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GYN Infections
| Question | Answer |
|---|---|
| Is Bacterial vaginosis an STI? | Probably not an STI. Trichomonas Vaginitis is an STI, Yeast Vaginitis is controversial, Atrophic Vaginitis is not an STI |
| What causes atrophic vaginitis? | low estrogen, cervix and epithelium will be pale, decreased rugae, labia will be thin and flattened, urethra may be pale w/ redness around it, may have urethritis like sx w/ urination even w/o infx |
| Infectious causes of vulvar pruritis | Ulcerative Infections (HSV, Syphilis), Pediculosis pubis ("crab") or scabies, Yeast vaginitis/vulvitis |
| Non-Infectious causes of Vulvar Pruritis | Contact Dermatitis, atrophic changes, other dermatitis, Neoplasia (ongoing itching, discoloration of vulva, ALWAYS biopsy!) |
| multiple, vesicular, pruritic, painful and recurrent are words that describe | HSV. First outbreak is typically the most painful. Painful urination, defecation, speculum exam. May need hospital admission. Usually have a prodrome: tingling, discomfort, outbreak always in the same place |
| How do you screen/test for HSV? | Culture (not serology). If painful with jagged edges, think HSV |
| Single, "heaped up"/"rolled edge", textbook case never painful describes | Syhpilitic chancre. On the rise again. |
| If you're going to offer STD screening, do a | wet prep (for trich), GC, chlam, syphilis |
| Lots of excoriations all over suggests | Scabies. Treat the patient and everyone/thing around them |
| In which populations is yeast more prevalent? | Diabetics, abx use, elderly |
| Erythematous, confluent, symmetrical, excoriations and fissures, with chief complaint of vulvitis instead of vaginal discharge suggests | Yeast vulvitis. yeast typically itches |
| Tx of contact dermatitis | 1% hydrocortisone cream and removal of offending agent. Note: don't tx without looking at it first, as hydrocortisone may make the yeast worse |
| Atrophic Changes are associated with | reduced estrogen levels, postmenopausal or lactation. Appears: erythematous, smooth, shiny, thin smooth mucosa. Differentiate from lichen planus. May require bx for definitive dx. Tx is estrogen |
| Verrucous Lesions | Condyloma accuminata (HPV), Condyloma lata (Syphilis) |
| Fishy odor is from | anaerobic bacteria (bacterial vaginosis) |
| Bacterial Vaginosis Sx and Signs | Fishy odor from anaerobic bacteria, heavy thin bubbly discharge, pruritis not common, Odor after intercourse. Clue cells on wet prep, epithelial cells with indistinct border. KOH to differentiate between amine or fishy odor. TX: Flagyl (don't tx partner) |
| Dx of Bacterial Vaginosis | Requires 3 of the 4 criteria: Typical discharge, Alkaline pH 5.0-5.5 (nl 3.5-4), positive "whiff" test, clue cells on saline wet prep |
| Bacterial Vaginosis Notes | Relative absence of lactobacilli (nl flora), not considered an STI, Tx: Flagyl or Clindamycin (topical or oral); take with food, no alcohol, tastes like metal. No tx of male partners, if pregnant can treat after 1st trimester |
| Signs and Sx of Trichomonas vaginitis | Severe pruritis (from clit to rectum), Discharge musty, foam-like, trich under scope, Dysuria, Dyspareunia, may be asx (as may all vaginitis), greenish yellow froth, Petechia or strawberry markings on cervix |
| Greenish froth and strawberry cervix suggests | Trichomonas Vaginitis |
| Tx for Trichomonas Vaginitis | 2gm Metronidazole (Flagyl) stat, Tx partners, go back and look for other STDs! (STDs go together) |
| Signs and Sx of Yeast vaginitis | Pruritus, burning, "cottage cheese" discharge, Dyspareunia, vulvar erythema (can lead to puffy labia), vaginal erythema, not malodorous, may be asx |
| Dx of Yeast vaginitis | KOH wet prep, Pseudohyphae or budding yeast, may not be seen on wet prep 15% of the time, may need to tx presumptively, culture may be used |
| Tx of Yeast Vaginitis | OTC imidazoles, Rx topical imidazole vaginally, Oral Fluconazole 150mg stat. Base tx on pt preference, pregnancy (pregnant women get yeast infxns more often) |
| Yeast vaginitis may be precipitated by | Hormonal changes (pregnancy, OCPs), Corticosteroid Tx, Broad Spectrum Abx, Nylon underwear with tight pantyhose, tight jeans, hot weather |
| In patients with multiple, sequential recurrences of Yeast Vaginitis, consider | HIV, Diabetes, other causes. If other causes are ruled out, may need episodic or partner tx |
| Keep ____ in your differential in postmenopausal, lactating women, extreme exercise and no menses | Atrophic Vaginitis. Use a lubricant |
| Signs and Sx of atrophic vaginitis | Pruritus, burning, vaginal dryness, dyspareunia, possibly spotting, not associated with odor unless concomitant infxn, pale thin vaginal mucosa, absence of discharge, loff of vaginal rugation |
Created by:
ltm12