Packet 3 (Also shouldn't look at in public)

What is the definition of vaginitis?

Syndrome characterized by vaginal discharge and/or irritation

What are the 4 most common types of vaginitis?

Bacterial vaginosis, candida vulvovaginitis, trichomonas vaginitis, and atrophic vaginitis

What is another name for candida vulvovaginitis (CCV)?

Yeast

What is another name for trichomonas vaginitis (TV)?

Trich

What are 2 ways to diagnose bacterial vaginosis (BV)

Amsel’s criteria and nucleic acid amplification test

What is involved in a nucleic acid amplification test (NAAT)?

Swabbing the area in question intravaginally, put into a test-tube like kit, and sending it to the lab

How is bacterial vaginosis (BV) described?

Change in the balance of bacteria normally present in the vagina

What is usually the cause of Bacterial vaginosis?

Overgrowth of Gardnerella vaginalis

What is Amsel’s criteria for bacterial vaginosis?

White or thin white-yellowish discharge, pH greater than 4.5, positive whiff test, and presence of clue cells

How many criteria do you have to get to be diagnosed with bacterial vaginosis in Amsel’s criteria?

3

What symptoms are present in bacterial vaginosis?

Vaginal itching and/or burning may be present

How do you treat bacterial vaginosis?

Metronidazole 500 mg 1 tab po BID x 7 days or Clindamycin intravaginal 2% cream 1 applicator (5 grams) 40 gram tube intravaginally at night x 7 days

How big of a tube does clindamycin come in?

40 grams

What is another term for hour of sleep?

HS

Should you treat partner of somebody with bacterial vaginosis

Not recommended

Who is metronidazole bad for?

Pregnant women

How many women will experience vaginal candidiasis (yeast/fungal infection)

75%

What is the specific species of yeast that causes most yeast infections?

Candida albicans

What are 2 other species of yeast cause yeast infections besides candida albicans?

Candida tropicalis and candida glabrata

Who are the most common people to get vaginal candidiasis (yeast/fungal infection)

Those with diabetes mellitus and those who have recently used antibiotics

Common presentations of vaginal candidiasis (yeast/fungal infection)

Intense vulvar pruritus, white curd-like vaginal discharge, erythema on outside, burning after urination, and candidiasis

What infection is this most likely?

Bacterial vaginosis

What is this pointing at and what is it most likely?

Clue cell and bacterial vaginosis

What does this show and what is it most likely?

Vaginal candidiasis

What 4 ways can you diagnose vaginal candidiasis (yeast/fungal infection)

Wet-mount microscope exam for presence of budding yeast, Experienced clinicians may treat based on typical “cottage cheese” type discharge, then culture if no resolution of symptoms, finding may be reported on cytology smear, and women may self diagnose based on symptoms and the availability of over the counter treatments

How do you treat vaginal candidiasis?

Over the counter treatment include antifungals (Monistat), prescription antifungals (both topical and oral) i.e. Diflucan 150 mg 1 tab daily x 1 day, culture positive yogurt intake has not been consistently found to decrease recurrences or to prevent post antibiotic candida vulvovaginitis, strict diabetes mellitus control may decrease recurrences, use of cotton underwear, screen patient for diabetes if infections are recurrent or persistent

What medications help treat vaginal candidiasis?

Monistat (miconazole) and Diflucan (Fluconazole)

What non-medications help with vaginal candidiasis?

Cotton underwear, control of diabetes, and yogurt

Write a prescription for Diflucan for vaginal candidiasis

Diflucan 150 mg 1 tab po daily x 1 day

What is another name for budding yeast?

Hyphae

What test do you do to look for hyphae?

Wet-mount microscope exam

What are trichomonas?

Flagellated protozoan

What kind of disease is trichomoniasis considered?

Sexually transmitted infection

Should you treat partners with trichomoniasis

Yes

What are the clinical presentation of trichomoniasis?

Frothy yellow-greenish-whitish discharge, may or may not have phosphorus-smelling discharge, may have erythema of vulva, may have burning or itching, strawberry spots on cervix

What is a main presentation of trichomoniasis?

