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Women's health > Vulvovaginitis > Flashcards

Vulvovaginitis Flashcards

1
Q

what are some normal variations of the vagina

A
  • pigmentation varies from one woman to another
  • redness varies with skin complexion
  • size of labia and symmetry
  • size of vaginal opening
  • the normal vulvar skin texture is irregular and bumpy
  • clitoral size
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2
Q

symptoms of vulvovaginitis

A
  • itching
  • discharge
  • burning
  • pain
  • dysuria
  • odor
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3
Q

what alters the vaginal flora?

A
  • antibiotics
  • sexual activity
  • cleaning/douching
  • hormone changes(pregnancy, menopause, contraceptives)
  • diabetes
  • Moist, sweating environment (wet bathing suits, work-out clothes)
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4
Q

what alters the vaginal flora?

A
  • antibiotics
  • sexual activity
  • cleaning/douching
  • hormone changes(pregnancy, menopause, contraceptives)
  • diabetes
  • Moist, sweating environment (wet bathing suits, work-out clothes)
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5
Q

What would BV smell like

A

amonia

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6
Q

why is KOH helpful in identifying yeast infections?

A

KOH dissolves the cell walls of epithelial cells but no pseudohyphae or spores

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7
Q

angular with small nuclei, lots of cytoplasm
contain dots on surfaces, but edges smooth

A

epithelial cells

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8
Q

spheres
normal ratio of WBCs to epithelial cells is 1:1
increased # indicates inflammation

A

white blood cells

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9
Q

“good bacteria”
rod-shaped

A

lactobacilli

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10
Q

What could be seen on a wet mount that would deem it abnormal?

A

clue cells
yeast
trichomonads
inflammation (increased WBC)
change in flora

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11
Q

what are common causes of vulvovaginitis?

A

candidiasis
bacterial vaginosis
trichimoniasis

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12
Q
  • sudden onset itching, burning, thick white discharge, splash dysuria
  • vulva may be red and swollen
  • fissures
  • exocoriations
A

yeast infection

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13
Q

what are predisposing factors for yeast infection?

A
  • diabetes
  • antibiotic use
  • estrogen excess
  • increase frequency of coitus
  • IUD’s contraceptive sponge
  • immune system alterations (HIV, lupus, steroid use)
  • tight fitting clothes, synthetic underwear
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14
Q

what are topical treatments for candidiasis (yeast)? what are oral treatments?

A

OTC topical: Clotrimazole, miconazole
Prescription topical: terconazole
Oral: fluconazole

can use topicals for 1-7 days

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15
Q

how would you treat longer more complicated yeast infections?

A
  1. longer duration of treatment (7-14 days of topical therapy; fluconazole)
  2. culture if: non-albican species suspected, recurrent symptoms with negative wet prep, resistance suspected
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16
Q

Because candida might not show up on a wet prep- what is the next step that could be taken? what should you do if it is negative?

A

Fungal culture (use in symptomatic patients ONLY)
* cofirm diagnosis and identify species
* if negative=> look for another diagnosis

17
Q
  • common colonizer in asymptomatic patients
  • in symptomatic patients- treat with alternative anti-fungals
A

non-albicans yeast

18
Q

How should you treat recurrent & chronic yeast infections?

A

Fluconazole
* 1 tab weekly for 3-6 months
* **check LFT if using > 6 months **

Vaginal clotrimazole or miconazole
* insert vaginally twice per week x 6 months

Vaginal boric acid
* insert capsule intravaginally nightly to few times per week

19
Q
  • Non-dominant anerobic bacteria overgrowth
  • less lactobacilli and more gardnerella vaginalis
  • cultures are NOT useful in diagnosis
A

bacterial vaginosis

20
Q
  • Fishy odor
  • can occure following intercourse or menses
  • increased vaginal discharge (thin, milky, bubbly)
    • irriation
  • usually not itchy
A

Bacterial vaginosis

21
Q

what is the diagnostic criteria for BV?

A

3 of 4 must be met:
1. homogenous vagnial dishcarge
2. positive whiff test (amine odor)
3. clue cells (>20%)
4. pH >4.5

22
Q

What are predisposing factors of BV?

A
  • multiple or new sexual partners
  • douching
  • copper IUD
  • menses
23
Q

How do we treat recurrent BV?

A
  • metronidazole vaginal gel twice weekly for 3+months
  • metronidazole (oral or vaginal following menses)
  • vaginal boric acid nightly
24
Q
  • third most common cause of vaginitis
  • transmitted sexually
  • often asymptomatic
  • when symptomatic:diffuse, malodorous dishcarge
  • assoicated with other STIs
  • increases transmission rate of HIV
  • sexual partners should be treated!!!
A

Trichomoniasis

25
Q

symptoms of trichomonias?

A

Discomfort
* discharge, irritation, itching, burning, dyspareunia, dysuria and lower abodminal pain

Disharge
* copious yellow or green frothy vaginal discharge

Inflammation and erythema of vestibule and vagina “strawberry cervix”

26
Q

microscopic pear-shaped protozoan with flagella, shows jerky and twitching motility

A

Trichomonas vaginalis

27
Q

Treatment for trichomonas

A
  • Treat all partners
  • metronidazole or tinidazole
  • no intercourse until both partners are treated and symptoms have resolved
  • retest in 3 months (reinfection common)
28
Q

Dry thin, mucosa due to decreased estrognen
(low estrognen states like- postpartum, progesterone only contraceptive, postmenopause, testosterone therapy)

A

atrophic vaginitis

29
Q

treatment of atrophic vaginitis

A

topical estrogen
lubrication
regular sexual activity

30
Q

pruritis, buring (after scratching) dyspareunia, tight introitus
* may see figure 8 or hourglass distrubition
* hypopigmentation- typically crinckled whitening
* fissures
* cliteral hood adhesions
* may have small risk of cancer

A

lichen Sclerosus

31
Q

How do you treat lichen sclerosis?

A

topical steroids (clobetasol, betamethasone)

32
Q
  • rawness, pain, burning
  • dyspareunia, post-coital bleeding
  • dysuria
  • less often pruitis
  • generally, peri-postmenopausal
A

vulvovaginal lichen planus

33
Q
  • eczema, atopic dermatitis of vulva
  • hx of intense itching and intense pleasure with scratching
  • itch-scratch cycle
  • appearance depends on wheter patient rubs (lichenification) or scratches (excoriations)
A

Lichen simplex chronicus

34
Q
  • Chronic discomfort
  • burning- most common
  • stinging
  • irritation
  • rawness
  • parasthesia
  • described as “deep aching”, “sand paper” insects crawling under skin, “zapping shooting”
A

Vulvodynia

Women's health (14 decks)

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