Women's Health Flashcards
What is the role of lactobacilli in the vagina?
produces lactic acid and hydrogen peroxide to keep acidic pH (4-4.5) and protect against pathogens
Describe normal vaginal discharge?
Usually transparent or white
Mucus like
Odourless (or slightly malodorous but no offensive)
What can cause normal vaginal discharge to vary? (NOT infections)
Stage in menstrual cycle (may be stretchy and clear before ovulation and then thicker at other points)
Pregnancy and contraception - increase in oestrogen - increase in discharge
Menopause - reduction in volume of discharge
What are causes of abnormal (pathological) vaginal discharge?
Infective (non-STI)
BV
Thrush
Infective (STI)
Chlamydia
Gonorrhoea
Trichomonas
Non infective
Retained foreign object (tampons)
Inadequate hygiene
Irritant/allergic vaginitis
What is vaginal thrush?
Vaginal thrush (vulvovaginal candidiasis) is inflammation of the vagina due the overgrowth of candida yeast (candida albicans)
Is thrush an STI?
NO - as its due to the overgrowth of the natural vaginal flora .
Can thrush be passed on through sex?
Yes and can cause balanitis in men
What is the difference between acute and recurrent thrush?
acute : first or single isolate presentation
recurrent: four or more symptomatic episodes within a year
Symptoms of vaginal thrush
Cream coloured, cottage cheese-like discharge
Odourless or slightly yeasty
Intense itching
Vulval redness
Pain on urination (dysuria)
Pain during or after sex (dyspareunia)
What is the defining symptom of thrush?
intense pruritus
What are some signs of thrush in men?
Itching
Tip of penis is red
Possible discharge
Burning on urination
Asymptomatic
What are some risk factors of developing thrush?
Local irritants that disrupt pH - e.g. perfumed toiletries
Vaginal douching
Recent antibiotic use
Undiagnosed/poorly controlled diabetes
Pregnancy
HRT
Immunosuppression
Differential diagnoses for vaginal thrush - infective
BV - less itchy, discharge is white and MALODOROUS
Trichomonas - itch and grey-green frothy malodorous discharge
Chlamydia - discharge and dysuria (not itchy)
Gonorrhoea - pain, yellow or bloody discharge
Genital herpes - vulval pain. redness, itching and ulceration - not associated with discharge
Differential diagnoses for vaginal thrush - noninfective
- normal physiological changes in discharge
- Contact/allergic dermatitis
- Vulval eczema
- Atrophic vaginitis
- Cytolytic vaginitis
- Foreign body e.g. retained tampon
- Mechanical irritation
- Malignancy
Referral criteria for thrush? (15)
Under 16 or over 60
First presentation
Symptoms not consistent with previous episodes
Two episodes in 6 months and hasn’t seen GP in over a year
History of STI/exposure to STI
Abnormal bleeding or lower abdominal pain
Blood stained discharge
Sores, blisters, ulcers
Pregnancy/breastfeeding
Systemic symptoms
Uncertainty of diagnosis
Symptoms not resolved after 7 days of treatment
Unexplained treatment failure
Immunosuppressed/poorly controlled diabetes
Known allergy to treatment
What are the THREE first line treament options for vaginal thrush?
Single dose fluconazole 150mg oral capsule
Single dose clotrimazole 500mg intravaginal pessary
Topical imidazole (clotrimazole 1%/2%) cream applied 2-3 times a day for 2 weeks
What are some considerations when supplying fluconazole 150mg oral capsules
