Womens Health - Vaginitis

Question 1

Trichomonas

Answer 1

-Vaginal Pruitis
-Malodorous, frothy Yellow-green discharge
-Vaginal erythema
-Red macular lesions on cervix in severe cases (strawberry cervix)

Question 2

Trichomonas Treatment

Answer 2

-Treat both partners
-metronidazole 500 mg PO BID x 7 days for women
-metronidazole 2g PO once for men

Question 3

Trichomonas Diagnostics

Answer 3

-Nucleic acid amplification test to ID T Vaginalis
-Rapid diagnostic tests (Affirm VP III and OSOM trichomononas rapid test
- Microscopic exam - motile organisms with flagella

Question 4

BV Bacterial Vaginitis

Answer 4

• Grayish discharge,
  sometimes frothy
• Fishy odor present if alkalinized with 10% potassium hydroxide

Question 5

BV Treatment

Answer 5

• Metronidazole 500 mg PO BID x 7 days
• OR clindamycin vag cream 2% 5g daily x 7 days
• OR metronidazole gel 0.75% 5 g BID x 5 days

Question 6

BV Diagnostics

Answer 6

-pH 5.0 - 5.5
- Wet mount: epithelial cells covered with bacteria to such extent that cell boarders are obscured

Question 7

Vulvovaginal Candidiasis VCC

Answer 7

• one of most common cause of vaginal itch and discharge, erythema
  -Candida albicans most common culprit but can be caused by other organisms

Question 8

VVC Risk factors

Answer 8

• recent antibiotic therapy (esp PCNs)
  —> in pts prone to yeast inf. if giving PCN also Rx diflucan
• Immunocompromised
  —>Corticosteroid use, immmunobiologics or HIV
• Pregnancy
• Hypothyroidism
  -Diabetes
  -Anemia (esp. Iron def.)
• Oral contraceptives
• Wearing tight fitting clothing - not cotton
• Previous candidal vulvovaginitis
• Obesity

Question 9

VVC Assessment

Answer 9

• thick white curdy vaginal discharge
  -white patches on vaginal mucosa
• extreme itching
• erythema and edema
  -painful intercourse
  -Dysuria
  -ususally no odor

Question 10

VVC Diagnostics

Answer 10

• 10 % KOH prep and microscope
  —>If pseufohyphae then + for candidiasis
• vaginal pH <4.5

if recurrent yeast infx:
- culture
-may need testing if suspected diabetes or other immunocompromised

Question 11

VVC Management : NONPHARM

Answer 11

*Practice good perineal hygiene:
- Wear cotton underwear
-avoid panty liners
-avoid anything scented
-No soaps, no powders, no bubble baths, no douching
-sleep without underwear
-refrain from intercourse until the symptoms are gone

*Probiotics help keep the vaginal flora stable

Question 12

VVC Management: PHARM

Answer 12

*OTC:
- Clotrimazole
- Miconazole
- Tioconazole

*Rx:
-Butoconazole 2% cream, 5 g vaginally w/ single app
- Terconazole 0.4% cream, 5g vaginally x7 days
- terconazole 0.8% cream, 5g vaginally x3 days
- terconazole 80 mg vag suppository- 1 supp daily x3days
- fluconazole 150mg PO once

Question 13

RECURRENT VVC

Answer 13

*4 or more episodes of symptomatic VVC w/in 1 yr:

• pathogenesis is poorly understood
  -Most have no apparent predisposing or underlying conditions
  -antimycotic therapies are not as effective against the non-albican species

Question 14

Recurrent VVC - C Albicans

Answer 14

• short duration of the topical azole therapy x7-14 days, or
  -fluconazole 100mg, 150mg, or 200mg q3rd day for total of 3 doses
  -some specialists recommend longer duration of therapy to attempt mycologic remission before initiating maintenance antifungal regimen

Question 15

Recurrent VVC C Albicans Maintenance/prevention

Answer 15

• oral fluconazole 100 mg, 150mg, or 200 mg wkly x6 months
• consider topical treatments intermittently if oral fluconazole isn’t feasible
  -suppressive maintenance therapy

*symptomatic women who remain cx + w/ regimen:
- refer to specialist

Question 16

Recurrent VVC NON-albicans

Answer 16

• 7 to 14 days of nonfluconazole azole treatment

-topical boric acid in gelatin capsules, vaginally wkly x 2 weeks
—>if persistent, refer to specialist

• sex partners may need to be treated as well**

Question 17

How long should therapy be for immunocompromised women be?

Answer 17

sometimes prolonged 7 to 14 days if needed

Question 18

VVC management w/ HIV pt

Answer 18

• systemic azole exposure is associated with isolation of non-albican candida
  -VVC tx should be same for seronegative women
  -prophylactic therapy in HIV women is not recommended in absence of recurrent VVC

Question 19

VVC treatment w/ pregnancy

Answer 19

*increased risk during pregnancy due to elevated levels of glycogen and hormones:

• only topical azole therapy limited to 7 days should be used during pregnancy

Question 20

VVC treatment w/ breastfeeding

Answer 20

• AVOID fluconazole if breastfeeding