Vulvovaginitis Flashcards
1
Q
Trichomoniasis Infection Signs
A
- Copious, malodorous, yellow-gray, frothy, purulent discharge
- ~70% asymptomatic
- Whiff test pos.
- Fishy odor
- Vaginal irritation
- Usually pruritus
- “Strawberry cervix”; erythematous macules covering the vaginal wall and ectocervix
- Vagina pH >4.5
2
Q
Trichomoniasis Treatment
A
Recommended Regimen
- Metronidazole 2g PO 1 dose
*can be used pregnancy
- Tinidazole 2g PO 1 dose
Alternate Regimen
- Metronidazole 500mg PO 2x daily for 7 days
Must obstain from sex during treatment
3
Q
Trichomoniasis Diagnosis
A
- Elevated vaginal pH (>4.5)
- Motile trichomonads
- Many polymorphs
- Whiff test may be pos.
- Rapid antigen test (10min) and dipstick test (Affirm), a nucleic acid probe (45min) or culture can be used to diagnose if wet mount is noncontributory
4
Q
Candidiasis Symptoms
A
- Thick, white “cottage cheese” like discharge, vulvar/vaginal pruritus and dysuria
- Inflammation and erythema
- Vaginal pH <4.5
- No odor
- Whiff test neg.
- May have burning, irritation, dyspareunia
- Candida can be part of vaginal flora
5
Q
Candidiasis Treatment
A
- Fluconazole
- In fluconazole resistant species use Boric Acid suppository (has to be inserted in vagina)
6
Q
Candidiasis Diagnosis
A
- Normal vaginal pH
- Microscopy shows pseudohyphae, mycelia tangles, or budding yeast cells
- Neg. whiff test
7
Q
Candida balantis
A
- HIV and Candidiasis
8
Q
Candida balantis Treatment
A
- Topical such as clotrimazole or miconazole cream or oral fluconazole 150-200mg OD up to seven days
9
Q
Congenital cutaneous candidiasis
A
- Infant born from mother w/ yeast infection during 3rd trimester
- Disseminated rash, oral thrush and diffuse lymphadenopathy
- Full recovery is expected in FT infants
10
Q
Congenital cutaneous candidiasis Treatment
A
- Topical ketoconazole
11
Q
Bacterial Vaginosis Predisposing Factors
A
Anything that disturbs the normal flora of the vagina
- Presence of concomitant STIs-especially trichomoniasis
- Multiple sex partners
- Earlier coital experience
- IUD
- New sexual partner
- Antibiotic therapy
- Absence of H2O2-producing Lactobacili
12
Q
Bacterial Vaginosis Symptoms
A
- Foul-smelling “fishy” vaginal odor that increases after sex
- Thin, dull-gray, nonpruritic, homogenous discharge that adheres to vaginal wall
- Vaginal pH >4.5
- Pruritus
- Burning during urination
- Up to 50% have no complaints
- Whiff test pos.
13
Q
Lactobacillus
A
- Protective role in the vagina
- Acidophilic lactobacilli predominant organisms in normal vaginal flora
- Lactobacilli found in 96% of women w/ normal vaginal flora vs. only 52% of women w/ BV
- Produce lactic acid and H2O2
- Protects against BV, overgrowth of Candida, adherence of C. albicans to epithelial cells
- Inhibit E. coli and prevent UTI
14
Q
Elevated vaginal pH causes
A
- Normal vagina pH: 3.8-4.2; controls composition of normal vaginal flora
- Elevated pH assoc. w/:
*loss of H2O2-producing Lactobacilli
*bacterial vaginosis, trichomoniasis
*possibly enhanced HIV transmission
15
Q
Bacteria causing “fishy odor”
A
- BV
- Trichomoniasis
16
Q
KOH “Whiff” Test
A
- Sample of vaginal secretions place in a test tube w/ 10% KOH
- KOH alkalizes amines produced by anaerobic bacteria; results in a sharp “fishy odor”
17
Q
BV Complications/Assoc. Conditions
A
- Obstetric conditions
*preterm birth, premature rupture of membranes, amniotic fluid infection, low birthweight, chorioamnionitis, postpartum endometritis
- PID
18
Q
BV Treatment
A
- Similar to Trichomoniasis
- Metronidazole
- Tinidazole
- Clindamycin cream
*NOT for pregnant women
19
Q
BV Diagnosis
A
- Elevated pH (>4.5)
- Clue cells (epithelial cells coated w/ coccobacilli)
- Pos. whiff test (fishy odor noted after adding potassium hydroxide to the discharge)
20
Q
PID Diagnosis CDC Criteria
A
CDC minimal criteria
- Uterine tenderness
- Adnexal tenderness +/- cervical motion tenderness
- Other symptoms include: endocervical discharge, fever, lower abdominal pain
21
Q
PID Complications
A
- Infertility: 15-24% w/ 1 episode PID secondary to gonrrhea or chlamydia
- 7x risk of ectopic pregnancy w/ 1 episode PID
- Chronic pelvic pain in 18%
- Pelvic pain due to adhesions
- Infection-induced selective loss of ciliated epithelial cells along the fallopian tubes resulting in impaired ovum transport
22
Q
Definitive Criteria for PID
A
- Histologic evidence of endometritis on endometrial biopsy
- Transvaginal sonography or MRI showing thickened, fluid filled tubes or Doppler studies suggesting pelvic infection (tubal hyperemia)
- Laparoscopic abnormalities showing tubal purulent exudate, erythema and edema
- “Chandelier sign”- painful pelvic exam
23
Q
PID Diagnosis Algorithm
A
24
Q
Fitz-Hugh Curtis Syndrome
A
- RUQ pain due to perihepatic adhesions “violin strings” (b/w liver capsule and peritoneum)
- Due to PID
25
2 Hypotheses to how chlamydia ascends to upper genital tract
- Hypothesis 1: **Cellular paradigm** assumes that actively infected epithelial cells have a key role by secreting chemokines that damage the tissues directly. Identifying and treating infections before they ascend should be the main focus of **control programs**
- Hypothesis 2: **Immunological paradigm** assumes that tissue damage occurs b/c of T-cell responses involved in clearing infection (repeat or persistent). Prevention of repeat infections should be prioritized.
26
PID Treatment
- Cefotetan
- Doxycycline
Alternate Perenteral Regimen
- Ampicillin/Sulbactam
- Doxycycline
