Vaginal Infections

vulvitis

• inflammation of vulva skin, involving perineum & perianal area

• sx, usually secondary to irritants, infections (Candida), dermatologic conditions (eczema)

vulvovaginitis

• most common reason why women seek gynecologic care

• etiology:

  • infection w/ sexually transmitted organisms

  • by disruption of normal defense mechanisms w/ overgrowth of normal flora

  • noninfectious causes (allergic reactions, irritants, atrophic postmenopause)

• most common types: bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis

• diagnosis made from purulent vaginal discharge

vulvovaginitis sx

irritation which causes increased abnormal vaginal discharge, vulvar irritation, burning & itching, dysuria, dyspareunia, bleeding w/ intercourse or foul odor

bacterial vaginosis

• etiology: r/t change in normal vaginal flora

• pathogen: gardnerella vaginalis, mycoplasma hominis

• increase risk for PID, HIC, preterm birth, PROM, low birthweight babies

bacterial vaginosis sx

• excessive thin, watery, white or gray vaginal dc with foul “fishy” odor

• often asymptomatic

bacterial vaginosis tx

• metronidazole (oral or gel) or clindamycin cream

  • avoid alcohol

• probiotics adjunctively

vulvovaginal candidiasis

• yeast infection

• second most common cause of vaginitis

• most commonly caused by candida albicans

• risk factors: antibiotics, pregnancy, diabetes, immunosuppression

vulvovaginal candidiasis sx

• non-malodorous, thick, white, curdy (cottage cheese-like) vaginal discharge

• severe itching, dysuria, dyspareunia

vulvovaginal candidiasis tx

topical azoles, oral fluconazole

bartholinitis

• infection of bartholin gland causing inflammation, can be complicated by abscess formation in gland themselves

• infection from gonorrhea, staphylococcus, e. coli (often polymicrobial)

bartholinitis sx

unilateral pain & swelling, mild to severe pain (worse when sitting or walking)

bartholinitis management

• I&D of abscess

• C&S of discharge

• antibiotics

• word cath placement after drainage to prevent recurrence

• comfort measures: analgesics, warm sitz baths

toxic shock syndrome

• caused by toxin-producing strains of Staph aureus

• toxins alter capillary permeability, causing intravascular fluid to leak from blood vessels, causing hypovolemia, hypotension, & shock

• coag deficits present

• associated w/ use of high absorbency tampons, cervical cap or diaphragm

toxic shock syndrome sx

sudden spiking fever (>102), flu-like sx, hypotension, generalized rash resembling sunburn

toxic shock syndrome tx

• immediate hospitalization

• fluid replacement

• vasopressor drugs for hypotension

• broad-spectrum antibiotics

• monitor for organ failure

• consider ICU care