A. Vaginal Infections

Question 1

What are the 3 main vaginal infections listed in order of prevalence?

Answer 1

BV
Candida/Yeast
Trich

Question 2

What are the different subtypes of Candidiasis listed in order or prevalence?

Answer 2

Albicans
Tropicalis
Glabrata

[Think GTA]

Question 3

Which subtypes of Candidiasis tend to be more resistant to treatment & therefore present as chronic infections more often?

Answer 3

Tropicalis & Glabrata

Question 4

What are the risk factors for Candidiasis?

Answer 4

• Immunocomprimised
• Preg/Oral contraceptives (increase glycogen)
• Diabetes
• Antibiotics like doxycycline or tetracycline for acne (kill normal flora)
• Corticosteroids

Question 5

Which of the 3 vaginal infections present with pruritis & erythema?

Answer 5

Candida & sometimes Trich (NOT BV)

Question 6

Which vaginal infection presents with a green/yellow frothy discharge? Cottage cheese discharge? Thin gray discharge?

Answer 6

Trich
Candida
BV

Question 7

Which vaginal infection has a fishy smell? What can increase the intensity of the smell?

Answer 7

BV

Bases (KOH or semen)

Question 8

What is normal vaginal pH? Which vaginal infection(s) has/have normal pH? Altered pH?

Answer 8

Normally acidic ~4

Normal = candida
High (less acidic) = BV & Trich

Question 9

Which vaginal infection presents with Satellite Lesions?

Answer 9

Candida

Question 10

What are symptoms of Candida?

Answer 10

Vuvla & vaginal erythema/pruritis/edema
Satellite lesions in groin
Cottage cheese discharge

Question 11

Lab findings for Candida?

Answer 11

Normal pH
Hyphae & budding yeast on KOH
Culture only done with recurrent

Question 12

Which vaginal infection(s) use(s) KOH in the lab for diagnosis?

Answer 12

BV

Candida

Question 13

Preventative measures for Candida?

Answer 13

No bubble baths
No douching (additives)
Good hygiene
Cotton underwear (instead of nylon which doesn’t breathe)

Question 14

Candida Treatment?

[On Test]

Answer 14

Topical Miconazole (monostat) or Clotrimazole 
Single dose oral Fluconazole (Diflucan)

Question 15

Which of the vaginal infections tend to create symptoms in the entire groin region? Which can have systemic symptoms?

Answer 15

Candida

BV

Question 16

How is trichomonas spread?

Answer 16

True STD
Extremely contagious (1 encounter = 90%)
Incubation period = hours

Question 17

Which vaginal infections present with similar symptoms to UTI?

Answer 17

Trich

Question 18

What are the symptoms in Trich?

Answer 18

\+/- Erythema/pruritis
Strawberry Cervix (punctate hemorrhages)
Yellow-green frothy discharge
Dysuria
Dyspareuria

Question 19

What are the lab findings for Trich?

Answer 19

High pH
Motile organisms with tail on saline prep
Seen on pap smear

Question 20

How often are cultures used for vaginal infections?

Answer 20

Rarely

Only if chornic Candidiasis

Question 21

What are the sensitivities of the different Trich lab tests?

Answer 21

~70% Pap & saline

~90% culture (rarely done)

Question 22

What microorganisms from vaginal secretion or PAP smear can appear motile?

Answer 22

Trich

Sperm

Question 23

Trich treatment?

Answer 23

Single 2g dose of Metronidazole (higher compliance that longer course)

Question 24

What preventative measures should be taken with Trich?

Answer 24

Treat partner

Use condoms until the end of treatment

Question 25

Which drug has serious side effects related to alcohol consumption?

Answer 25

Metronidazole | Blocks breakdown of alcohol --> build up of acid aldehyde --> really sick

Question 26

What are the subtypes of BV listed in order of prevalence?

Answer 26

Tends to be polymicrobial Anaerobes Gardinella Vaginalis Mobiluncis Mycoplasma

Question 27

What is the main defense against BV normally?

Answer 27

Lactobacilli normal flora --> acid enviroment

Question 28

Risk factors for BV?

Answer 28

Anything that effects the vaginal enviroment or normal flora Menses Douching Intercourse Antibiotics

Question 29

Symptoms of BV?

Answer 29

Fishy odor | Thin gray discharge

Question 30

Lab tests for BV?

Answer 30

+ amine/whiff test with KOH Saline microscopy --> clue cells, less lactobacilli, increased cocci & bacilli High pH

Question 31

Which vaginal infection presents with Clue cells?

Answer 31

BV

Question 32

Complications of BV?

Answer 32

PID Postoperative pelvic pain Preterm delivery Intrapartum/postpartum infection

Question 33

BV treatment?

Answer 33

Oral metronidazole twice daily for 7 days

Question 34

Present with green-yellow frothy discharge, pruritis & increased pH. Treatment? [On Test]

Answer 34

Trich --> single dose (4 pills) of metronidazole

Question 35

What tests are generally done for trich in a primary care setting? [On test]

Answer 35

Saline & PAP | NOT culture

Question 36

Thin gray discharge, fishy odor & no inflammation/pruritis. Diagnosis? [On test]

Answer 36

BV

Question 37

Which vaginal infection(s) use(s) saline in the lab for diagnosis?

Answer 37

BV & Trich

Question 38

Diagnostic test for Candida? [On test]

Answer 38

KOH prep looking for hyphae & budding yeast