Vulvovaginal Disorders

Question 1

Infections such as bacterial vaginosis and trichomoniasis have been linked to what health problems

Answer 1

PID, UTIs, cervicitis, endometriosis, preterm labor, tubal infertility, inc susceptibility
to HIV transmission

Question 2

estrogen role

Answer 2

presence increases glycogen content of vaginal epithelial cells which enourages colonization of lactobacilli which produces lactic acid –> pH 4-4.5

Question 3

normal leukorrhea production

Answer 3

1.5g/day

Question 4

a vaginal pH test of >4.5 means

Answer 4

BV or Trich

Trich needs referral to Dr

Question 5

Vulvovaginal Candidiasis (VVC, yeast infection) risks

Answer 5

ABX, immunosuppressnats, estrogen containing contraceptives, estrogen replacement therapy, systemic steroids, SGLT2i

Question 6

VVC, pregnant, asx

treat?

Answer 6

no

Question 7

VVC clinical presentation?
discharge?
sx?
microscopy?
pH?

Answer 7

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

Question 8

non pharm tx VVC

Answer 8

diet: dec foods with sucrose and carbs, d/c med if caused VVC, probiotics not rec

Question 9

pharm tx VVC topical and oral
partner?
OTC and/or Rx?
MOA?

Answer 9

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

Question 10

VVC antifunglas AE and counseling

Answer 10

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

Question 11

Bacterial Vaginosis (BV)
common?
cause?
risks?

Answer 11

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

Question 12

BV clinical presentation?
discharge?
microscopy?
pH?

Answer 12

thin, off-white, foamy discharge, with fishy odor
vaginal discomfort, dysuria, itching

pH>4.5
microscopy: clue cells

Question 13

BV tx non pharm

Answer 13

oral/vaginal L. acidophilus or yogurt

if sx return try the other one

Question 14

BV pharm tx

tx partner?

Answer 14

RX ONLY
NO PARTNER TX
Metronidazole 500mg PO BID x7d
Metronidazole 0.75% gel 5g Intravaginally x5d
Alternates: Secnidazole, Tinidazole, clindamycin topical or oral

Question 15

Trichomoniasis (Trich)
causes…?
RFs?

Answer 15

15-20% of vaginal infections

multiple partners, non barrier contraception, presence of other STI

Question 16

Trich clinical presentation?
discharge?
Sx?
Microscopy?
pH?

Answer 16

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)

Question 17

Trich tx
partner?
Rx or OTC?

Answer 17

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

Question 18

Atrophic Vaginitis (AV)
patho
RFs

Answer 18

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)

Question 19

AV clinical presentation

Answer 19

dec lubrication
vaginal irritation, dryness, itching, leukorrhea, dyspareunia
thin, watery sometimes bloody or yellow malodorous discharge

if bleeding present, eval for endometrial cancer

Question 20

AV tx

Answer 20

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