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Clin Med- P > female external Genitalia D/O > Flashcards

female external Genitalia D/O Flashcards

1
Q

how many sexually active people will get an STI by 25?

A

1 in 2 people (50%)

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2
Q

what is vulvitis? is it common?

A

Inflammation of vulva: possible involvement of introitus and/or vault
- very common

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3
Q

symptoms of vulvitis (6)

A 
itching
redness
swelling
discharge
pain/irritation
lesions
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4
Q

most common cause of vulvitis?

A

Most commonly 2º to vaginitis (3 kinds)

  • BV
  • Candida
  • Trichomonas
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5
Q

lesser common infectious causes of vulvitis?

A

cellulitis and HSV

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6
Q

other kinds of causes of vulvitis?

A

contact dermatitis/irritation

dermatologic (lichen planus, lichen simplex chronicus, lichen sclerosus) & psoriasis

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7
Q

if the vulvititis presenting symptom is erythema, what is the likely cause?

A

infectious: Vaginitis or cellulitis

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8
Q

if the vulvitis presenting symptom is pale appearance/atrohpy, what is the likely cause?

A

derm: lichen planus OR menopausal changes

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9
Q

if the vulvitis presenting symptom is skin thickening/plaques, what is the likely cause?

A

derm (lichen planus, lichen sclerosus (*this one may actually cause skin thinning), lichen simplex chronicus)

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10
Q

Most common chronic vulvar condition?

A

vulvar lichen sclerosus

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11
Q

what causes vulvar lichen sclerosus? (weeds)

A 
many things.. 
vitamin A deficiency
autoimmune process
excess of  elastase
decreased activity of 5-α reductase
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12
Q

how does vulvar lichen sclerosus present? what is the general progression of symptoms? (7)

A
  1. first, erythema & edema
  2. WHITE PLAQUES
  3. intense “ITCH-SCRATCH” CYCLE … leading to telangectasias and subepithelial hemorrhages… leading to erosions/fissures/ulcerations
  4. thin wrinkled, white skin (CIGARETTE PAPER SKIN)
  5. agglutination (sticking together) of labia minora –> phimosis over clit
  6. contraction of vulvar structures –> introital stenosis
  7. involvement of perianal region
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13
Q

txt for vulvar lichen sclerosus (initial)

A
  1. stop itch-scratch cycle
  2. minimize inflammation
  3. general vulvar hygiene
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14
Q

what is the general vulvar hygiene for lichen sclerosus? (3)

A
  1. avoiding tight underwear
  2. cleansing daily with mild soap
  3. drying the vulvar skin with a hair dryer
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15
Q

two medical txts for vulvar lichen sclerosus? whats the major benefit of these?

A
  1. oral anti-histamine each night
  2. high-potency topical steroid (at the start)
    * gives immediate relief to stop the itch-scratch cycle and restores pts belief in provider-care.
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16
Q

txt for those who dont respond to topical steroids for vulvar lichen sclerosus? (3) (maybe weeds)

A
  1. tacrolimus cream, retinoid, antimalarial agents, or photo therapy (if NO steroids work)
  2. steroid injection
  3. surgery: undercut nerve fibers (mering procedure)
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17
Q

why is vulvar lichen sclerosus harderto diagnose in younger children?

A

can present as shiny/waxy skin

  • hypopigmentation harder to see on natural pale young skin
  • purpura and fissures can be mistaken as child abuse
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18
Q

HIGH rate of ____ in women with lichen sclerosus

A

SCC (squamous cell carcinoma) 3-5%

*biopsy all new lesions!

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19
Q

what is vulvar lichen simplex chronicus? what causes it?

A

benign epithelial thickening and hyperkeratosis from chronic irritation: (i.e. use of perfumed pads or chronic vulvovaginal infections)

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20
Q

vulvar lichen simplex chronicus.. presenting symptoms?

