PHA 425 Vaginal Conditions

What are factors that affect bacterial colonization?

-hormonal fluctuations

-medications

-feminine cleansing

-sexual activity

Presentation of bacterial vaginosis

-change in normal flora of vagine

-increase in garderella vaginalis

-can occur in women that have not had intercourse

Risk factors of BV

-multiple sexual partners

-new sexual relationship

-smoking

-vaginal douching

-intrauterine contraceptive device

Common symptoms of BV

-fishy vaginal odor

-thin yellow or white discharge

-increased wetness

Criteria for BV diagnosis

-thin white coating on vaginal wall

-pH >4.5

-fishy odor of discharge when combined with potassium hydroxide

-clue cells present

Presentation of trichomoniasis

-STD

-protozoan parasite

-70% asymptomatic

-more common in older women

Risk factors for trichomoniasis

-unprotected sexual intercourse

-multiple sex partners

-previous infection

Common symptoms of trichomoniasis

-yellow/green frothy discharge

-fishy smell

-erythema

-irritation

-pruritus

Diagnosis criteria for trichomoniasis

-pH > 4.5

-parasite present under microscope

BV and Trichomoniasis Complications

-pelvic inflammatory disease

-preterm birth

-facilitation of HIV transmission

Pathophysiology of vulvovaginal candidiasis

-Candida albicans

causes:

-increased use of non-prescription antifungal

-short courses of topical imidazole therapy

-long term suppressive therapy with imidazole antifungals

Risk factors for VVC

-pregnancy

-menstruation (increased pH)

-hormones, antibiotics, immunosuppressants

-douching

-intercourse

Common symptoms of VVC

-odorless

-cottage cheese discharge

-vaginal erythema, irritation or itching

Diagnosis criteria of VVC

-presentation

-pH < 4.5

-fungal culture or observation under microscope

Counseling on testing pH

-many state that testing cannot occur until 72 hours after use of any vaginal preparation

(spermicide or anti fungal products)

-testing should occur 48 hours or more after sexual intercourse

Self-care Exclusions

-pregnancy

-less than 12 years

-Recurrent VVC

-first vulvovaginal episode

-fever

-pain in pelvic region, lower abdomen, back or shoulder

-corticosteroids or antineoplastics

-diabetes or HIV

Non-pharm treatment to VVC

-do not douche

-limit heat and moisture in vaginal area

-eat yogurt with live cultures

-sitz bath for irritation

Why avoid douching?

-disrupts normal vaginal flora

-increases risk for infections and diseases

-impacts fertility

Pharm treatments and available formulations

-clotrimazole

-miconazole

-tioconazole

-1, 3, or 7 days

-cream, ointment, suppository or tablet

Adverse effects of anitfungals

-abdominal cramps

-burning

-itching

Drug interactions of antifungals

warfarin and miconazole

-increased bleeding

What is an equally effective treatment?

-imidazole antifungals

General counseling on antifungals

-apply once daily at night

-wash area with mild soap and water

-dry before applying

-resolve in 48-72 hours

-continue treatment for recommended time

-can use during menstruation but should avoid using tampons

-abstain from intercourse

-do not use barrier methods until 3 days after therapy

Counseling on creams/ointments

-puncture cream seal with cap

-screw cream tube to end of applicator

-squeeze tube from bottom to push cream into applicator

-fill until outside of applicator is pushed out as far as possible

Counseling on suppositories/tablets

-remove wrapper

-place into end of barrel

What are examples of complementary therapies?

Lactobacillus probiotics

-reestablish normal flora

Tea tree oil

-antibacterial or anti fungal properties

Gentian violet

-antifungal properties

Boric acid supplements

-reduce pH

-antifungal properties

How does lactobacillus work?

-reestablish normal flora

-expensive

How do boric acid supplements work?

-vaginal capsules

-restores acidic environment of vagina

Follow up parameters

Refer to PCP:

-do not improve in 3 days

-persist past 7 days

-worsen on therapy

-develop new symptoms

Clinical presentation of Atrophic Vaginitis

-inflammation caused by atrophy

-secondary to a decrease in estrogen levels

-decreased lubrication

-painful intercourse

Self-care exclusions of Atrophic Vaginitis

-severe dryness, dyspareunia or bleeding

-symptoms not localized

-symptoms not relieved by personal lubricants

Treatment to atrophic vaginitis

-lubricant products

Counseling points for Atrophic Vaginitis

-water based lubricants only

-apply frequently as needed for relief of symptoms

-liberal application then tailor to specific needs

-leakage may occur

(use panty liner)

-relief usually within hours of first dose

-refer if symptoms have not improved in a week