Term
| what characterizes symptoms associated with vaginitis? |
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Definition
| symptoms are nonspecific and self dx/physician dx is reliable w/o histological or lab confirmation of a specific disorder (many times a simple wet mount is all that is needed). |
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Term
| what are the causes of vaginitis? |
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Definition
| infection, chemicals, atrophy of the vagina (declining estrogen levels = thinning of vaginal lining + pH increase), systemic diseases, and drugs |
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Term
| what are the three most common vaginal infections? (*probable exam question*) |
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Definition
| 90% of vaginitis is due to: bacterial vaginosis (fish smell), candida vulvovaginitis (yeast), and trichomoniasis (flagellated) |
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Term
| what characterizes normal processes in the vagina? |
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Definition
| 1-4 mL secretions in a day @ reproductive age (can increase during ovulation, if on OCP, and during pregnancy), pH of 4-4.5, mostly squamous cells and rare PMNs, and normal flora (lactobacilli, diphtheroids, and staph epidermidis) |
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Term
| what pH is seen in premenarchal and postmenopausal females? |
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Definition
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Term
| what is the approach to a bacterial vaginosis dx? |
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Definition
| hx - ask about: discharge (describe), pruritus, irritation, burning, soreness, odor, dyspareunia, dysuria, bleeding, sexual partners (their symptoms), symptoms related to menses (yeast often premenstrual and trichomoniasis often post menses), medications?, hygiene practices (detect irritants/poor hygiene - *women try and get rid of normal secretions w/constant pad use), menopausal (oral/transdermal HRT often doesn't give adequate vaginal E2 levels - can boost w/a topical) |
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Term
| what should the physical exam consist of for a vaginitis pt? |
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Definition
| examine the *entire vulvovaginal and perianal areas (check for ulcerations, redness, irregular borders, scratches, white thickening, discharge), check the cervix (red/bleeding? - may be CA/STD @ the squamo-columnar junction), and on the pelvic exam: cervical motion tenderness may indicate an infection |
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Term
| what is the most important test when evaluating vaginitis? |
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Definition
| vaginal pH: dry swab the *sidewall of the vagina then apply it to pH paper (narrow range 4-4.5). |
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Term
| what does a ph > 4.5 in a premenopausal female suggest? |
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Definition
| bacterial vaginosis or trichomoniasis |
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Term
| what might be the cause of bacterial vaginosis in a premenopausal female w/a pH of 4-4.5? |
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Definition
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Term
| why is it harder to dx vaginitis in a postmenopausal female? |
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Definition
| their vaginal pH is normally 4.7 or higher |
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Term
| what are microscopic diagnostic studies performed w/a q-tip for diagnosing yeast, bacterial vaginosis, or cervicitis as the cause of vaginitis? |
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Definition
| wipe a q-tip swabbed in the vagina on a slide w/saline and add 10% KOH. this destroys cellular elements, allowing better visualization of yeast along w/an amine odor if bacterial vaginosis (whiff test). if excess WBCs are visualized on microscopy w/o yeast, clue cells, or trich, this indicates cervicitis. |
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Term
| why is a cx not usually beneficial for vaginitis? when would a cx be normally done? |
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Definition
| b/c the cause is usually going to be bacterial vaginosis, yeast or trichomoniasis. a cx would be done if the pt is pregnant, and group B strep is tested for (comes from the bowel and can harm the baby). |
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Term
| what characterizes herpes as a cause of vaginitis? |
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Definition
| herpes is a big cause of vaginitis (40% of the population is infected) and will get worse pre-menstrual cycle (like a *yeast infection). herpes can present as simply scratches (paper cut) that look like chronic irritation. |
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Term
| how is herpes tested for? treated? |
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Definition
| dx: HSV-1,2 selective IgG serology (or IgM if first breakout. serology = more accurate than cx). tx: acyclovir valacyclovir, famciclovir. |
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Term
| what is the "completely moral" approach to a pt w/herpes? |
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Definition
| make sure they are on antiviral suppressive therapy (every day), men should wear condoms, and partners should tell each other. |
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Term
| why is douching a risk factor for vaginitis? |
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Definition
| b/c the pt may accidentally wipe out important normal flora such as lactobacillus that keep pH low |
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Term
| what is the treatment for bacterial vaginitis? |
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Definition
| metronidazole 500 mg PO x7 days (disulfiram rxn), clindamycin cream, and tinidazole (PO, longer t 1/2 than metro). *the first two can be used in pregnancy* |
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Term
| what makes up 1/3 of vaginitis? |
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Definition
| candida vulvovaginitis - which is not sexually transmitted (candida makes up normal flora in 50% of women - but less in postmenopausal b/c pH is higher). however, there are some other yeasts such as torulopsis glabrata which are more resistant and cause recurrent yeast infections. |
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Term
| what are risk factors for candida? |
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Definition
| DM, antibx, increased E2 levels (OCP/pregnancy), immunosuppression (HIV/steroids), contraceptive devices (sponge, IUD, diaphragm), genetic susceptibility, and behavioral factors. |
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Term
| what is the clinical presentation for candida? |
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Definition
| itchiness, redness, dysuria, pain over the vulva, pain w/sex, and cottage cheese discharge. |
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Term
| how does candida appear on microscopy? |
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Definition
| hyphae and cells which break up w/KOH addition |
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Term
| what are treatments for candida vulvovaginitis? |
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Definition
| monistat OTC and fluconazole (one pill) |
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Term
| if pts have recurrent vaginitis due to yeast, what should be considered? |
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Definition
| r/o DM. try fluconazole the week of their menstrual period every month, betadine douche, or if torulopsis glabrata - try giemsa topical. |
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Term
| what characterizes vaginitis due to trichomoniasis? clinical features? |
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Definition
| 35% of vaginitis - most common in non-hispanic black women. it is a flagellated protozoan which is usually sexually transmitted. clinically: green, foul smelling discharge, painful sex/urination, redness and *strawberry cervix (dots). |
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Term
| what complications are associated with trichomoniasis? |
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Definition
| inflammation after a hysterectomy (if present), infertility, possible tube infection, and in pregnancy - possible premature rupture of the membrane (PROM, bacteria can crawl up the cervix and create a nidus for infection) |
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Term
| how is trichomoniasis diagnosed? |
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Definition
| visualization of trichomonads on a wet mount, pH >4.5, increase in PMNs on wet mount (*pap smear will not work) |
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Term
| how is trichomoniasis treated? |
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Definition
| metronidazole. treat partner (and refer for STI testing) and avoid intercourse |
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Term
| what is the great imitator? |
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Definition
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Term
| what can a retained tampon cause? |
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Definition
| staph w/toxic shock (smells) |
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Term
| what is desquamative inflammatory vaginitis? |
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Definition
| increased PMNs but no trichomonas, no bacterial vaginosis, no yeast present - treat w/steroids. |
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