vaginal and vulvovaginal disorders

OTC exam 4

what are the infectious vaginal disorders

bacterial vaginosis

vulvovaginal candidiasis

trichomoniasis

what are the non-infectious vaginal disorders

vaginal dryness

atrophic vaginitis

allergic/chemical reaction

what is vulvovaginal candidiasis

overgrowth of candida in the vaginal canal → disrupt normal vaginal flora and cause discomfort and vaginal discharge

what are risk factors for VVC

increased vaginal pH

poor glycemic control

antibiotic use

immunosuppression

sexual activity

what are the symptoms of VVC

vaginal discharge

vaginal/vulvovaginal itching and irritation

vulvovaginal erythema

dysuria

what are red flag symptoms of VVC

abnormal bleeding

cramping

what are the characteristics of VVC

thick, white vaginal discharge with no odor

normal vaginal pH

what are red flag characteristics of VVC

green/yellow discharge

thin/watery discharge

fishy odor

vaginal pH >4.5

when can vaginal pH tests NOT be used

within 72 hours of vaginal products (spermicides, antifungals)

within 48 hours of intercourse or douching

within 5 days after a period

what are red flags of history with VVC

no history of VVC

>3 infections/year

vaginal infection in the past 2 months

when are patients at higher risk for VVC

with menstruation

new onset of regular sexual activity

receptive oral intercourse

what are the red flags of location of VVC

systemic symptoms

pelvic/abdominal pain

back pain

what can aggravate VVC

tight-fitting clothes

non-absorbent clothing material

high glycemic foods

intercourse — red flag

what can relieve VVC symptoms

yogurt containing live cultures

sodium bicarbonate sitz bath

dietary changes to reduce glycemic index

loose clothing

breathable fabrics

how should a sitz bath be prepared

1 tsp sodium bicarb to 1 pint of water → 2-4 tbsp of solution to 2 inches of bath water

sit in bath water for 15 minutes prn

what medications can increase risk of VVC

high-dose contraceptives

estrogen therapy

antibiotics

corticosteroids

anti-neoplastics

immunosuppressants

intrauterine or vaginal barrier contraceptives

what allergies should we consider when treating VVC

azole antifungals

topical skin sensitivity

applicator materials

what conditions are at higher risk for VVC

diabetes

organ transplant

HIV

pregnancy

what are exclusions for VVC

pregnancy

girls <12 years

concurrent symptoms

meds that predispose VVC

conditions that predispose VVC

recurrent (>3 infections/year or infection in past 2 months)

first VVC episode

what OTC medication is recommended for uncomplicated VVC

imidazole antifungals

how do imidazole antifungals work

inhibit CYP450 enzymes in fungal cell membranes leading to a decrease in synthesis of ergosterol, causing structural damage to the fungal cell membrane and increased permeability

what are the adverse effects of imidazole antifungals

vulvovaginal burning, itching, or irritation

what formulations of imidazole antifungals are available

creams, suppositories, and tablets

what dosage forms are available for clotrimazole

1% cream

2% cream

100 mg tablet

which clotrimazole product is used for 3 days instead of 7 days

gyne-lotrimin 3 cream (2%)

how is clotrimazole dosed for itching of the vulva

twice a day prn for 7 days

what formulations are available for miconazole nitrate

2% cream

4% cream

suppository

how long is miconazole 4% cream used

every day for 3 days

what formulations does tioconazole come in

6.5% ointment

how long is tioconazole ointment used

1 day

what are some side effects of vaginal antifungals

vaginal burning and irritation

headache

can vaginal antifungal be stopped as soon as symptoms resolve

no — therapy should be completed per package instructions

when is relief expected to occur with vaginal antifungals

within 24-48 hours of initiating therapy

when should a provider be contacted when using vaginal antifungals

if symptoms have not improved after 3 days

if symptoms persist after 7 days

can vaginal antifungals and tampons be used together

no — cannot be used during therapy or for 3 days after therapy

what products can be used for itch relief related to VVC

benzocaine

hydrocortisone

povidone/iodine

homeopathic products

what complementary/alternative products can be used for VVC

lactobacillus preparations

tea tree oil

gentian violet

boric acid

how can lactobacillus preparations treat VVC

re-establishes normal vaginal flora to inhibit growth of Candida

can be PO or vaginal

how can tea tree oil help treat VVC

antibacterial/antifungal properties

suppository used at bedtime for 6 nights

how can gentian violet help treat VVC

dye active agent resistant to Candida infections

soak tampon in product and insert for several hours daily or BID for 5 days

will stain clothing

how can boric acid help treat VVC

useful for non-C. albicans infections

gel capsule inserted into vagina QD for 14 days

DO NOT INGEST ORALLY (teratogenic)

what are the symptoms of atrophic vaginitis

dyspareunia (painful intercourse)

vaginal irritation, dryness, burning, itching

discharge

spotting

what are the characteristics of discharge related to atrophic vaginitis

thin, watery

yellow

malodorous

when should a patient with atrophic vaginitis be referred

severe symptoms

first episode of post-menopausal bleeding

non-localized symptoms

vaginal lubricant products do not help (no improvement in 7 days)

when does atrophic vaginitis usually occur

typically happens with menopause

what can usually worsen atrophic vaginitis

intercourse

what can be used to treat atrophic vaginitis

water-soluble vaginal lubricants

what is the purpose of vaginal douching

mechanically irrigate the vagina and clear away mucus/accumulated debris

what is douching contraindicated in

pregnancy

what are the counseling points for vaginal douching

use lukewarm water to dilute products

do not use forceful pressure

do not use more than twice a week

do not use until ≥8 hours after intercourse

do not use for at least 3 days after vaginal antifungal

do not use ≤ 42 hours prior to gyno exam

what is the bulb-syringe method of douching

bulb holds solution

nozzle inserted into vagina

available as disposable or non-disposable

rate of fluid regulate by hand pressure on bulb

what is the bag method of douching

bag or syringe holds solution

tubing for solution flow

shutoff valve

tips to insert (1 for enema, 1 for douching, not interchangeable)

rate of flow regulated by shutoff valve