Vaginitis & STIs Flashcards
(32 cards)
Define vaginitis vs vaginosis
- Vaginitis: inflammation of vagina w/ increased discharge containing WBC & increased bacteria
- Vaginosis: inflammation of vagina e/ increased discharge and vaginal order w/o increase WBC & decrease in lactobacilli
*both occur when ecology of vagina distrubed
How can vaginal discharge be evauluated
- 0.9% saline wet prep
- 10% KOH for hyphae (after wet prep)
- Whiff or amine test for fishy odor (after KOH)
- nitrazine strep for pH
Bacterial Vaginosis (BV)
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test
most common cause of vaginitis
- etiology: d/t decrease in lactobacilli allowing for overgrowth of anaerobes
- symptoms: vaginal irritation, itching
- appearance/odor: milky white discharge; adherent to vaginal walls; malodorous
- pH > 4.5
- wet mount: clue cells (clumping) present on wet prep
-whiff test (+)
BV treatment & edu
Treatment
- metronidazole or clindamycin (oral)
treat all pregnant people
- metronidazole (gel) for pregnancy
Education
- no yogurt or oral lactobacillus
- can use boric acid BUT NO oral ingestion (can cause death)
Vulvovaginal candidiasis (VVC) [yeast infection]
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test
- etiology: candida albicans (90%)
- symptoms: pruritus, erythema, edema, dysuria d/t contact w/ vulva
- appearance/odor: thick, white, curdy/clumpy discharge clinging to vaginal wall (cottage cheese)
- pH < or = 4.5
- wet mount: hyphae (oval budding) & WBC present; lactobacilli in KOH
-whiff test (-)
Which STI resembles cottage cheese
Vulvovaginal candidiasis [yeast infection]
BV linked to
high recurrence rate
- PROM
- premature delivery
- low birthweight delivery
- aquisition of HIV/STD
- PID or post op infections after gyn procedure
- chorio
- postpartum endometritis
- post c/s wound infection
Risk factors for VVC (yeast infection)
- repeated courses of antibiotics
- diabetes (uncontrolled)
- pregnancy
- obesity
- genetics
- corticosteroids and hormones
- immunosuppression
- local allergic reactions
- hormone therapy (vaginal estrogen) [remember estrogen regulated pH]
UTI dysuria vs VVC dysuria
UTI: internal burning in urethra
VVC: external burning when urine contacts vulva
Treatment & education for VVC
Treatment
- Fluconazole (oral) 1 tablet
- topical azole only for pregnancy
- boric acid intravaginally for recurrent VVC
Education
- sitz bath or colloidal oatmeal for irriation/swelling
- dry perineal area w/ hair dryer
- avoid tight clothing
Trichononiasis “trich”
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test
- testing
- etiology: trichomonas vaginalis
- symptoms
- appearance/odor: frothy gray/yellowish/green discharge; strawberry pink cervic w/ cervial petechiae; malodorous
- pH >4.5
- wet mount: motile flagellated (swimming w/ tail) WBC present
-whiff test: (+) - testing: microscopy & NAAT
sexually transmitted
Trich treatment & education
Treatment
- metronidazole (7 days) women & (1 day) for men
- same treatment for pregnancy
always treat partner - STD
retest 3 months after tx
Screening recommendations for STIs
- All individuals who are sexually active should be screened for STI
- annual screening for all women <25 & >25 w/ risk factors for GC & CT - Ask 5 P’s
- Partners
- Practices
- Prevention of pregnancy
- Protection from STIs
- Past hx of STIs - Edu on s/sx of STIs
- All pregnancy ppl should be screens for
- Chlamydia
- Gonorrhea
- Syphilis
- Hep B
- HIV
- Hep C
Assessment for STIs include:
- sexual hx
- menstrual hx
- PE (external genitalia, speculum exam, bimanual exam, inguinal nodes & abd)
What STIs are required to be reported to public health officials
- Gonorrhea
- Chlamydia
- Syphilis
- HIV
Chlamydia
- etiology
- symptoms
most common STI
-etiology: chlamydia trachomatis
-symptoms (female): usually asymptomatic; spotting, postcoital bleeding, dysuria & urine frequency, lower abd pain, dyspareunia; CMT or rebound –> PID
-symptoms (male): usually asymptomatic; acte epididymitis, testicular pain, swollen scrotum, painful intercourse, blood in semen, discharge from penis
Consequences of delayed treatment of chlamydia
- PID
- infertility
Treatment for chlamydia
Doxycycline
Azithromycin for pregnancy
follow up culture obtained no sooner than 3 months
Gonorrhea
- etiolgoy
- symptoms
2nd most common STI
most common complication of GC = PID
- etiology: neisseria gonorrhoeae
- symptoms (women): usually asymptomatic; dyspareunia, change in vag discharge, uni/bilateral labial pain/swelling, lower abd discomfort
- symptoms (men): green/yellow/white discharge, buring urination, epididymitis, swollen throat (oral)
Treatment for gonorrhea
Ceftriaxone
-safe for pregnancy
*test for cure 3-4 wks after tx is completed. if (+) in 1st trimester retest in 3rd trimester
Newborn complication of untreated gonorrhea & chlamydia and treatment
complication: ophthalmia neonatorum
treatment: 0.5% erythromycin
PID
- symptoms
GC or CT most common cause
- symptoms: pelvic/abd pain (peritonitis), CMT, adnexal tenderness (bilateral), abd tenderness, abnormal discharge, T >102 F, low backache, WBC on wet prep
Tx of PID
Non-pregnant: parenteral (IV) abx regimen (ceftriaxone + doxycycline etc)
Pregnant: hospitalized for parenteral (IV) abx d/t risk of pretemr birth & matenral morbidity (NO doxycycline)
IUD and PID risk
- greatest risk for PID 1st 21 days after insertion
- IUD usually does not need to be removed if tx successful
- no improvement w/in 48-72 hrs –> remove IUD
