tx VVC topical and oral
partner?
OTC and/or Rx?
MOA?
Topical products
OTC and Rx: Imidazole, Miconazole (Monistat), , Clotrimazole (Gyne-Lotrimin/Mycelex),
RX ONLY: Terconazole (Terazole), Butoconazole (Gynazole)
Oral products:
Fluconazole
Ibrexafungerp (new)
antifungal effect by altering the membrane permeability of fungi
VVC antifunglas AE and counseling
AE: minor burning, itching irritation
Counsel: apply, avoid carbs and sucrose, avoid touches eyes and mouth, AE, ax improvement in 2-3d, resolution in 7d
Bacterial Vaginosis (BV)
common?
cause?
risks?
most common, 33% of vaginal infections
overgrowth of bacteria in vagina
smoking, multiple partners, new partners, douching, african american race, IUD, reception of oral sex
BV clinical presentation?
discharge?
microscopy?
pH?
thin, off-white, foamy discharge, with fishy odor
vaginal discomfort, dysuria, itching
pH>4.5
microscopy: clue cells
BV tx non pharm
oral/vaginal L. acidophilus or yogurt
if sx return try the other one
BV pharm tx
tx partner?
RX ONLY
NO PARTNER TX
Metronidazole 500mg PO BID x7d
Metronidazole 0.75% gel 5g Intravaginally x5d
Alternates: Secnidazole, Tinidazole, clindamycin topical or oral
Trichomoniasis (Trich)
causes…?
RFs?
15-20% of vaginal infections
multiple partners, non barrier contraception, presence of other STI
Trich clinical presentation? discharge? Sx? Microscopy? pH?
strawberry spots (ulceration on vagina/cervix)
copious yellow green, malodorous discharge
vulvar irritation, may be asx
microscopy: trich vaginalis a flagellum (protozoan)
WBC in vaginal culture
pH: 5-7.5 (like BV)
Trich tx
partner?
Rx or OTC?
TREAT PARTNER
RX ONLY
depends on infection…
sx & asx = Metronidazole 2g po x1, Tinidazole 2g po x1
persistent, recurrent infections = Metronidazole 500mg po bid x7d, Tinidazole 2g po x1
preggo = Metronidazole 2g po x1
**single dose regimens preferred, avoid intercourse with both partners until tx completed
Atrophic Vaginitis (AV)
patho
RFs
inflammaiton of vagina related to atrophy of the vaginal mucosa secondary to dec estrogen levels (menopause)
RFs: post-meno, post partum, currently breast feeding, antiestrogenic meds (clomiphene, medroxyprogesterone, tamoxifen, raloxifene, danazol, leuprolide, nafarelin)
AV clinical presentation
dec lubrication
vaginal irritation, dryness, itching, leukorrhea, dyspareunia
thin, watery sometimes bloody or yellow malodorous discharge
if bleeding present, eval for endometrial cancer
AV tx
OTC if mild: water sol products for vaginal lubrication, daily use, prior to intercourse, self-tx usually ok avoid irritants (powders, perfumes, spermicides and panty liners
