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Pharm 129 > Vulvovaginal Candidiasis > Flashcards

Vulvovaginal Candidiasis Flashcards

(48 cards)

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1
Q

What is vaginitis

A

Inflammation of the vaginal tissue that may be accompanied by itching, burning, irritation, pain, odor and vaginal discharge

One of the most common reasons women seek medical care

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2
Q

What are non-infectious causes of vaginitis

A

Causing vulvovaginal pruritus without discharge (itching)

Causing vaginal discharge primarily (no/less itch)

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3
Q

what are the causes of vulvovaginal pruritus

A 
• Poor hygiene
• Irritant or allergic dermatitis
• Skin disorders: 
– Psoriasis
– Lichen planus
– Lichen sclerosus
– Squamous cell hyperplasia
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4
Q

what are the causes of vaginal discharge (without itch)

A
  • Desquamative inflammatory vaginitis
  • Atrophic vaginitis
  • Foreign bodies
  • Excessive physiologic secretions (stress, pregnant, ovulation)
  • Certain cancers
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5
Q

what are infectious causes of vaginitis

A

Bacterial Vaginosis (BV) - most common
Vulvovaginal Candidiasis (VVC) - yeast infection
Trichomoniasis
Other (chlamydia, gonorrhoea, etc)

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6
Q

Which type of vaginitis:

  • little itching
  • homogenous, white-grey discharge, malodorous “foul fishy”
  • ph >4.5 (5-6)
A

bacterial vaginosis

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7
Q

Which type of vaginitis:

  • some itching
  • frothy, yellow-green discharge, malodorous
  • dysuria
  • strawberry cervix
  • ph >4.5 (6)
A

Trichomoniasis

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8
Q

Which type of vaginitis:

  • LOTS of itching
  • cottage cheese discharge, no odour
  • dysuria and dyspareunia
  • redness and/or swelling
  • pH <4.5 (normal pH)
A

VVC

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9
Q

What organism causes bacterial vaginosis

A

Gardnerella vaginalis

Mycoplasma hominis +

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10
Q

What organism causes trichomoniasis

A

Trichomonas vaginalis

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11
Q

What organism causes VVC

A

Candida albicans

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12
Q

Which type of vaginitis is sexually transmitted

A

trichomoniasis

not an STI in bacterial vaginosis but rates > in sexually active women

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13
Q

What are risk factors for bacterial vaginosis

A 
IUD use
Vaginal Douching 
Absence of or decrease in lactobacilli 
New/multiple sexual partners
smoking
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14
Q

Risk factors for trichomoniasis

A 
History of STIs
Lack of condom use 
Multiple sex partners
Lower socioeconomic status
smoking
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15
Q

Risk factors for VVC

A 
Race (more likely for african americans)
Vaginal Douching 
Meds: ABX, CST
increased Estrogen Levels 
Uncontrolled DM 
Immunodeficiency
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16
Q

Treatment for bacterial vaginosis

A

Preferred treatment:
• Metronidazole 500mg BID x 7 days

  • Metronidazole 0.75% gel: 5g intravaginally once a day x 5 days
  • Clindamycin 2% cream: 5g intravaginally once a day x 7 days
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17
Q

Partner management for bacterial vaginosis

A

treatment of partner not warranted

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18
Q

Treatment of trichomoniasis

A
  • Metronidazole 500mg BID x 7 days (can be used if no swab test is done bc will treat BV or trichomoniasis)
  • Metronidazole 2g single dose
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19
Q

Partner management for trichomoniasis

A

Treat partner
Avoid sex
- dont treat/defer asymptomatic pregnant patients

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20
Q

Partner management for VVC?

Study These Flashcards
A

Typically NO need to treat sexual partner (unless uncircumcised)
Exception: C. balanitis, RVVC

Avoid sex until therapy complete

21
Q

How does VVC occur?

Study These Flashcards
A
  • candida is a normal part of the vagina flora
  • symptomatic candidiasis is caused by overgrowth (usually due to changes in host environment)
  • disruption of vaginal ecology can occur with diabetes, pregnancy, or HIV disease. In some women, disruption can occur with the use of antibiotics and douching
22
Q

What are the 2 classes of VVC

Study These Flashcards
A

Uncomplicated (can be treated by RPh) and complicated (refer)

23
Q

What is uncomplicated VVC

Study These Flashcards
A
  • Sporadic, Infrequent VVC
  • Mild-to-moderate signs and symptoms
  • Likely caused by C. albicans
  • Non-immunocompromised host
24
Q

