Vaginosis and Vaginitis Flashcards
(28 cards)
What is normal vaginal ecology?
Lactobacillus:
ferments glucose to lactic acid
produces hydrogen peroxide
protects against bacterial overgrowth
protects against other cervical pathogens including GC and HIV
should be the predominant organism in the vagina
Other bacteria: Gardnerella vaginalis Bacteroides spp. Mobiluncus spp. Mycoplasma hominis
What can disrupt the normal vaginal ecology?
Elimination of protective bacteria with antibiotics
Exposure to sexually transmitted agents
Douching
Inherent lack of peroxide-producing lactobacilli
What is vaginitis?
Inflammatory response of the vagina
Presence of WBCs is the primary manifestation
Reflects infection or irritation of vaginal mucosa
Distinguish from cervicitis
What is vaginosis?
alteration of normal vaginal flora
Characterized by decreased levels of lactobacillus and overgrowth of gram-negative rods and anaerobes
Absence of WBCs
Describe the vaginal specimen collection:
Insert speculum until cervix is visualized
Collect a cotton-tipped swab immersed in vaginal secretions
Streak two glass slides with the vaginal secretions
Place one drop of 0.9% normal saline on one slide and one drop of 10% KOH on the other
What are you examining and smelling for on the KOH prep test?
Sniff sample for “whiff” test Cover with a cover slip Gently heat-fix Examine at low power (10x then 40x) Look for pseudohyphae and budding yeast DON’T overheat or let slide dry out
What is the difference between a KOH prep and a wet mount? When do you use each?
KOH Prep:
whiff test
hyphae
Saline: clue cells trichomonas WBCs Budding yeast
Describe the history, symptoms, and PE of Candida vaginitis:
History: DM, pregnancy, recent abx, steroids, immunosuppressed.
Symptoms: thick, white, cottage cheese discharge, intense itching, NO odor.
PE: vulvovaginal edema and erythema, discharge adherent to vaginal wall and is easily swabbed off.
Describe what you lab findings you will have for Candida:
- pH < 4.5
- saline wet mount may show budding yeast, hyphae, and WBCs
- KOH will show hyphae
How do you treat Candida vaginitis? do you need to treat the partner?
Intravaginal azole (monistate or gyne-lotrimin) for 7 days
Fluconazole 150 mg by mouth (do not use if pregnant) x 1
NOT an STD
Don’t treat partner unless recurrent.
Describe what you will find on history, symptoms, and PE for trichomonas:
History:
history of STDs
Men often asymptomatic carriers
Symptoms:
profuse, frothy yellow-green vaginal discharge
intense itching
usually has foul-smelling odor
Physical exam:
erythema of exocervix but NO purulent drainage
profuse, frothy, foul-smelling discharge
“strawberry” cervix (2-5%)
What will lab results show you for trichomonas:
Laboratory exam:
pH > 4.5
motile trichomonads
WBCs present
What are complications of trichomonas?
- In pregnancy may cause premature rupture of the membranes and preterm delivery.
- May also increase a woman’s risk of acquiring or transmitting HIV infection.
What is the treatment for trichomonas?
Treatment:
Metronidazole 2 gm PO once Can use in 1st trimester of pregnancy Metronidazole 500 mg po BID X 7 days Tinidazole 2 gm orally, single dose MetroGel is not effective
What do you tell the patient in regards to trichomonas infection?
- this is an STD
- partner needs to be treated
- avoid sex until cured
- side effects of metronidazole (no alcohol!)
What is the most common cause of vaginal discharge?
bacterial vaginosis
50-75% of women are asymptomatic
Associated with multiple sex partners, douching, and lack of vaginal lactobacilli
Unlikely transmitted via sexual activity
What are the history, symptoms, and PE associated with bacterial vaginosis?
History:
bacterial vaginosis
douching
Symptoms:
thin, homogeneous discharge (white or gray)
foul odor (fishy)
dyspareunia
Physical exam:
May look normal or have scant homogeneous secretions
Unpleasant odor
What will lab results show for bacterial vaginosis?
Laboratory Exam: pH > 4.5 clue cells on saline wet mount amine odor on addition of KOH -- positive whiff test absence of WBCs (Diagnosis consists of 3 out of 4)
Are there any complications of bacterial vaginosis?
- In most cases, BV causes no complications.
- Pregnant women with BV may have premature birth and low birth wt. babies.
- Infection may move upward causing a PID.
- Can increase susceptibility to HIV.
What is the treatment for bacterial vaginosis?
Treatment:
A. Metronidazole 500 mg po bid X 7 days 750 mg po daily X 7 days In pregnancy, only use oral medication 0.75% intravaginal gel 1-2X/day X 5 days Single does is NOT effective
B. Clindamycin
2% intravaginal cream qhs X 7 days
300 mg po bid X 7 days (alternative)
What will you tell the patient who has bacterial vaginosis?
This is NOT an STD
Side effects of medications
May be recurrent
Which has a pH lower than 4.5?
candidia
Which has a fishy smell and frothy appearance?
trich
which is an STD
trich
