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Bacterial Vaginosis, Vulvovaginal Candidiasis, Trichomoniasis,
Terms in this set (37)
What are the symptoms of bacterial vaginosis?
Vaginal discharge, with or without vaginal odor and pruritus
What are the signs of bacterial vaginosis?
Homogenous, frothy discharge, elevated vaginal pH, and a positive whiff test
What is the whiff test?
Detection of a fishy odor (caused by amines) when vaginal secretions are placed in 10% KOH
What is seen on the wet mount in bacterial vaginosis?
Clue cells and the absence of leukocytes, trichomonads, and the normal flora of rods
What are clue cells?
Squamous epithelial cells with ragged borders and stippling caused by colonization with bacteria
How is the diagnosis of bacterial vaginosis made?
At least 3 of the following are required: 1. Thin homogeneous vaginal discharge 2. Elevated vaginal pH (>5) 3. Clue cells 4. Positive whiff test
What is the treatment for bacterial vaginosis?
Metronidazole, 500 mg by mouth twice daily for 7 days
What is the incidence of vulvovaginal candidiasis?
Three-fourths of women suffer from at least 1 episode in their lifetime, and nearly half of these women have recurrent episodes.
What are the risk factors for vulvovaginal candidiasis?
Oral contraceptive use, recent antibiotic therapy, corticosteroid therapy, pregnancy, poorly controlled DM, and tight-fitting undergarments. Infection with HIV has been associated with an increased incidence of persistent or recurring infections.
What organisms are most commonly associated with vulvovaginal candidiasis?
Candida albicans (80%-90%). Candida tropicalis and Candida glabrata also cause vaginitis.
What is the cardinal symptom of vulvovaginal candidiasis?
What are other symptoms and signs of vulvovaginal candidiasis?
External dysuria; dyspareunia; premenstrual onset; vulvar erythema; and cheesy, white, thick vaginal discharge
How is the diagnosis of vulvovaginal candidiasis made?
Identification of pseudohyphae in vaginal secretions mixed with 10% KOH confirms the diagnosis. Vaginal pH is normal (<4.5).
What is the sensitivity of the KOH prep in vulvovaginal candidiasis?
What is the utility of culture in vulvovaginal candidiasis?
Culture is more sensitive than KOH microscopic examination, but it does not prove an etiologic role; at least 20% of healthy women harbor vaginal Candida.
What is the treatment for vulvovaginal candidiasis?
Topical antifungal agents such as miconazole, clotrimazole, terconazole, or a single dose of oral fluconazole
What risk factor is associated with trichomoniasis?
Having an increased number of sexual partners
What are the symptoms of trichomoniasis?
Yellow vaginal discharge (75% of patients), dysuria (25%-50%), vulvar itching, dyspareunia, and occasionally lower abdominal pain
What are the clinical findings of trichomoniasis?
Purulent frothy discharge with foul odor; vaginal pH > 5
What is the etiologic organism associated with trichomoniasis?
The protozoan parasite Trichomonas vaginalis
How is the diagnosis of trichomoniasis made?
Motile trophozoites, often accompanied by polymorphonuclear cells, are seen on the wet mount.
What is the sensitivity of the wet mount in trichomoniasis?
60%-80% in symptomatic women
What is the treatment for trichomoniasis?
Metronidazole or tinidazole, 2 g by mouth as a single-dose therapy. All sexual partners of the index case should also be treated.
THICK WHITE COTTAGE CHEESE
FISHY, grey, scant, THIN, STICKY
10% KOH pseudohyphae
+ Whiff Test
PH < 4.5
Fluconazole 150 mg PO X 1 repeat in 7 days
Metronidazole: 500 mg PO b.i.d. × 7 days or 750 mg QD x 7 days
Metronidazole 2g PO x 1 dose
Motile flagellated protozoa
Irritation, dryness, painful intercourse, increased UTIs, urinary incontinence
Sexually active young woman in root of question
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