Week 2 - DDx Vaginal Discharge Flashcards
When during the cycle is the highest peak for volume of discharge?
day before ovulation/ at ovulation
What does d/c look like at ovulation?
day before & day after ovulation: wet & slippery
What days does a woman produce dry/tacky/thick cervical mucus? (aka not fertile)
2 days before flow& 2 days after flow
what does cloudy d/c signify?
semi-fertile
stretchy
days surrounding ovulation, before & after wet & slippery
what d/c is thick white, curd-like, pruritic, excoriations, sour odour
candida
what d/c is m/c gardnerella vaginalis w/elevated pH (>4.5, fishy odour)
bacterial vaginosis
what d/c thrives in alkaline environment? profuse grey green , frothy, malodourous
trichomonas vaginali
what are Amsel criteria for BV dx?
thin, white, yellow homogenous d/c
clue cells on microscopy
pH >4.5 (slightly alkaline; vagina normal pH = 3.8-4.2)
what is normal pH of vagina?
slightly acidic
3.8-4.2
release of fishy odour on adding alkali (KOH)
BV treatment options?
- herbal suppositories (one 5d/wk for 2 wks)
- Vag-Pak suppositories (one 2d/wk for same 2wks as herbal suppository)
- vaginal lactobacillus suppository (daily for 6 d)
- oral lactobacillus (one daily 2-6mos to restore normal vaginal ecology)
- if recurrence, add boric acid suppository (one daily x2wks)
whats in an herbal suppository?
myrrh echinacea ulmus fulva hydrastis althea geranium achillea
whats in a vag-pak suppository?
mag sulfate glycerin complex hydrastis tincture thuja oil tea tree oil bitter orange oil vitamin A 100,000 IU ferric sulfate ferrous sulfate
what dose of boric acid suppository?
600 mg
one daily x 2 wks
trichomoniasis is associated with increased risk of transmission of which infection?
HIV
trichomoniasis may cause woman to deliver infant with which negative outcome?
low birth weight
premature
what is tx for trichomoniasis for pregnant & non pregnant patients?
metronidazole 2000mg po, once
95-97% cases resolved w/one dose
