vaginal infections

vagina

1. betw bladder and rectum

2. lined w stratified squamous epithelium containing glycogen, converted into lactic acid by lactobacilli

3. lactic acid and h2o2 prevents vaginal infections

4. healthy vagina is 1.5g of vaginal discharge. increases with ovulation, pregnancy, following menses, sexual excitement, emotional flares.

5. altered vaginal secretion s= vaginal irritation

factors affecting vaginal ecosystem (8)

1. hormonal changes

2. aging

3. diseases like DM

4. meds like contraceptives/ abx

5. hygiene

6. douching/ washing with soap

7. sexual intercourse

8. number of sexual partners

types of vaginal infections (3)

1. bacterial vaginosis

2. trichomoniasis

3. vulvovaginal candidiasis

bacterial vaginosis

1. fishy odour

2. thick, foamy, green/grey discharge

3. increase in vaginal discharge, itching, irritation, dysuria

4. G. Vaginalis/ anaerobes

5. cause PID, UTI, preterm labour, low birth weight infants, infertility, facilitate HIV transmission

risk factors (5)

1. smoking

2. douching

3. multiple sex partners

4. unprotected sexual intercourse

5. low socioeconomic value

trichomoniasis

1. foul

2. frothy, yellow-green/ grey discharge

3. erythema, itching, irritation, dysuria

4. trichomoniasis vaginitis

5. cause PID, UTI, preterm labour, low birth weight infants, infertility, facilitate HIV transmission

risk factors (3)

1. low socioeconomic status

2. unprotected sexual intercourse

3. multiple sex partners

vulvovaginal candidiasis

1. no odour + normal pH

2. thick white discharge like cottage cheese

3. itching, burning, soreness, dyspareunia

4. candida fungi & C albicans

risk factors of vvc (9)

1. pregnancy —> inc in estrogen

2. high dose of contraceptives

3. estrogen replacement therapy

4. menstruation —> blood in pH

5. DM —> dec pt immunity

6. broad spectrum abx —> disrupt normal flora of vagina

7. corticosteroids/ immunosuppressants —> suppress immune sys = inc risk of opportunistic infections

8. oral sex

9. intrauterine devices

treatment goals (2)

1. relief symptoms & eradicate infection

2. re-establish normal vaginal flora

exclusion for self treatment (6)

1. pregnant

2. under 12

3. fever/ pain in lower abdomen, back, shoulder

4. corticosteroids

5. DM, HIV infection

6. recurrent VVC —> 3 infections per year/ infection in past 2 mnth

pharmacologic therapy (2)

1. non rx imidazoles

• miconazole nitrate 2%

• Clotrimazole 1%

• Isoconazole

2. Triazole: Fluconazole

adv of imidazole (4)

1. Superior efficacy

2. Improved patient compliance due to ease of use

3. Less frequent local reactions

4. Short treatment duration

moa

1. Alter mem permeability of fungal cells

2. Inhibit cytochrome p450 enzyme (lanosterols 14-α-demethylase)

3. Reduce ergosterol content & inc lanosterol like methylated sterols 

4. Sterols cause structural damage to fungal mem = loss of function

PK & safety profile

1. topical/ local vaginal imidazole preparations are not appreciably absorbed 

2. Minimal side effects incl : vulvovaginal burning, itching, irritation 

3. Drug interactions are unlikely EXCEPT with warfarin

4. Contraindications: allergy to azoles

how to apply vaginal tablet (9)

1. Start treatment night before going to bed, lying down reduces leakage

2. Wash entire vaginal area with mild soap and water, dry completely

3. Stand with ur feet slightly apart and knees bent/ lie on ur back w knees bent 

4. Pull plunger until it stops and place the vaginal tablet into the applicator

5. Carefully insert the applicator containing the tablet as deeply as possible into the vagina (best achieved when lying on ur back)

6. Push plunger carefully until it stops, this deposits the tablet into the vagina. Remove the applicator

7. Clean the applicator by pulling the 2 pieces apart and wash them with soap and warm water

8. Can wear a panty liner to absorb leakage of vaginal antifungal

9. Continue using product for length of time specified in the product instruction 

how to apply vaginal cream (8)

1. Start treatment night before going to bed, lying down reduces leakage

2. Wash entire vaginal area with mild soap and water, dry completely

3. Stand with ur feet slightly apart and knees bent/ lie on ur back w kneed bent

4.  Take cap off tube of medicine and screw onto applicator

5. Squeeze medicine into applicator slowly until plunger reaches prescribed dose measurement

6. Remove applicator from tube of medicine and put the cap back on

7. Put the applicator into ur vagina asfar as u can

8. Slowly press the plunger until it stops. Remove the applicator and rinse it 

alternative therapies (4)

1. Lactobacillus acidophilus preparation

2. Sodium bicarbonate sitz bath (1tsp in 1 pint of water), sit in sitz bath for 15mins

3. Gentian violet/ potassium permanganate: dilute few drops in 1 pint of water for cleansing of vagina

4. Hydrocortisone 1% / Benzocaine: itchy  

pt counselling (6)

1. self treatment only for mild- moderate symptoms

2. symptom shld improve 2-3 days of initiating therapy, & resolve within 1 wk

3. if symptom persist >1wk aft treatment/ recur within 2 mnths/ occur more than 3 time sin a year = SEEK MEDICAL EVALUATION

4. use non perfumed soaps when washing

5. avoid tight clothing

6. avoid douching