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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

Bacterial vaginosis
Vulvovaginal Candidiasis


what are the risk factors for getting bacterial vaginosis?

sexual acitivity can change microflora
receiving oral sex
vaginal soaps and douches
presence of STI
contraceptive IUD
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

pH <4.5
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
- miscarriage
- chorioamnionitis


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
superficial dysuria

- erythema and swelling of vulvae
- red, pustular lesions with superficial white pseudomembranous plaques
- curd like discharge


what are the differentials for vulvovaginal candidiasis?

bacterial vaginosis


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


how is candidiasis infection in pregnancy managed?

intravaginal anti-fungals
do not use oral anti-fungals
treat vulval symptoms with topical anti-fungals.