PT III Vaginal Conditions (Kieck) (Exam 3)

bacterial vaginosis (BV)

trichomoniasis

vulvovaginal candidiasis (VVC)

what are the three types of vaginal infections?

bacterial vaginosis

change in normal flora of vagina

increase in Gardnerella vaginalis

multiple sexual partners

new sexual relationship

cigarette smoking

vaginal douching

IUD

what are risk factors for BV? (5)

yes

can women who have not had sexual intercourse develop BV?

bacterial vaginosis

"fishy" vaginal odor

thin white or gray discharge

increased "wetness"

pelvic exam (thin white coating on vaginal wall)

pH test > 4.5

whiff test (fishy odor)

clue cells present

what are the diagnosis methods for BV? (4)

trichomoniasis

common sexually transmitted disease

50% asymptomatic

more common in women than men, common in older women than younger women

unprotected sexual intercourse

multiple sex partners

previous trichomoniasis infection

what are risk factors for trichomoniasis? (3)

trichomoniasis

yellow or green frothy discharge

fishy smell

erythema

irritation

pruritis

vaginal pH > 4.5

parasite present

how to diagnose trichomoniasis? (2)

pelvic inflammatory disease (PID)

preterm birth

facilitation of HIV transmission

what are complications of BV and trichomoniasis? (3)

no

can you treat BV or trichomoniasis with OTC?

yes

can you treat vulvovaginal candidiasis OTC?

pregnancy (increase estrogen)

menstruation (higher pH)

medications (hormones, antibiotics, immunosuppressants)

douching

intercourse

tight fitting clothing

what are the risk factors for VVC? (6)

VVC

odorless

thick white "cottage cheese" discharge

vaginal erythema, irritation and/or itching

presentation

pH < 4.5

fungal culture or observation under microscope

how to diagnose VVC? (3)

non-infectious

clear or white discharge

no odor

erythema and itching

must wait 72 hours after using vaginal preparation (spermicide, anti-fungal products)

must wait 48 hours after intercourse or douching

don't use until 5 days after a menstrual period

what are counseling points for testing pH? (3)

pregnancy

girls < 12 y/o

recurrent VVC (>3 infections per year or 2 in 2 months)

first vulvovaginal episode

concurrent symptoms: fever or pain in pelvic region, lower abdomen, back or shoulder

medications that predispose to VVC: corticosteroids, antineoplastics

medical disorders that predispose to VVC: diabetes, HIV infection

what are self-care exclusions? (7)

provide symptomatic relief

eradicate fungal infection

reestablish normal flora

what are the goals of therapy? (3)

don't douche

limit heat and moisture in the vaginal area

eat yogurt with live cultures

sitz baths for irritation

what are non-pharm recommendations? (4)

clotrimazole

miconazole

tioconazole

what are the three anti-fungal medications?

warfarin and miconazole suppositories (increased bleeding)

what is the documented interaction with vaginal products?

clotrimazole (7 day course)

what product is preferred for pregnancy?

apply once daily at bedime

wash the vaginal area with mild soap and water and dry before applying

symptoms usually resolve in 48-72 hours

continue treatment for the recommended time even if symptoms resolve

products can be used during menstruation but should avoid using tampons

abstain from sex and do not use barrier methods for contraception until 3 days after therapy is complete

what are counseling points for vaginal products? (6)

external imidazole

what product is recommended for external itching?

lactobacillus probiotics - reestablish normal flora

tea tree oil

gentian violet

boric acid suppositories

what are complementary therapies? (4)

symptoms do not improve in 3 days

symptoms persist past 7 days

symptoms worsen on therapy

patient develops new symptoms especially if discharge develops an odor, becomes frothy or discolored

when to seek medical attention/refer?

atrophic vaginitis

vaginal inflammation caused by atrophy

decreased lubrication

secondary to a decrease in estrogen levels

severe vaginal dryness, dyspareunia or bleeding

symptoms not localized

vaginal dryness or dyspareunia not relieved by use of personal lubricants

what are self-care exclusions for atrophic vaginitis? (3)