Flashcards in Non Sexually transmitted infections Deck (21):
what is the pathophysiology behind bacterial vaginosis? Including organisms responsible
there is a disturbance to the normal microflora of the vagina. Lactobacilli normally produce acid to create a low pH <4.5 in the vagina to inhibit growth of other organisms.
In bacterial vaginosis there is a reduction in lactobacilli and thus the pH rises and other organisms can grow.
Thus the infection is often polymicrobial but most common organisms found are Gardnerella vaginalis, anaerobes and mycoplasma
name two types of no nSTIs
what are the risk factors for getting bacterial vaginosis?
sexual acitivity can change microflora
receiving oral sex
vaginal soaps and douches
presence of STI
ethnicity - more common in black
what are the clinical features of bacterial vaginosis?
may be asymptomatic
offensive fishy smelling discharge
not usually associated with itching/soreness
thin white/grey homogenous vaginal discharge
how does the discharge compare in bacterial vaginosis, candidiasis and trichomonas vaginalis ?
bacterial vaginosis - fishy smelling thin white/grey homogenous discharge
candidiasis - thick white curd like and itchy
Trichomonas vaginalis - thin, frothy, offensive discharge with irritation, dysuria and vaginal inflammation
how can bacterial vaginosis be investigated ? what would indicate a positive diagnosis?
high vaginal smear (HVS) and gram staining:
- clue cells
- reduced lactobacilli
- absence of pus cells
KOH whiff test
what are clue cells?
cells seen in bacterial vaginosis
vaginal epithelial cells studded with gram variable coccobacilli
what is the KOH whiff test?
test for bacterial vaginosis
KOH (alkaline) is applied to discharge which causes the release of a strong fishy odour
how is bacterial vaginosis managed?
asymptomatic cases do not require treatment.
otherwise metronidazole - oral or vaginal gel
Clindamycin or Tinidzole may also be used
advice: avoid douching, shower gels and vaginal scents
What complications occur during pregnancy in someone with untreated symptomatic bacterial vaginosis?
increased risk of
- premature birth
how are pregnant women treated for bacterial vaginosis? breastfeeding women?
pregnant: same way as non pregnant - metronidazole
breastfeeding: adviced to use lower doses of metronidazole because it can affect the taste of breast milk.
what is vulvovaginal candidiasis?
fungal infection of lower reproductive tract in women
caused by candida albicans in 90% of cases
what are the risk factors to candidiasis infection?
immunosuppression - HIV, cancer, corticosteroids
broad spec Abx - kills vaginal flora allowing candida to flourish
what are the clinical features of candida infection
pruritis of vulvae - which can extend to perianal region in some women
thick white curd like discharge - non offensive
- erythema and swelling of vulvae
- red, pustular lesions with superficial white pseudomembranous plaques
- curd like discharge
what are the differentials for vulvovaginal candidiasis?
how would you investigate vulvovaginal candidiasis?
in uncomplicated cases the history alone is enough
vaginal pH and examination can be performed
if complicated cases then vaginal smear and microscopy is indicated
what is found on vaginal smear and microscopy for candidiasis?
presence of spore and mycelia
how is vulvovaginal candidiasis managed?
initial course of intravaginal antifungals such as fenticonazole or clotrimazole - usually inserted into vagina by applicator
oral antifungals - fluconazole or itraconazole - as an alternative treatment.
Topical imidazole can be prescribed as well as oral or intravaginal treatment. This addresses vulval symptoms.
advice - reduce using soaps in the area and wearing tight clothing.
what should you do if the symptoms of candidiasis do not resolve within 7 -14days ?
consider alternative diagnosis by measuring vaginal pH and taking swabs for microscopy and culture
consider predisposing risk factors and try to address e.g. diabetes
consider compliance to medication issues.
why is candidiasis more common in pregnancy?
O levels stimulate glycogen production which provides a favourable environment for microbes to thrive
also encourages it to stick to walls and grow better