VULVOVAGINITIS

 

1. TRICHOMONA

Etiology:

  1. sexually  transmitted protozoa

S&S:

  1. grayish-green discharge on strawberry color background
    pt c/o itchiness, foul smell, dysuria

DX:

  1. NS ( wet mount ) applied on slide reveals flagellated tear -drop shaped organism and many PMNs
     
  2. pH is >5.5
     
  3. not uncommonly, routine UA can be diagnostic

Therapy:

  1. if not pregnant pt: Metronidazole 2gm PO x 1 or 500 mg PO BID x 7days
                                   
  2. if pregnant pt : Clotrimazole suppositories QHS x 7 days
     
  3. Metronidazole interferes with  folic acid. Metronidazole has disulfiram-like effect and should be avoided in alcoholics.
     
  4. 90%  of male partners are asymptomatic and must be  treated.

 

2. CANDIDA

Etiology:

  1. DM
     
  2. Pregnancy or post-menopause
     
  3. Antb, steroids, contraceptives
     
  4. normal flora in 50% of healthy women

S&S:

  1. itchiness
     
  2. thin or thick discharge with dysuria, dyspareunia
     
  3. discharge is cottage  white and vulvovaginal  erythema is present

DX:

  1. pseudohyphae on 10% KOH prep

Therapy:

  1. can be treated with:
     
    • Clotrimazole 200mg ( class B )          }
    • Miconazole 200mg   ( class B )          }     all are available as suppositories
    • Terconazole 80mg    ( class C )         }           and used QHS x 3 days
    • Butaconazole 2% cream ( class C )    }
    • Nystatin  1 supp  ( class A )               }   x 14 days
    • Fluconazole 150 mg ( class C )          }   x 1 dose

 

3. GARDENELLA (Bacterial  Vaginosis )

Etiology / S&S / Dx:

  1. Normal flora in 40%
     
  2. itchiness, foul smell
     
  3. homogeneous  gray-white discharge
     
  4. KOH placed on slide gives amine odor ( fishy odor )
     
  5. vaginal  pH > 4.5
     
  6. "clue cells"- one can appreciate vaginal epithelial  cells covered by bacteria  (on wet mount)

Therapy:

  1. Metronidazole 500mg BID x 7 days  or, if pregnant, Clinda 300mg BID x 7 days
     
  2. Treatment of asymptomatic patient or partner not recommended  by CDC.

 

4. FB VULVOVAGINITIS

    1. In adults usually FB are condoms  or tampons.
       
    2. When left for over 48 hrs. they cause localized infection 2ry to E.Coli , anaerobes  and overgrowth of vaginal flora
       
    3. Pt presents with  c/o  foul  smell
       
    4. Treatment: only removal of FB is needed  and Betadine douches. F/U must be arranged.

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