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Foundations 3 > Vaginal Disorder > Flashcards

Vaginal Disorder Flashcards

1
Q

What are the causitive agents of Vulvaginal Candidiasis

A

Candida albicans

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2
Q

Clinical presentation

A

Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation

Thick, curd-like vaginal discharge

Normal vaginal pH <4.5

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3
Q

Risk factors for Vulvovaginal Candidiasis?

A

Taking antx

Immunocomprosmise

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4
Q

How is VVC diagnosed?

A

Clinically based on presentation

Wet mount with microscope (KOH)
Looking for budding yeast with hyphae

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5
Q

Treatment for uncomplicated VVC?

A

Short course (1-3 days) of topical (vaginal) azole, eg. clotrimazole (OTC)

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6
Q

Treatment for VVC in pregnancy

A

Topical azole x 7 days or single dose fluconazole

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7
Q

When do you need to treat the partners of someone with VVC?

A

Male partner doesn’t need treatment unless he has balanitis (inflammation of the skin coveriing the glands of the penis

In patients with recurrent or difficult to treat yeast infections, evaluate for DM, HIV

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8
Q

What is the causative organism for Bacterial Vaginosis?

A

Results from disruption of usual, “healthy” vaginal microflora (Lactobacillus sp) - allows overgrowth of bacteria

Cause is usu. polymicrobial - often assoc. with Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)

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9
Q

Clinical presentation of Bacterial Vaginosis?

A

Vaginal irritation, thin white or gray discharge with strong fishy odor

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10
Q

Risk factors for Bacterial Vaginosis?

A

New or multiple sex partners

Douche

Rarely affects women who have never been sexually active

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11
Q

How is Bacterial Vaginosis Diagnosed?

A

Amsel’s criteria: at least 3 out of 4

  1. Thin white homogenous discharge that smoothly coats vaginal walls
  2. Clue cells on microscopy
  3. Vaginal fluid pH > 4.5
  4. Release of fishy odor when adding KOH solution (+ whiff test)
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12
Q

What are Clue cells

A

vaginal epithelial cells studded with adherent coccobacilli

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13
Q

How is Vacterial Vaginosis treated?

A

Treat all pts with symptoms*
Metronidazole (Flagyl) orally for 7 days*
Avoid EtOH while taking metronidazole

Metronidazole gel intravaginally for 5 days

Clindamycin orally or intravaginally

Pregnant patients
Use oral medication

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14
Q

What is recommended treatment for partners exposed to partners with Bacterial Vaginosis?

A

Routine trearment is not recommended

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15
Q

What are complications of Bacterial Vaginosis?

A

Increases risk of acquiring & transmitting HIV

Increases risk of acquiring herpes, gonorrhea (GC) & chlamydia

Association with PID (?independent risk factor)

Persistent or recurrent BV is common

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16
Q

Clinical presentation of Atrophic Vaginitis?

A

Dyspareunia
Post-coital bleeding d/t trauma from loss of elasticity
Leukorrhea

Burning, raw, dry sensation
o “feels like a yeast infection”
Urinary symptoms

17
Q

What would you see on physical exam for Atrophic Vaginitis?

A

Vagina has loss of rugae
Pale - red coloring, petechiae
Purulent vaginal discharge, fissures or erosions Wet mount parabasal cells, decreased/absent lactobacilli
o pH > 5 (more alkaline than normal)

18
Q

Treatment for Atrophic Vaginitis?

A

− OTC vaginal moisturizer (baseline, easiest) - use if contraindications to estrogen
o Replens, etc
− Mechanical treatment (vaginal dilators)
− Sexual intercourse restores blood flow
− Vaginal prasterone (DHEA)

19
Q

If moisturizers don’t work what else can you give for Atrophic Vaginitis?

A

Vaginal Etrogens
Vaginal prasterone (DHEA)
Ospermifene

20
Q

What is the typical age range of Vaginal INtraepithelial Neoplasia?

A

35-55

21
Q

What virus needs to be present for VaIN?

A

HPV

22
Q

What are risk factors for Vaginal Intraepithelial Neoplasia?

A

Same as CIN
o Smoking, multiple sexual partners and early onset of sexual activity
History of CIN III
o Unclear how CIN migrates to vagina
Some women with 1o vaginal cancer have NO history of CIN III or cervical cancer

23
Q

How are VaIN classified

A

−VaIN 1: benign viral proliferation
−VaIN 2: intermediate risk
−VaIN 3: true precursor to vaginal cancer

24
Q

How are VaIN diagnosed?

A

Pap smear

Colposcopy

25
Q

Treatment for VaIN 1?

A

Observation is justified in younger women

Cytology/HPV/Colposcopy Q 6 months

26
Q

Treatment for VaIN 2?

A

Surgical intervention vs. Topical chemotherapy

27
Q

What surgeries or procedures can be sued for VaIN?

A

Vaginectomy

Laser Vaporization

28
Q

slide 28

A

28

29
Q

Slide 30-31

A

slide 30-31

Foundations 3 (25 decks)

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