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Terms in this set (30)
4 causes of vaginitis
i. Bacterial vaginosis (50%)
ii. Vulvovaginal candidiasis (30%)
iii. Trichomoniasis (5-20%)
iv. Postmenopausal atrophic vaginitis
Dx of BV
1. Homogeneous vaginal discharge (color and amount may vary)
2. Amine (fishy) odor when potassium hydroxide (KOH) solution is added to vaginal secretions (commonly called the "whiff test")
3. Presence of clue cells (greater than 20%) on microscopy*
4. Vaginal pH greater than 4.5 (should be 3.8-4.2)
most effective treatment for BV is __________.75 cream for 5 days or 500mg tabs for 7 days. (ok in pregnancy, preferred systemic)
2nd most effective treatment for BV is ____________ 2% cream x 7 days OR 300mg 2xday x 7days
nonspecific vaginitis or....... . It is an alteration of normal vaginal bacterial flora that results in the loss of hydrogen peroxide-producing aerobic ...... and an overgrowth of predominantly ........ bacteria .
The most common form of vaginitis .?
repeated alkalinization of the vagina, which occurs with frequent ....... or use of ....., plays a role.
-sexual intercourse, douches
women with BV are at increased risk for p......... .... ... , .... ..... , ..... .... .... after hysterectomy ,and abnormal cervical cytology .
-elvic inflammatory disease (PID)
postoperative cuff infections
Pregnant women with BV are at risk for
premature rupture of the membranes ,
preterm labor and delivery,
postcesarean endometritis .
In women with BV who are undergoing surgical abortion or hysterectomy, perioperative treatment with ...... eliminates this increased risk.
Trichomonas Vaginitis (TV)
Trichomonas vaginitis is caused by .......... The transmission rate is .....; 70% of men contract the disease after a single exposure to an infected woman.
-the sexually transmitted, flagellated parasite, Trichomonas vaginalis
The parasite, which exists only in form......, is an anaerobe that has the ability to generate hydrogen to combine with oxygen to create an anaerobic environment. It often accompanies ....., which can be diagnosed in as many as 60% of patients with trichomonas vaginitis.
- associated with a profuse, purulent, malodorous vaginal discharge that may be accompanied by vulvar pruritus.
-a patchy vaginal erythema and colpitis macularis ("strawberry" cervix) (high concentration of organism)
- pH higher than 5.0
-Microscopy of the secretions=motile trichomonads and increased numbers of leukocytes
-Clue cells may be present because of the common association with BV.
-The whiff test may be positive.
Morbidity associated with trichomonal vaginitis may be related to ....
Pregnant women with trichomonas vaginitis are at increased risk for ...
premature rupture of the membranes and preterm delivery.
Because of the sexually transmitted nature of trichomonas vaginitis, women with this infection ....... ...... .... ...., particularly Neisseria gonorrhoeae and Chlamydia trachomatis.
......... for syphilis and human immunodeficiency virus (HIV) infection should also be considered
-should be tested for other sexually transmitted diseases (STDs)
Tx of TV
....... is the drug of choice for treatment of vaginal trichomoniasis. Both a single-dose (2 g orally) and a multidose (500 mg twice daily for 7 days) regimen are highly effective and have cure rates of about 95%.
The ...... should also be treated.
....... ..., although highly effective for the treatment of BV, should not be used for the treatment of vaginal trichomoniasis.
Vulvovaginal Candidiasis (VVC)
An estimated ...... of women experience at least one episode of vulvovaginal candidiasis (VVC) during their lifetimes.
....... is responsible for 85% to 90% of vaginal yeast infections. Other species of Candida, such as ...... and ......., can cause vulvovaginal symptoms and tend to be ...... to therapy.
Candida are ..... fungi existing as ...., which are responsible for transmission and symptomatic colonization, and as mycelia, which result from blastospore germination and enhance colonization and facilitate tissue invasion.
Factors that predispose women to the development of symptomatic VVC include ..., ...., .....
antibiotic use , pregnancy , and diabetes .
Pregnancy and diabetes are both associated with a qualitative decrease in cell-mediated immunity
Sporadic or infrequent
Mild to moderate sympt
Dx of VVC
-vulvar pruritus associated with a vaginal discharge=cottage cheese.
- discharge= vary from watery to homogeneously thick
-Vaginal soreness, dyspareunia, vulvar burning, and irritation
-External dysuria ("splash" dysuria) during micturition=exposure of the inflamed vulvar and vestibular epithelium to urine.
-erythema and edema of the labia and vulvar
-Discrete pustulopapular peripheral lesions
- vagina may be erythematous with an adherent, whitish discharge
-normal pH (<4.5).
-budding yeast forms or mycelia, appear in as many as 80% of cases. increase in the number of inflammatory cells in severe cases.
-The whiff test is negative.
Tx of VVC
+ hydrocortizone cream
The cause of cervical inflammation (cervicitis) depends on the ...... affected.
The ectocervical epithelium can become inflamed by the same micro-organisms that are responsible for ......
In fact, the ectocervical squamous epithelium is an extension of and is continuous with the ......... Trichomonas, candida, and HSV can cause inflammation of the ectocervix.
Conversely, ....... and ...... infect only the glandular epithelium .
-N. gonorrhoeae, C. trachomatis
The diagnosis of cervicitis
-a purulent endocervical discharge, generally yellow or green in color and referred to as "mucopus "
-"mucopus " =increased number of neutrophils
-The presence of intracellular gram-negative diplococci = gonococcal endocervicitis , If negative for gonococci= chlamydial cervicitis
-nuclei acid amplification tests (prefer)
- 50% is unknown
Tx of Neisseria gonorrhoeae endocervicitis
-Ceftriaxone, 125 mg intramuscularly (single dose), or
Ciprofloxacin, 500 mg orally (single dose)a, or
Tx of Chlamydia trachomatis endocervicitis
Azithromycin, 1 g orally (single dose), or
Doxycycline, 100 mg orally twice daily for 7 days, or
Ofloxacin, 300 mg orally twice daily for 7 days, or
Levofloxacin, 500 mg orally for 7 days
It is imperative that all ....... be treated with a similar antibiotic regimen. (cervicitis)
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