wk 9 key Flashcards
bacterial vaginosis from
anaerobic bacteria (i.e. gardnerella, mycoplasma)
top 3 causes of vulvovaginitis
BV, vulvovaginal candidiasis, trichomoniasis
BV
candida
trichomoniasis
odor and discharge quality
BV- fishy
candida: thick cheesy curd, no odour
rich: green yellow, frothy, foul odor
pH and whiff test is candida
ph<4.5
negative amine whiff test
BV = loss of what
loss of acid; loss of lactobacilli
BV risks
low estrogen –> low glycogen and less lactobacilli (lactobacilli need to eat glycogen)
douching
new sex partners
IUD
pregnancy
candida risk
antibitoics
hot and occlusive clothes
OCP
estrogen therapy (estrogen –> glycogen which candida grow off)
uncontrolled diabetes
corticosteroids
damsel criteria for BV (3/4)
- Thin, white, homogeneous vaginal discharge
- pH greater than 4.5
- Positive amine whiff test
- Presence of clue cells on microscopic examination
findings in trichomoniasis
ph and whiff
ph >4.5
positive amine whiff test
atrophic vaginitis wet mouth findings
lots of WBC
decrease lactobacili
increase gram + cocci and gram - rods
occasional basal or parabasal cells
abdominal pain or fever when having vaginal irritation
consider PID, cervicitis, toxic shock syndrome
ph >4.5 then consider
trichomoniasis and BV
(ph<4.5 in candida)
wet prep
swab for vagina
cells on microscopic exam for vagina
squamous epithelial cells: normal
clue cells: in gardnerlla
WBC: candida, atrophic vaginitis, trichomonas, chlamydia, gonorrhea
parabasal cells: atrophic vaginits
gold standard for BV
gram stain
gold standard for yeast detection
cell cultures
diethylstilbestrol (DES) and cancer risk
given to pregnant women in 1980s –> DES daughters increased breast and vaginal cancers
these women are in their 50s now
American College of Obstetricians and Gynecologists (ACOG)
annual genital exam?
annual external exam if over 65yoa
DES daughters get annual internal exam
uncomplicated vs recurrent candidiasis
recurrent is probbaly not Candida albicans species –> Obtain a vaginal culture to guide specific antifungal therapy
also might have underlying immunocompromised etc
A 22-year-old woman presents to clinic concerned about vaginal itching and a foul-smelling discharge. She reports no recent changes in her personal hygiene products. She is sexually active with one partner and uses condoms inconsistently. She denies any past medical history and has not had a gynecological examination in the past two years.
Which of the following is the most appropriate next step?
a.
Recommend an immediate transvaginal ultrasound to assess for pelvic inflammatory disease (PID), going to the emergency room for this if necessary
b.
Conduct a detailed sexual history to identify risk factors for sexually transmitted infections and bacterial vaginosis, followed by a pelvic examination
c.
Advise her to change her personal hygiene products and observe for symptom resolution
d.
Recommend she start an antifungal medication based on her symptoms
b.
Conduct a detailed sexual history to identify risk factors for sexually transmitted infections and bacterial vaginosis, followed by a pelvic examination
BV and trichomoniasis whiff test and pH
candidiasis opposite
positive whiff and pH >4.5