A

itch-scratch cycle from pruritis
ALWAYS itching
-burning, pain & tender
-may have skin thickening

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21
Q

txt for vulvar lichen simplex chronicus? (3)

A
  1. vaginal hygiene
  2. sitz bath and lubricants
  3. oral antihistamines
  4. topical steroids (injectable if it doesnt work)
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22
Q

lichen simplex chronicus: Vulvar epithelium takes at least ___ weeks to heal

A

6

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23
Q

what is vulvovaginal lichen planus ?

A

Relatively rare mucocutaneous dermatosis

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24
Q

what characterizes vulvovaginal lichen planus?

A

sharply marginated flat-topped papules on the skin
but LESS sharply marginated white plaques on oral and genital mucous membranes
-leukoplastic lesions & (later) erosive lesions

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25
Q

what are the 6 Ps of lichen planus?

A 
Pruritus
Polygonal
Planar
Purple
Papules
Plaques
(but the moist environment and walking around can really alter the morphology of the primary lesions here)
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26
Q

generalized glazed erythema, Some erosions, beginning loss of clitoris and labia minora. what is this?

A

advancing vulvovaginal lichen planus

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27
Q

treatment of vulvovaginal lichen planus?

A

initial then step-up..

  1. topical: vaginal hydrocorticone foam
  2. stronger corticosteroids
  3. tacrolimus cream
  4. systemic steroids
    * careful exam for formation of adhesions.. may need vaginal dilators
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28
Q

vulvitis from menopausal atrophy: 3 main characteristics?

A
  • enlarged clitoris
  • shiny atrophic vestibule
  • loss of hair
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29
Q

vulvitis from severe ulcerative allergic contact dermatitis: 2 characteristics

A
  • severe, generalized erythema & swelling

- erosions, and extensive ulceration

30
Q

vulvitis txt is diagnosis-specific but in general, what are the txt guidlines? (3)

A
  1. txt underlying infection (if there is one) & avoid irritants
  2. sitz baths
  3. steroids (medium potency)
31
Q

Most common STI in the world?

A

HSV

32
Q

how is most HSV spread? ( at what percent?)

A

~70% transmitted via asymptomatic viral shedding

33
Q

HSV vulvovaginitis symptoms

A

Prodrome: itching or tingling, constitutional (effect many body systems)
- Multiple, small, painful blisters then . . .
Shallow ulcers
-Crusts over in 7-10 days

34
Q

recurrences of HSV in what percent of cases? (maybe weeds)

A

50%

35
Q

Dx of HSV: what is good and what isnt?

A

clinical (multiple vesicles/ulcers, PAINFUL), then ELISA to type it
- tzank smear, DNA PCR, and viral cultures ARE NOT sensitive enough

36
Q

txt for HSV

A

symptomatic: topical barriers, analgesics (xylocaine)
systemic- NSAIDS + narcs
sitz baths
anti-virals: “-cyclovirs”

37
Q

3 kinds of vaginitis/vaginosis and what causes each?

A

Bacterial Vaginosis: Gardnerella
Candidiasis: Candida albicans
Trichomonas: Trichomonas vaginalis

38
Q

most common cause of vaginal discharge in women of reproductive age. also found in ___% of asymptomatic women

A

BV , 40%

39
Q

what is BV?

A

alteration of normal vaginal flora (lactobacilli)

increase # anaerobes (which produce ammines)

40
Q

what is Amsel’s criteria for BV?

A

need 3 of the 4…

  1. a thin, homogeneous, white, non-inflammatory adherent discharge
  2. clue cells (make up at least 20% of all epithelial cells seen)
  3. vaginal pH of ≥4.5
  4. positive “whiff” test: a fishy odor after adding KOH
41
Q

what are clue cells?

A

gardnerella vaginalis bacteria taking up 75% of the border of epithelial cells
(in BV)

42
Q

3 txt options for BV

A
  1. flagyl PO
  2. flagyl topical (metroGel) - intravaginal
  3. 2% clindamycin cream - intravaginal
43
Q

what is vaginal candidiasis ?