Strawberry spots on cervix

What infection does this likely show?

Trichomoniasis

What infection does this likely show

Trichomoniasis

Diagnosis of trichomoniasis is done by…

Microscopic identification of actively swimming trichomonads, culture if patient has persistent symptoms and trichomonads not identified on prior exam, and/or NAAT test

What infection do these guys diagnose?

Trichomoniasis

What infection do these guys diagnose?

Trichomoniasis

How do you treat trichomoniasis?

Metronidazole 2 grams orally as single dose or 500 mg 1 tab po BID x 7 days

If symptoms are persistent for trichomoniasis what may be needed?

Prolonged treatment

What causes atrophic vaginitis?

Decreased estrogen production

Who is diagnosed with atrophic vaginitis the most?

Post menopausal women

What are the symptoms of atrophic vaginitis?

Asymptomatic but may claim of erythema, dryness, or urinary symptoms (urination frequently and/or burning while urinating)

Why is atrophic vaginitis a problem?

Vaginal epithelium is thinned and susceptible to infection or trauma (especially during intercourse)

Clinical presentations of Atrophic vaginitis?

No vaginal discharge, vaginal dryness, they might have spotting because of vaginal tissue becoming friable (bleeding easily), and pain with intercourse (dyspareunia)

What is the treatment of atrophic vaginitis?

Topical estrogen (Premarin vaginal cream 0.625 mg with 7 gram applicator, 30 gram tube, 0.5 grams intervaginal twice weekly as needed)

What is another name for Chlamydia?

Chlamydia trachomatis

What is chlamydia and what is it associated with?

Bacteria associated with infertility and ectopic pregnancy due to the chronic inflammation from the infection

What is an ectopic pregnancy?

Pregnancy outside the uterus

Clinical presentation of chlamydia?

Asymptomatic but can be present with purulent (pus-like) discharge, inflammation (usually seen with erythema), urinary frequency, burning, and/or dysuria (pain while urinating)

Diagnosis for chlamydia

Lab testing using NAAT

What should you also test for if someone has chlamydia?

Gonorrhea

How do you treat chlamydia?

Doxycycline 100 mg 1 tab po BID x 7 days

What is the positive organism for gonorrhea?

Neisseria gonorrhea

What can gonorrhea progress into?

Infertility and ectopic pregnancy caused by constant inflammation

Clinical presentations of gonorrhea

Asymptomatic but can be present with purulent (pus-like) discharge, inflammation (usually seen with erythema), urinary frequency, burning, and/or dysuria (pain while urinating)

How do you diagnose gonorrhea?

NAAT test

How do you treat gonorrhea?

Ceftriaxone 500 mg IM x 1

If you have both chlamydia and gonorrhea what is treatment?

Doxycycline 100 mg 1 tab po BID x 7 days and Ceftriaxone 500 mg IM x 1

What is pelvic inflammatory disease (PID)?

General acute chronic or recurrent infection of the internal pelvic structures

What are the most common reasons for pelvic inflammatory disease (PID)?

Gonorrhea and/or chlamydia, lot of sexual partners, use of IUDs, and after elective abortions

Clinical presentations of pelvic inflammatory disease (PID)

Acute or insidious lower abdominal or pelvic pain (usually bilateral), pelvic pressure, back pain, and may have elevated temperature

Physical exam finding of pelvic inflammatory disease (PID)

Purulent vaginal discharge, abdominal tenderness, and tenderness on motion of the cervix (cervical motion tenderness)

Diagnosis of pelvic inflammatory disease (PID)

A lot of white blood cells in wet mount with purulent vaginal discharge, abdominal tenderness, and tenderness on motion of the cervix

Treatment of outpatient with pelvic inflammatory disease (PID)

Ceftriaxone 500 mg IM x 1, Doxycycline 100 mg 1 tab po BID x 14 days, and Metronidazole 500 mg 1 tab po BID x 14 days

Reasons to admit a patient with pelvic inflammatory disease (PID) - Inpatient

Temp greater than 102, no response to treatment, can’t tolerate side effects of outpatient treatment, if pregnant, and if tubo-ovarian abscess (TOA)