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Mo's vaginitis

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Vaginitis

Veröffentlicht in: Gesundheit & Medizin
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Mo's vaginitis

  1. 1. Vaginitis by Maureen Foster, CNM
  2. 2. Definition: Disorder of the vagina caused by infection, inflammation, or changes in the normal vaginal flora. Symptoms include vaginal discharge, odor, pruritus, and/or discomfort.
  3. 3. Causes: Most common causes of vaginaits are: 1. Bacterial vaginosis 2. Candida vulvovaginitis 3. Trich These disorders account for more than 90% of vaginitis cases.
  4. 4. Bacterial Vaginosis: *Most common cause of vaginal discharge - 40-50% of cases *Prevalence of BV 29% in general population of women aged 14-49 yrs of age and 50% prevalence in African American women.
  5. 5. Diagnosis: *3 of the 4 criteria listed below are necessary to make the diagnosis of BV *homogeneous, thin, graysish/white discharge that smoothly coats the vaginal walls. *ph>4.5 *positive whiff test (+ fishy odor - gross!) when 10% KOH is added to the slide. *clue cells on saline wet mount
  6. 6. Presence of clue cells is the single most reliable predictor of BV. At least 20% of the epithelial cells should be clue cells.
  7. 7. Symptoms: *approximately 50-75% of women with BV are asymptomatic • most common complaint is an unpleasant "fishy" smelling discharge. * burning, itching, dyspareunia, dysuria
  8. 8. Treatment: Non-Pregnant Women: • Flagyl 500 mg po bid X 7 days • Metrogel 0.75% 5 grams intra vaginally once daily X 5 nights * Clindamycin 2% cream for 7 days (recurrent)
  9. 9. Treatment in Pregnancy: * Flagyl (metronidazole) 500 mg bid X 7 days * Flagyl 250 mg tid X 7 days * Clindamycin 300 mg bid X 7 days
  10. 10. Candida Vulvovaginitis: * Candida Vulvovaginitis accounts for approx. 1/3 of vaginitis cases. * Candida species are part of the lower genital tract flora in 20-50% of healthy asymptomatic women. * Candida albicans is responsible for 80- 92% of episodes of vulvovaginal candidiasis. * Candida organisms access the vagina via migration across the perianal area from the rectum.
  11. 11. Risk Factors: * Diabetes - Type 2 more prone to non- albicans species * Use of antibiotics: 1/4-1/3 of women taking broad spectrum antibiotics will inhibit normal bacterial flora which then allows growth of potential pathogens such as candida. * Increase estrogen levels - ie, oral contraception use, pregnancy or estrogen therapy. * Immunosuppression * Contraceptive devices
  12. 12. Clinical Features: * Vulvar pruritis is the most common complaint * Dysuria (typically externally) * Irritation, soreness and dyspareunia * Vaginal discharge can be typically white/clumpy (curd like)
  13. 13. Diagnosis: * Vag pH is 4-4.5, which distinguishes it from BV (4.5) or trich. * Confirmed by finding the organism on wet mount from the vaginal discharge
  14. 14. Treatment: • treatment indicated for relief of symptoms • oral meds take a day or two longer to relieve symptoms • topical treatments may cause burning when applied • Diflucan (fluconazole) 150 mg 2-3 sequential doses 72 hrs apart. • For severe cases (vulvar inflammation) some clinicians suggest use of low potency corticosteroids for 48 hrs until the anti-fungal med exerts its effect.
  15. 15. Trichomonas * The responsible organism is the flagellated protozoan trichomonas vaginalis. * Found in the vagina, urethra, and paraurethral glands of infected women. * Trich is virtually always sexually transmitted.
  16. 16. Symptoms: * Purulent, malodorous, thin vaginal discharge (70% of cases) burning, pruritus, dysuria, increased frequency, and dyspareunia. Post-coital bleeding can occur. * Exam reveals erythema of the vulva and vaginal mucosa. * Classic green-yellow frothy discharge is seen in 10-30% of affected women.
  17. 17. Diagnosis: * Presence of motile trichamonads on wet mount is diagnostic of infection in 50-70% * Organism remain motile for 10-20 min after collection. * Vaginal culture in pt with suggestive clinical findings or when microscopy is unavailable.
  18. 18. Treatment: * Both partners must be treated!! * 2 grams of either tinidazole or metronidazole (single dose better compliance). * Metronidazole 500 mg bid X 7 days
  19. 19. Thank you so much!

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