A

yeast part of normal flora of vagina (present in 25-50% of healthy patients. BUT an overgrowth leads to this yeast infection

44
Q

what % of women will get a yeast infection? how many will have more than one episode?

A

75%

40-50% have more than one episode

45
Q

5 risk factors for yeast infection (maybe weeds)

A
  1. DM
  2. pregnancy
  3. antibiotic therapy (broad-spectrum usually)
  4. steroids or other immunosuppressive therapy
  5. HIV infection
46
Q

symptoms of yeast infection (vaginal candidiasis) (4)

A
  1. perivaginal pruritis or burning. . .
  2. . . . with or without associated dysuria
  3. perhaps mild erythema
  4. thick, white, curd-like discharge
47
Q

what does KOH show with yeast infection?

A

spores and hyphae

48
Q

yeast infection txt

A

antifungals : azoles

2nd line- nystatin (suppository- cheap)

49
Q

most prevalent non-viral STI in the world. men or women?

A

trichomonas
men- carrier- asymptomatic
women- symptomatic

50
Q

what causes trichomonas ?

A

T. vaginalis: flagellated anaerobic protozoa that attacks the vaginal epithelium or the perivaginal glands

51
Q

transmission and incubation of trichomonas?

A

transmission: almost EXCLUSIVELY sexually
incubation: 4-28 days

52
Q

trichomonas symptoms

A
  1. vulvar and vaginal pruritis
  2. copious, yellow-green, frothy discharge
  3. strawberry cervix
53
Q

trichomonas generally presents with what other things?

A

other STIs and BV

54
Q

txt for trichomonas?

A
  1. systemic therapy! Flagyl

topical only has effective txt of less than 50%

55
Q

why do you need systemic therapy for trich?

A

infection can be multifocal, involving vaginal epithelium, the urethra, or perivaginal glands such as Bartholin’s or Skene’s glands.

56
Q

what is bratholin’s cyst/abscess?

A

bartholin’s glands: bilateral in labia minora

-usually pea-sized, can become cystic (blocked and fluid filled)and form an abscess

57
Q

what age group do bratholin’s cyst/abscess usually present in? fast or slow onset?

A

fast, women 20-30yo

*usually delay in seeking care so by the time they show up, they area abscesses

58
Q

what organisms cause bratholin’s cyst/abscess?

A

anaerobes(majority)

gonorrhea

59
Q

bartholin’s abscess txt (3 part process)

A
  1. local anesthesia & sterile prep. incision 1-1.5cm long (from INSIDE the labia)
  2. hemostat to break up loculations
  3. word catheter placed to drain
60
Q

do NOT txt barthonlin’s abscess with what?

A

antibiotics!

61
Q

most common cause of STIs and cervicitis?

A

GC and chlamydia

62
Q

how many cases of chlamydia a year (maybe weeds)

A

1.2 million

63
Q

STI/cervicitis presentation (7)

A

dysuria, frequency, urgency, pelvic pain,VAGINAL BLEEDING, and vaginal discharge

64
Q

Mucopurulent cervicitis is often _______

A

asymptomatic.

65
Q

is mucopurulent discharge sensitive predictor of GC or chlamydia infection?

A

no, most patients with these infections actually do not present with mucopurulent discharge.

66
Q

pelvic exam for STI/cervicitis

A

may reveal a tender, friable cervix with mucopurulent discharge
but can be completely normal

67
Q

Dx of cervicitis

A

mostly presumptive

cervical swab & culture

68
Q

Txt of cervicitis- gonorrhea

A

250mg IM rocephin (ceftriaxone)
or 400mg PO cefixime
(amox or erythromycin if allergic)

69
Q

txt of cervicitis- gonorrhea but pregnant?

A

same txt as if not pregnant….

just NO quinolones or TCN

70
Q

txt cervicits- chlamydia

A

single dose azithromycin or doxycycline

  • amoxicllin if pregnant
  • erythromycin if allergic

Clin Med- P (124 decks)

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