Vulvovaginitis & Vulvovaginal Atrophy

Question 1

Is vulvovaginitis sexually-transmitted or sexually-associated?

Answer 1

Sexually-associated

Question 2

Can vulvovaginitis be self-diagnosed?

Answer 2

Self diagnosis is OFTEN INACCURATE

Question 3

What pathogen/s should be expected with vulvovaginitis?

Answer 3

• Bacterial vaginosis (BV):
  - most common
• Vulvovaginal candiasis (VVC):
  - 95% = Candida albicans
• Trichomoniasis:
  - common in teens
  - women > 40 years may be
  asymptomatic for decades

Question 4

What action should be taken for a patient with recurrent yeast infections?

Answer 4

Screen for:
- Diabetes
- Pregnancy
- HIV
- Others as indicated (especially STIs)

Question 5

What instructions should be given to patients with vulvovaginitis?

Answer 5

• Abstinence is recommended until infection is resolved -OR- use condoms
• No douching (due to potential link to ovarian cancer)

Question 6

What pharmaceutical management is recommended for vulvovaginitis due to bacterial vaginosis?

Question 7

What oral pharmaceutical management is recommended for VVC (vulvovaginal candidiasis)?

Answer 7

Fluconazole/Diflucan
- Oral single dose
- 72 hours duration
- Delayed symptom relief x 24 hours
- Narrow-spectrum coverage (for c. albicans)
- Avoid in pregnancy
- Cost-effective @ $4

Question 8

What topical pharmaceutical management is recommended for VVC (vulvovaginal candidiasis)?

Answer 8

Rx: Butoconazole/Gynazole
- Single dose vaginally
- Bio-adhesive, time-released
- Broad spectrum
- OK = DM or immunocompromised
- NOT OK = pregnancy
- More effective than OTC

Rx/OTC*:
- Miconazole/Monistat
- Clotrimazole/Gyne-Lotrimin
- Tioconazole/Vagistat
- Terconazole/Terazole

*(both Rx and OTC are equally effective except butoconazole)

Question 9

What is another name for vulvovaginal atrophy (VVA)?

Answer 9

Genitourinary Syndrome of Menopause (GSM)

Question 10

What are the symptoms and exam findings associated with vulvovaginal atrophy (VVA)?

Answer 10

• Vaginal:
  
  • irritation
    - dryness
    - burning
    - pH ≥ 5
    - loss of rugae
    - variable discharge
• Dyspareunia
• Urinary tract symptoms (due to estrogen in the urinary tract)

Question 11

What is the treatment for vulvovaginal atrophy (VVA)?

Answer 11

• Vaginal estrogen (cream, tablets, ring):
  - New option: Imvexxy, vaginal daily
  x 2 - 4 weeks then twice weekly
  - Vaginal ring (Estring): every 3 months
• Ospemifene/Osphena:
  - Selective serotonin receptor modulator
  (SERM), oral daily
• DHEA/Prasterone/Intrarosa vaginal

NOTE: 2018 FDA warning against vulvovaginal laser treatment (called Mona Lisa Touch)