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Clin Med - Repro > Lecture 10 - VV Disorders > Flashcards

Lecture 10 - VV Disorders Flashcards

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1
Q

What is the most common vaginal complaints?

A

infectious vaginitis

  • BV
  • candidiasis
  • trichomoniasis
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2
Q

What is the normal acidity of the vagina?

A

3.5 - 4.5

mostly aerobic colonization
Lactobacilli

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3
Q

Lactobacilli

A

found in the vagina
produced lactic acid –maintains acidic environment
inhibits growth of bacteria

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4
Q

Physiologic Discharge

A

composed of vaginal squamous cells suspended in fluid

  • clear to slightly cloudy
  • odorless, non-adherent to walls
  • +lactobacilli
  • no itching, burning, or malodor

normal increase in volume during ovulation, after coitus, after menses, and during pregnancy

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5
Q

Wet Mount

A

typically you do two slides

1) KOH
- candida
- “whiff” test for BV
2) saline
- BV, trichomonas

samples obtained from lateral vaginal wall

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6
Q

What is considered a normal wet mount?

A

normal epithelial cells
cell border are well defined, linear, and distinct
lactobacilli

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7
Q

What can you do if a pt comes in on her period with vaginal complaints?

A

nothing
blood with distort the wet mount and pap smear
come back when not on period

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8
Q

BD Affirm VP III

A

FDA approved DNA probe to test for high concentration of gardnarella, trichomonas, and candidia

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9
Q

BV

A

bacterial vaginosis
MC vaginal infection in women 14-49 years old

MC cause of vaginal discharge and odor

pregnant pts at increased risk of preterm delivery

Gardnerella vaginalis

increased pH

50% are asymptomatic

sexually associated

high prevalence in women who have sex with women

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10
Q

What are the risk factors of BV?

A

recent ABX use
douching -alters pH
unprotected sex - alters pH

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11
Q

What are the signs and sxs of BV?

A

increased discharge - white or grey in appearance
“fishy” odor –in 75% of pts
odor may be worse after sex
no dyspareunia

copious thin, white vaginal discharge - not adherent to walls

+KOH “whiff” test
Clue cells on saline wet mount
ph >4.5

stippled cell borders

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12
Q

What findings on wet mount would make you think about BV?

A

+ KOH “whiff” test

Clue cells on saline wet mount

pH >4.5

stippled cell borders

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13
Q

Amsel Criteria

A 
Used to dx BV 
need 3 out of 4: 
-homogenous, thin, grayish-white discharge 
-vaginal pH >4.5 
-positive "whiff" test
- clue cells on wet mount

> 90% sensitive
77% specific

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14
Q

What is the first line treatment for BV?

A

Metrogel Vag (0.75%) - insert one applicator intravaginally QHS (every bedtime) X 5 days

Metronidazole 500mg PO BID x 7 days (NO EtOH)

Clincamycin cream (2%) insert one applicator intravaginally QHS x 7 days

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15
Q

What are the SE of metronidazole?

A

increase risk of yeast infection (true with any ABX)
bloating
metallically taste in mouth

no EtOH

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16
Q

What is the second line treatment for BV?

A

clinamycin 300mg PO x 7 days

Tindazole - 2nd gen nitroimidazole (no EtOH)

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17
Q

How do you treat BV in a pregnant pt?

A

Metronidazole PO 250mg TID x 7 days

Alternative: Clindamycin 300mg PO BID x 7 days

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18
Q

How do you treat BV in a pt with recurrent BV?

A

recurrent means >3/year

consistent condom use
longer treatment periods

explore WHY (what they are doing in their lifestyle) they are continually getting BV

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19
Q

Solosec

A

newly FDA-approved nitroimidazole
secnidazole (solosec) –single dose treatment for BV
longer half life

generated since compliance is a problem with the current 7 day treatments

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20
Q

Yeast infection

A

vulvovaginal candidiasis

2nd MC cause of vaginitis sxs

inflammation + candida
80-90% candida albicans
10-20% candida glabrata

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21
Q

What are the risk factors for yeast infection?

A

ABX use
increased estrogen levels (HRT, OCP, pregnancy)
DM, immunosuppression (steroid use, HIV+)
Douching
Menstrual pad/tampon use
Tight-fitting clothing

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22
Q

What are the signs/sxs of yeast infection?

A

vulvar pruritis - MC symptom

burning and irritation
thick “cottage cheese” like discharge

dysuria
dyspareunia (inflammatory condition)

erythema of vulva and vaginal mucosa
vulvar edema
pH 3.5 - 4.5 (normal)
thick, white discharge adherent to vaginal walls

pseudohyphae on wet mount (tree branch-like)

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23
Q

What is the wet mount of Candida?

