Vaginal Infections Self Care

Normal

discharge

clear/ white

odorless

viscous/ sticky

symptoms

none

pathogen

normal flora

Vulvovaginal

Candidiasis (VVC) or

Yeast Infections

discharge

very thick & white, odorless

symptoms

itching, redness, edema

pathogen

fungal

Bacterial Vaginosis

(BV)** REFER

discharge

thin (watery), off-white or gray, fishy odor

symptoms

none

pathogen

bacterial

Trichomoniasis** REFER

discharge

yellow, frothy, malodorous

symptoms'

vaginal irritation, redness, edema

pathogen

parasite

Vulvovaginal Candidiasis (VVC)

a. Also known as a: yeast infection

b. Most common75% of women report one infection over their lifetime

c. Candida albicans is the most common pathogen

d. No single causative factor:

i. Pregnancy

ii. High dose combined oral contraceptives or estrogen therapy

iii. Sexually active

e. Symptoms:

i. Discharge

1. thick and white

2. odorless

ii. Other Signs

1. Itching

2. Redness

3. Edema (swelling)

Vulvovaginal Candidiasis (VVC)

treatment goals and exclusions

i. Goals

1. Relieve symptoms

2. Eradicate the infection

3. Reestablish normal flora

i. Self-treatment is appropriate in uncomplicated disease, infrequent episodes, and mild-moderate

symptoms (no foul odor, correct appearance)

1. **Doctor must have diagnosed a previous infection

iii. Exclusion to Self-Treatment

1. first yeast infection (2nd and on then can treat)

2. Recurrent infections at least 3 documented infections in one year

3. Fever or pain in the pelvic area

4. Pregnant

5. Younger than 12 years old

6. Reinfection within 2 months

Non pharm and pharm

Non-Pharmacologic

1. Nonabsorbent clothing (think breathable underwear)

2. YogurtLactobacillus

3. Limiting sucrose and refined carbohydrates

4. Discontinue any offending agent after consult with PCP (ex. antibiotics)

v. Pharmacologic

1. Imidazoles are first line; considered part of the antifungal pharmacologic class

2. Alters fungal cell membrane permeability; cause structural damage to fungal membranes

3. Come as tablets, creams, and suppositories → all patient specific

4. All equally effective just dependent on the treatment duration of 1, 3, or 7 days

a. 7 day treatment allows for smaller, less concentrated doses over an entire week

compared to a single potent dose with 1 day of therapy

Duration of therapy does not correspond to time of resolution

of symptoms

a. Miconazole (Monistat®)

b. Clotrimazole (Myclex®, Gyne-Lotrimin®)

c. Tioconazole (Vagistat®)

i. Only comes as a 1-day formulation

all resolves in a week

Adverse Effects uncommon, typically see with the first dose mimic symptoms of the

infection

.a. itching

b. Irritation

c. Vulvovaginal burning

7. Drug Interactions

a. Unlikely because limited absorption

Counseling Points

a. Prefer to administer therapy at bedtime to minimize leakage

b. Symptoms should improve within 2-3 days and resolution of infection within 1

week (ALL PRODUCTS: 1, 3, and 7)

c. Call physician if seeing no improvement or if symptoms worsen

d. Can use these antifungals during menstruation

Other Therapies/Complimentary Agents

1. Benzocaine products (i.e. Vagisil® cream)

→ bug bites, hemorrhoid, burns and wounds, vaginal itching

a. Relieve itching but does not address underlying cause

b. Add on therapy only for itching

c. Can be used for just itching alone and no VVC

Urinary Tract Infection (UTI)

. Need to differentiate between a yeast infection and a UTI when deciding if self-treatment is appropriate

b. Symptoms

i. Pain or burning when urinating; cloudy urine

ii. Need to urinate but having issues passing urine

iii. Frequent trips to the bathroom

c. Treatment

i. Non-Pharmacologic

1. Hydration with water to help flush bacteria out

2. Urinate after intercourse

3. Breathable underwearcotton

4. Avoid any irritants

5. Cranberry

a. Not for treatment

b. May have a role for prevention

i. Decrease the bacteria on the wall of the

membrane

ALWAYS REFER for antibiotic therapy

UTI Pharmacologic

1. ALWAYS refer to doctor for antibiotic therapy

a. Eradicate the infection

b. Stop possible progression to the kidneys

2. Symptom management only with OTC products:

a. Phenazopyridine (AZO® Maximum Strength or Uristat®)

i. Dose: 95 mg

ii. Directions: 2 tabs PO TID with meals for a maximum of 2 days

iii. Counseling:

1. Drink lots of water -flushes bacteria

2. May discolor urine/contact lenses/mucous membranes an orange

color -very brown/ red tablet

• urine → bright red

b. AZO® Urinary Tract Defense® or Cystex®

i. Dose: Sodium salicylate (NSAID analgesic 162.5 mg) and methenamine → do not give if person has NSAID allergy

(antibacterial agent 162 mg)

ii. Directions: 2 tabs PO TID with meals for a maximum of 2 days

iii. Counseling:

1. Drink lots of water

2. does NOT discolor urine

Home Diagnostic Tests

a. UTI Tests

a. Early detection for patients with a history of recurrent UTIs

b. Confirmation of eradication following antibiotic therapy

c. Mechanism: detects nitrite & leukocyte esterase (found in urine when UTI is present)

Pregnancy test

1. Fertilization--produces human chorionic gonadotropin (hCG) hormone

2. Placenta produces hCG as early as 7 days after conception

3. hCG is excreted in the urine

4. Normal menstruation cycle – no hCG! Pregnancy hormones = HUGE spike in hCG!

5. Counseling = Follow package instructions!! Urinate directly on test stick vs. clean catch (cup)

6. Timing is everything: most accurate 1 week after first day of missed period

7. Use 1st morning urine because hCG most concentrated

8. Test immediately after collection & lay device on flat surface

Ovulation/Fertility Tests = Similar to pregnancy test

1. Detects changes in luteinizing hormone (LH) found in urine; LH spike = ovulation!

2. Testing should begin 2-4 days before the estimated day of ovulation

3. Test every day until LH is detected

4. Early morning detection is best (LH surges early in day)

5. Chances of conceiving are increased over next 48 hours