Vaginosis, Vaginitis, Wet Preps: What I Want You To Know Stephen Poff, M.D.

1. Vaginosis, Vaginitis,& Wet Preps:What I Want You To Know!Stephen Poff, M.D.

3. Know Normal! Epithelial Cells 2. Lactobacilli - 5 to 15 � 3. WBCs - Few = NL - Never > Epi�s - Many = Inflammation (Parabasilar Cell) >

4. Vaginitis - Know 2+ Trichomonas - Many WBCs 2. Candidiasis/Yeast Candida albicans: 1) Blastospores �CANDIDIASIS� 2) Budding Yeast 3) Pseudohyphae Candida glabrata: 1) Blastospores (Torulopsis g.) 2) Budding yeast �YEAST� - Grow is clusters = CUMULI > - Many WBCs

5. Vaginosis - Know 3 Bacterial Vaginosis - NONE/FEW Lactobacilli (5 to 15 �) - Few WBCs!!!!!!! Cytolytic Vaginosis - �Lactobacillus Overgrowth Syndrome� - Can look like NORMAL - MANY Lactobacilli (5 to 15 �) - Few WBCs!!!!!!! Lactobacillosis - �Leptothrix� - Can look like YEAST - LONG Lactobacilli (40 to 75 �) - Few WBCs!!!!!!!

6. Vaginosis - Know 3 1. Bacterial Vaginosis - FEW or NO LACTOBACILLI - MANY Coccobacillary Orgs. = �GARBAGE� - CLUE CELLS = CELL EDGE - FEW WBCs!!!!!!! - MOBILUNCUS = MOTILE

7. Vaginosis - Know 3 2. Cytolytic Vaginosis = �Lactobacillus Overgrowth Syndrome� - MANY LACTOBACILLI - 5 to 15 � - Few WBCs!!!!!!! - Symptoms: � - middle of cycle � - menses - ++Vaginal itching - ++Vulvar dysuria - ++Dyspareunia - Treatment: - No tampons 6mths - � vaginal pH - 1 Tsp Na-Bicarb/1Pint H2O/ Douche 1 � 2 X/wk - 2-4 Tbsp Na-Bicarb/2 in bath/ Sitz Baths 2 � 3 X/wk

8. Vaginosis - Know 3 3. Lactobacillosis = �Leptothrix� - LONG LACTOBACILLI - 40 to 75 � - Few WBCs!!!!!!! - Symptoms: � - 1wk before menses - +Vaginal itching - +Vulvar dysuria - Curd-like discharge - Treatment: - Augmentin or Doxycycline

9. 3 Cases � Case 1 A 29-year-old woman comes in with a chief complaint of a white vaginal discharge off and on for the last 2 months. She notices that the discharge �smells really fishy after intercourse.� She reports that she has tried Monistat 3 vaginal suppositories with no relief. �I don't feel clean unless I douche on a regular basis.�

10. 3 Cases � Case 1

11. 3 Cases � Case 2 A 33 year old woman complains of monthly vaginal infections. She reports that she has vaginal itching, no noticeable discharge, and �the outside of my vagina burns� particularly with urination. She states the symptoms disappear during her menses and then get worse again in the middle of her cycle. �I can't have intercourse during this time because it is too painful... I have tried to use over-the-counter [OTC] lubricants and nothing eases the pain.�

12. 3 Cases � Case 2

13. 3 Cases � Case 3 A 44 year old woman reports symptoms of vaginal itching, burning, and irritation with a thick, white, curdy vaginal discharge. She reports the symptoms appear about a week and a half before her menses. She has tried many OTC products initially and finally called her �OB/GYN� who did not see her but did call in prescriptions for Flagyl and Diflucan. However, the symptoms continued even after this treatment.

14. 3 Cases � Case 3

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