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General Medicine & Family Medicine > Women's Health/ Vaginitis > Flashcards

Women's Health/ Vaginitis Flashcards

1
Q

What is vaginitis?

A

Vaginal inflammation

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2
Q

What are some typical symptoms of vaginitis?

A
  • vaginal discharge
  • pruritus
  • irritation
  • burning
  • soreness
  • odor
  • dyspareunia
  • dysuria
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3
Q

What are noninfectious causes of vaginitis?

A
  • atrophic vaginitis
  • reaction to allergens (eg, latex condoms and antifungal agents)
  • chemical irritation (eg, spermicides and hygiene products)
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4
Q

What are the infectious causes of vaginitis?

A
  • Bacterial vaginosis (BV)
  • vulvovaginal candidiasis
  • Trichomonas vaginalis
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5
Q

What is the normal vaginal pH of a woman of reproductive age?

A

4.0-4.5

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6
Q

From where should the vaginal pH sample be obtained?

A
  • The vaginal sidewall to avoid the posterior fornix (pooled blood, semen, and cervical mucus can increase the pH)
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7
Q

What common vaginal bacteria accounts for this acidic environment?

A
  • Lactobacilli produce lactic acid and hydrogen peroxide, and the acidity is hostile to the growth of pathogens and inhibits bacterial adherence to vaginal squamous epithelial cells.
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8
Q

Which causes of vaginitis present with an elevated vaginal pH?

A
  • BV
  • Trichomonas
  • atrophic vaginitis (decreased estrogen decreases Lactobacilli)
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9
Q

What medications or practices can alter the normal vaginal pH?

A
  • Antibiotics (can decrease Lactobacilli leading to increased pH)
  • oral contraceptive pills
  • sexual activity (semen can increase pH)
  • douching (may increase pH)
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10
Q

How does normal physiologic vaginal discharge in a reproductive age woman appear?

A

White or transparent, mostly odorless, less than 4 mL per 24 hours

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11
Q

What are some nonpathogenic causes of an increased amount of vaginal discharge?

A
  • pregnancy
  • oral contraceptive pill use
  • ovulation
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12
Q

What are the most important tests to diagnose vaginitis?

A
  • Vaginal pH
  • microscopy (saline wet mount and 10% KOH preps)
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13
Q

What type of cells will you see on the saline (wet mount) prep with BV?

A

“Clue cells” (vaginal squamous epithelial cells covered with bacteria)

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14
Q

What type of smell will you notice with the KOH prep in BV?

A

Gardnerella produces amines causing a fishy smell, known as the “whiff test.”

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15
Q

What are Amstel criteria for diagnosing BV?

A
  1. Abnormal gray discharge (often “fishy” smelling)
  2. Vaginal pH >4.5
  3. Positive amine “whiff test”
  4. Clue cells seen on microscopy

Note: three out of four criteria must be present to diagnose BV.

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16
Q

How do you treat BV?

A
  • Metronidazole (500 mg PO BID × 7 days) or
  • Clindamycin (topical 2% cream or 300 mg PO BID for 7 days)
  • both are safe in pregnancy
17
Q

How does vulvovaginal candidiasis present?

A
  • odorless white
  • thick “cottage cheese” discharge
  • vulvar itching
  • burning
  • dyspareunia
  • dysuria
18
Q

What are risk factors for vaginal candidiasis?

A
  • antibiotics
  • diabetes mellitus
  • increased estrogen (eg, oral contraceptive pills and pregnancy) leading to increased glycogen, which increases adherence to epithelial cells
  • immunosuppression
19
Q

What do you see on microscopy in candidiasis (albicans-species)?

A

Budding yeast cells and pseudohyphae on saline and KOH mounts

20
Q

Why is KOH mount preferred over a saline mount?

A

KOH destroys other cellular elements

21
Q

How do you treat uncomplicated candidiasis?

A
  • Topical or oral azoles, commonly oral fluconazole (a single dose of 150 mg)
22
Q

How do you treat severe candidiasis?

A
  • oral fluconazole (a single dose of 150 mg)
  • give a second dose of oral fluconazole 3 days after first dose.
23
Q

How do you treat recurrent candidiasis?

A
  • Daily oral fluconazole for 7-14 days, then weekly for 6 months
24
Q

What is the best method for treating candidiasis in pregnancy?

A

Topical azole therapy for 7 days

25
Q

What are the signs and symptoms of trichomoniasis?

A
  • copious thin, yellow-green discharge
  • pruritus
  • dysuria
  • irritation
26
Q

How does Trichomonas appear under microscopy?

A

Motile trichomonads with four flagella on saline prep if checked less than 20 minutes after specimen obtained

27
Q

How is Trichomonas spread?

A

Sexual contact

28
Q

How do you treat Trichomonas ?

A
  • Metronidazole (2 g PO × 1)
  • treat sexual partner(s) also
29
Q

Trichomonas can cause what complications of pregnancy?

A
  • preterm delivery
  • premature rupture of membranes
30
Q

What cause of dysuria should you consider in a postmenopausal woman with a normal urinalysis and negative urine culture?

A

Atrophic vaginitis

31
Q

What is the treatment for atrophic vaginitis?

A

Intravaginal estrogens (creams, suppositories, or vaginal rings)

General Medicine & Family Medicine (150 decks)

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