vulvovaginal disease Flashcards
how would you treat an itchy vulva with associated cottage cheese discharge with red inflammed vulva
clotrimazole (antifungal)
check for vaginitis and if so give for both inside and outside cream
how would you recognise litchen sclerosis on examination of the vulva
white/dyspigmentation, flat labia majora
atrophy looking vulva
how do you manage a patient presenting with litchen sclerosis
Refer
Tx with potent topical steroids such as dermatave
Regenerate vulva skin with stem cells
Discuss aetiology and managemnent of VIN (vulvula intraepithelial neoplasia)
raised, hyperpigmented
ass with high grade intraepithelial lesion.
HSIL occurs in younger women
Differentiated VIN in older, not ass with HPV
Aetiology: HPV 16&18
HIV
Smoker
Tx: Pap, Refer
-Med management: Exclude invasion by biopsy, then preserve vulva anatomy by therapies such as: Aldara, topical chemotherapies
surgery: co2 laser, excision biopsy
which vulvula lumps are common in young people (4)
Warts
-HPV 6&11 associated
-PP: an itch noticed by pt or partner
-OE: scattered small lesions on vulva near anus. can be a big couliflour like lesion
-Tx: pap (hpv exposed)
-topical agents- pedophylin (with vaseline cause it burns) & trichlo acetic acid applied directly
-Check HIV
-Refer if couliflour like lesion for excision
-Complications in pregnancy/childbirth: baby may have papillomatosis in throat from the HPV
Herpes
-HSV associated
-PP: tingling or severe itch. Vesicles, may be ruptured
-OE: vesicles, small ulcers from rupture
-Tx: Analgesia and Acyclovir. Counsel on presenting early. Treat partner
Bartholin’s Abscess
PP: swelling near posterior inflammed tender lump
-severe pain
-blocked duct
OE: Unilateral posterior inflammed lump
Tx: Usually requires incision and drainage+ marsupilisation
Analgesia and refer
Syphilis
PP: primary syphilis asymptomatic
OE: painless lump, painless lymphadenopathy
Tx: Serology to confirm diagnosis. Benzathine penicilin 2.4 MU Stat. Inform partner
which vulva lumps are common in older/ menopausal women
Vulva Ca
-lump, pain, bleeding, dyspareunia
-non tender lymphadenopathy
OE: Fungatind or ulcerating mass +/- VIN/LS/LN/superinflaction
Tx: Refer
outline the FIGO staging of vulva tumour
Stage 1 - Tumour confined to the vulva
1A Lesions ≤ 2 cm in size, confined to the vulva or perineum and with stromal invasion ≤ 1.0mm, no nodal metastases
1B Lesions ≥ 2 cm in size, or with stromal invasion > 1.0mm, confined to the vulva or perineum, with negative nodes
Stage 2 - Tumour of any size with extension to adjacent perineal structures (lower 1/3 urethra, lower 1/3 vagina, anus) with negative nodes
Stage 3 - Tumour of any size with or without extension to adjacent perineal structures (lower 1/3 urethra, lower 1/3 vagina, anus). positive lymph nodes
3A (i) with 1 lymph node metastasis (≥5mm), or
(ii) 1-2 lymph node metastasis(es) (≥5mm)
3B (i) with 2 or more lymph node metastases (≥5mm), or
(ii) 3 or more lymph node metastases (<5mm)
3C With positive nodes with extra-capsular spread
Stage 4 - Tumour invades other regional (upper 2/3 urethra, upper 2/3 vagina) or distant structures
4 A - Tumour invades any of the following:
(i) upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone, or
(ii) fixed or ulcerated inguino-femoral lymph nodes
4 B - Any distant metastases including pelvic lymph nodes
List the Advantages and Disadvantages of Syndromic management of STIs (5*2)
No lab tests needed
Reduced costs
Pt doesn’t need to wait for results
Control of STDs and limits spread if HIV
Simple to use
Can be used at any levels of care
Disadvantages
Most STIs are asymptomatic
Overtreat vs undertreat
Not all discharges are STIs
Overuse of drugs
-costs
-side effects
-resistance
List the Amsel Diagnostic criteria for bacteria vaginosis
3 of 4
- Homogenous vaginal discharge , colour may vary
- Amine (Fishy) odour when potassium hydroxide is added to vaginal secretion
- Presence of Clue cells
- Raised vaginal pH (more than 4.5)
What tx would you give for trichomonas vaginitis
Flagyl (Metronidazole)