What is complicated VVC

Study These Flashcards
A
  • Recurrent VVC (RVVC)
  • Severe symptoms
  • Non-albicans species
  • Compromised host
25
Red flags of VVC
- Is pregnant - Is premenarchal - Presents w/ vaginal symptoms for the 1st time - Presents w/ concurrent symptoms of fever or pelvic pain - Presents w/ signs or symptoms inconsistent with VVC - Coloured or malodorous discharge - Is predisposed to VVC: DM, HIV - Is taking predisposing medications - Has a recurrence of VVC (>3/year or 2 within past 2 months)
26
What are the criteria for self treating VVC?
1. vaginal symptoms infrequent 2. >1 previous diagnosed episode 3. current symptoms are mild-moderate and consistent with VVC 4. vaginal pH <4.5 (if measured)
27
What is vagisense
- tells you if pH >4.5 (turns blue) - detects BV or trichomoniasis infections - do not use around menses (pH naturally elevated)
28
When to avoid using vagisense
* In pregnancy * <1 day before or the day after your period * there are signs of menstruation or any vaginal bleeding * <12 hours after sexual intercourse or vaginal douching * <72 hours after the application of vaginal preparations
29
Goals of therapy for VVC
• Rapidly relieve signs & symptoms • Eradicate causative organism • Prevent recurrence & complications – Reestablishment of normal vaginal flora • Prevent misdiagnosis and delayed treatment of another condition • Reduce inappropriate use of anti-fungals
30
Vaginitis prevention: Hygiene measures
* Keep genital area CLEAN and DRY; wipe from front to back. * Avoid OTC feminine hygiene products & douches. * Change sanitary pads & tampons regularly; Practice safe sex
31
Vaginitis prevention: Clothing measures
* Choose COTTON underwear (avoid synthetic, silk, or nylon) * Avoid tight or restrictive synthetic clothing; avoid thongs * Promptly change out of wet clothes/swimsuits
32
Vaginitis prevention: diet measures
* Balanced, nutritious diet * Decrease sucrose and refined carbs if poorly controlled diabetic * Drink sufficient fluids * Eat yogurt (8 oz/day) with live lactobacillus cultures
33
How to treat uncomplicated VVC
Non pharm therapy + nonRX (Vaginal Imidazole Antifungals or Oral Triazole Antifungal: Fluconazole) or RX (Vaginal Triazole Antifungal: Terconazole)
34
Nonpharm therapy
Sodium bicarbonate sitz bath – Add 1 teaspoon sodium bicarbonate to 1 pint of water – Add 2-4 tablespoons of the solution to 2 inches of bath water – Sit in the sitz bath or bathtub for 15 minutes as needed for symptom control Consume yogurt?
35
What are OTC Vaginal Imidazoles available
- clotrimazole (canestan) - 1/3/6 days - miconazole (monistat) - 1/3/7 days - CI: warfarin strength increases as days decrease
36
What type of product is recommended for bedtime
Creams
37
What type of product is recommended for anytime of day
ovule
38
What OTC oral triazoles are available?
Fluconazole (CanesOral, DiflucanONE, Monicure) 150 mg PO x 1 dose - do not use if pregnant or trying
39
What RX vaginal triazole is available?
Terconazole (terazol 7, taro-terconazole) | Vaginal Cream 0.4%: 1 applicatorful intravaginally qhs x 7 days
40
Do multi-day treatments work the same as single-dose?
- equal efficacy | - faster rates of symptom relief
41
What to do if nonRx therapy is ineffective?
refer
42
what should sexual partner do in RVVC cases?
- use antifungal cream x 7 days while woman is receiving treatment
43
How long should symptoms improve by
within 2-3 days, resolve within 7 refer if >7 days
44
When to follow up?
3 days
45
What treatments are recommended for pregnancy
- longer duration is better - clotrimazole 1% cream 5 g intravaginally per day x 7–14 days - clotrimazole 100 mg vaginal tablet once daily x 7 days - miconazole 2% cream 5 g intravaginally per day x 7 days - miconazole 100 mg vaginal suppository once daily x 7 days - terconazole 0.4% cream 5 g intravaginally x 7 days
46
What to avoid using when pregnant
fluconazole | boric acid
47
What is the best treatment option for breastfeeding women
Any topical Clotrimazole or Miconazole formulation Others: - nystatin does not enter breastmilk - fluconazole is excreted in milk but compatible
48
Products to avoid
* Vaginal Douches * Vaginal Anti-Itch Creams * Natural Health Products (need antifungal) * Personal/Genital Hygiene products

Pharm 129 (14 decks)

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