Vulvovaginitis Flashcards
What are Amsel criteria and what do they diagnose?
Need 3 of 4 for diagnosis of bacterial vaginosis.
- thin, white-gray discharge
- > 20% clue cells on microscopy (oftentimes the lab doesn’t report percentage and so clue cells on a wet prep isn’t enough alone to diagnose BV)
- pH >4.5
- positive KOH whiff test
What is the definition and treatment of recurrent bacterial vaginosis?
at least 3 documented separate episodes in 1 year
tx: twice weekly suppressive metronidazole gel for 16 weeks
What is complicated vulvovaginal candidiasis?
recurrent vulvovaginal candidiasis (4+ infections in 12 months) or severe symptoms (erythema, erosions, fissures, edema), infection with non-albicans Candida species or infection in immunocompromised patient e.g. diabetes, immunosuppresive therapy or HIV
How do you treat candidiasis in a patient with HIV? What sort of testing or monitoring needs to be performed with this treatment?
PO fluconazole x 7+ days (typically taken q3 days) or topical treatment for 7+ days (typically 10-14 days)
Monitor liver function if on an oral azole for more than 21 days
How often should women with HIV be screened for gonorrhea and chlamydia?
Screen for Gc/chlam upon entry to care and then annually. Be careful that many hospitals require you to order gonorrhea and chlamydia PCR separately (though they can both be tested from the same swab)
What is used to for daily HSV suppression in pregnancy and when should it be initiated?
acyclovir 400 mg TID or valacyclovir 500mg BID starting at 36 weeks gestation
how do you treat trichomoniasis?
metronidaozle 500 mg BID for 7 days. No this isn’t a typo…the guidelines have changed!
2nd line - tinidazole 2g x1 dose
How should you counsel patients taking nitroimidazoles (e.g. metronidazole etc)?
abstain from EtOH for at least 24 hours after completion of treatment with metronidazole and 72 hours after oral tinidazole due to the disulfiram interaction
How should you counsel patients using clindamycin ovules (a second line treatment for BV)?
can weaken latex or rubber condoms and therefore should be avoided in first 72 hours after completing treatment
How long should partners refrain from sexual activity after trichomoniasis treatment?
7 days from last antibiotic dose and are completely asymptomatic
expedited partner therapy has a role in treatment of partners for trichomoniasis
Should both women in a lesbian couple be treated for BV if a partner tests positive?
No studies have addressed this! Good idea for a research project.
