Vulvovaginitis Flashcards
what are some normal variations of the vagina
- 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
symptoms of vulvovaginitis
- itching
- discharge
- burning
- pain
- dysuria
- odor
what alters the vaginal flora?
- antibiotics
- sexual activity
- cleaning/douching
- hormone changes(pregnancy, menopause, contraceptives)
- diabetes
- Moist, sweating environment (wet bathing suits, work-out clothes)
what alters the vaginal flora?
- antibiotics
- sexual activity
- cleaning/douching
- hormone changes(pregnancy, menopause, contraceptives)
- diabetes
- Moist, sweating environment (wet bathing suits, work-out clothes)
What would BV smell like
amonia
why is KOH helpful in identifying yeast infections?
KOH dissolves the cell walls of epithelial cells but no pseudohyphae or spores
angular with small nuclei, lots of cytoplasm
contain dots on surfaces, but edges smooth
epithelial cells
spheres
normal ratio of WBCs to epithelial cells is 1:1
increased # indicates inflammation
white blood cells
“good bacteria”
rod-shaped
lactobacilli
What could be seen on a wet mount that would deem it abnormal?
clue cells
yeast
trichomonads
inflammation (increased WBC)
change in flora
what are common causes of vulvovaginitis?
candidiasis
bacterial vaginosis
trichimoniasis
- sudden onset itching, burning, thick white discharge, splash dysuria
- vulva may be red and swollen
- fissures
- exocoriations
yeast infection
what are predisposing factors for yeast infection?
- 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
what are topical treatments for candidiasis (yeast)? what are oral treatments?
OTC topical: Clotrimazole, miconazole
Prescription topical: terconazole
Oral: fluconazole
can use topicals for 1-7 days
how would you treat longer more complicated yeast infections?
- longer duration of treatment (7-14 days of topical therapy; fluconazole)
- culture if: non-albican species suspected, recurrent symptoms with negative wet prep, resistance suspected
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?
Fungal culture (use in symptomatic patients ONLY)
* cofirm diagnosis and identify species
* if negative=> look for another diagnosis
- common colonizer in asymptomatic patients
- in symptomatic patients- treat with alternative anti-fungals
non-albicans yeast
How should you treat recurrent & chronic yeast infections?
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
- Non-dominant anerobic bacteria overgrowth
- less lactobacilli and more gardnerella vaginalis
- cultures are NOT useful in diagnosis
bacterial vaginosis
- Fishy odor
- can occure following intercourse or menses
- increased vaginal discharge (thin, milky, bubbly)
- irriation
- usually not itchy
Bacterial vaginosis
what is the diagnostic criteria for BV?
3 of 4 must be met:
1. homogenous vagnial dishcarge
2. positive whiff test (amine odor)
3. clue cells (>20%)
4. pH >4.5
What are predisposing factors of BV?
- multiple or new sexual partners
- douching
- copper IUD
- menses
How do we treat recurrent BV?
- metronidazole vaginal gel twice weekly for 3+months
- metronidazole (oral or vaginal following menses)
- vaginal boric acid nightly
- 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!!!
Trichomoniasis
symptoms of trichomonias?
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”
microscopic pear-shaped protozoan with flagella, shows jerky and twitching motility
Trichomonas vaginalis
Treatment for trichomonas
- Treat all partners
- metronidazole or tinidazole
- no intercourse until both partners are treated and symptoms have resolved
- retest in 3 months (reinfection common)
Dry thin, mucosa due to decreased estrognen
(low estrognen states like- postpartum, progesterone only contraceptive, postmenopause, testosterone therapy)
atrophic vaginitis
treatment of atrophic vaginitis
topical estrogen
lubrication
regular sexual activity
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
lichen Sclerosus
How do you treat lichen sclerosis?
topical steroids (clobetasol, betamethasone)
- rawness, pain, burning
- dyspareunia, post-coital bleeding
- dysuria
- less often pruitis
- generally, peri-postmenopausal
vulvovaginal lichen planus
- 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)
Lichen simplex chronicus
- Chronic discomfort
- burning- most common
- stinging
- irritation
- rawness
- parasthesia
- described as “deep aching”, “sand paper” insects crawling under skin, “zapping shooting”
Vulvodynia