Study These Flashcards
A

10% KOH prep

normal pH

pseudohyphae have tree branch like appearance

24
Q

When would you culture for yeast infection?

Study These Flashcards
A

if negative microscopy

persistent sxs

25
What is the treatment for yeast infection?
Fluconazole 150mg PO x 1 ``` Topical: Miconazole (monistat) - OTC Clotrimazone (gynelotrimin) Terconazole (Terazol) insert applicator at bedtime x 1-3 days ```
26
How do you treat yeast infection in pts with immunosuppression or recurrent episodes?
Fluconazole 150mg PO x 2-3 days 72 hours apart topical medication - vaginal imidazole 7-14 days
27
How do you treat yeast infection in a pregnant pt?
NO oral meds topical (clotimazole or miconazole) x 7 days
28
What is the yeast infection is caused by C. glabrata instead of C. albicans, how does the treatment change?
must be isolated by culture before treatment Boric Acid 600mg intravaginally x 14 days made at compounding pharmacy
29
What is the most common no-viral STI worldwide?
trichomoniasis
30
Trichomonas vaginalis
flagellated protozoan infection asymptomatic in males tx both male and female
31
What are the sxs of trichomonas?
yellow-greenish vaginal discharge vulvovaginal irritation dyspareunia dysuria motile flagellated organisms on wet mount copious frothy (bubbly) cervical -vaginal discharge "Strawberry cervix" there can be a LONG dormant period in women
32
Does trichomonas progress to PID?
no - non inflammatory
33
How do you dx trichomonas?
motile trichomonads on saline wet mount -pear shaped usually concomitant BV infection -Clue cells, +whiff
34
How do you treat trichomonas?
partner must be tested Metronidazole 2g PO x 1 Metronidazole 500mg PO BID x 7 days no EtOH; Abstain x 1 week second line tindazole 2 g PO x1
35
How do you treat trichomonas in pregnancy?
metronidazole 2g PO x 1 associated with preterm delivery and low birth wt (if untreated I believe)
36
Bartholin glands are located where?
5 and 7 oclock pea-sized normally non-palpable
37
What is the function of bartholin glands?
maintain moisture of the vagina
38
What is the most common vulvovaginal tumor?
bartholin gland cyst
39
What age typically gets bartholin gland cysts?
ANY age if post-menopausal you must r/o malignancy
40
What is the difference between bartholin gland cyst and abscess?
abscess is when obstructed duct becomes infected
41
What are the sxs of bartholin cysts?
painLESS vulvar mass most detected on pelvic exam if very large can have discomfort with sitting, walking, sex clear, white fluid if drainage occurs
42
What are the sxs of bartholin abscess?
tender, erythematous, severe pain with mucopurulent drainage warm, tender, fluctuant mass consider culture, gonorrhea/chlamydia typically end up in the ER d/t pain
43
What is the treatment of bartholin cyst?
if asymptomatic, monitor Sitz bath consider biopsy to exclude malignancy in high risk populations (post- menopausal)
44
What is the treatment of bartholin abscess?
I and D with placement of Word catheter +/-ABXs Bactrim DS (cover MRSA) PO BID x 7 days
45
Word catheter
catheter placed after I and D for bartholin abscess goal: decrease recurrence left in for 4-6 weeks
46
Marsupialization
alternative treatment to word catheter for bartholin abscess
47
Vulvar Cancer
4% of gynecologic cancers typically in postmenopausal women average age of dx is 68
48
What are the risk factors of vulvar cancer?
``` HPV types 16, 18, 31 VIN - vulvar intraepithelial neoplasia lichen sclerosus hx cervical cancer HIV infection ```
49
What is the most common histological type of vulvar cancer?
SCC here paget's disease has a good prognosis unlike with breast cancer
50
How does vulvar cancer present?
vulvar lesion + pruritus unifocal plaque, ulcer, or mass on labia, clitoris or perineum +/- vulvar bleeding and pain
51
How do you dx vulvar cancer?
biopsy of lesion
52
What is the treatment of vulvar cancer?
surgery wide local resection to preserve vulva and inguinal lymph node dissection (preferred) radical vulvectomy and regional lymphadenectomy radiation therapy often given with chemo treat based on stage
53
Vaginal Cancer
rare >70y/o usually secondary to another primary metastatic tumor (cervix is MC) risk factors: - advanced age - HPV infection - smoking - cervical cancer - DES exposure 85% SCC upper third of vagina is MC site
54
What type of cancer is associated with DES?
clear cell adenocarcinoma - vaginal cancer
55
How does vaginal cancer present?
painless vaginal and/or postcoital bleeding
56
How do you dx vaginal cancer?
pelvic exam | vaginal biopsy
57
What is the treatment for vaginal cancer?
``` surgical excision (hysterectomy and upper vaginectomy) radiation therapy ```

Clin Med - Repro (18 decks)

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