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SPECIALIST CLINIC Dr ME Osborne

SPECIALIST CLINIC Dr ME Osborne. SPECIALIST CLINIC FOR WOMEN WITH RECURRENT VAGINAL COMPLAINTS DUE TO:. BV CANDIDIASIS MENOPAUSAL CHANGES. BACTERIAL VAGINOSIS (BV). Cause Commonest cause of abnormal discharge in women Aetiology unknown Overgrowth of anaerobic bacteria Gardnerella

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SPECIALIST CLINIC Dr ME Osborne

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  1. SPECIALIST CLINIC Dr ME Osborne

  2. SPECIALIST CLINIC FOR WOMEN WITH RECURRENT VAGINAL COMPLAINTS DUE TO: • BV • CANDIDIASIS • MENOPAUSAL CHANGES

  3. BACTERIAL VAGINOSIS (BV) Cause • Commonest cause of abnormal discharge in women • Aetiology unknown • Overgrowth of anaerobic bacteria • Gardnerella • Mycoplasma • Mobiluncus • Reduction of Lactobacilli • Increased PH, 4.5-7

  4. DIAGNOSIS • Gram staining of vaginal fluid • ISON and Hay Vaginal Flora Grading System

  5. PREDISPOSING FACTORS • Smokers • IUCD in situ • Non-consistent use of condoms • Commoner in black women

  6. INDICATION FOR TREATMENT • Symptomatic Women • Pre-Instrumentation of the cervix (e.g. TOP, insertion of IUCD) • H/O idiopathic pre-term birth or second trimester loss

  7. TREATMENT • All therapies achieve cure in 70-80% after 4 weeks • In recurrent BV, indication for suppressive therapy • Screening and treating male partners has not been shown to affect risk of BV recurrence

  8. VAGINAL CANDIDIASIS Cause • 80-95% of infections due to Candida albicans • Remaining: C. Glabrata C. Tropicalis

  9. Symptoms • Non-specific: Vulval Itching Burning Soreness • Superficial Dyspareunia • Abnormal Vaginal Discharge

  10. PERCIPITATING FACTORS • Pregnancy • D.M. • Antibiotics • O.C. (high oestrogen) • Immunosuppression • Tight fitting synthetic clothing • Local irritants

  11. DIAGNOSIS • Clinical – Symptoms & Signs • Microscopy – Gram stain: Spores Pseudohyphae • Culture – Sabouraud’s Medium

  12. TREATMENT • For symptomatic women • 20% of women carry candida asymptomatically • No need for treatment • No need for treatment of asymptomatic male partners • Symptomatic male partners need treatment

  13. RECURRENT VULVOVAGINAL CANDIDIASIS • 4 or more symptomatic episodes per year

  14. MANAGEMENT OF CHRONIC, RECURRENT VAGINAL PROBLEMS • Genital tract examination • Testing for STDs • Review of precipitating factors or underlying conditions • Treatment • Suppressive Therapy • Screening & treatment of partners

  15. SEXUAL HEALTH SERVICE FOR WOMEN WITH PERI-MENOPAUSAL & MENOPAUSAL PROBLEMS • Recurrent vaginal problems (usually due to atrophy) • Dryness • Soreness • Dyspareunia • Alteration in normal vaginal discharge • Alkaline PH • Lactobacillus reduction These changes can lead woman to feeling that they have an STI

  16. Recurrent urinary tract symptoms • Due to over active bladder: • Stress incontinence • Urge incontinence • Frequency • Nocturia • Recurrent UTIs

  17. SEXUAL DIFFICULTIES RESULTING FROM MENOPAUSAL SYMPTOMS Management • Recognising Concerns • Genital tract examination • Testing for STIs and UTIs • Treatment of: vaginal discharge, skin problems, UTIs • Advice of topical oestrogen therapy • Risk reduction advice for menopausal symptoms

  18. REFERRAL PATHWAY • Self Referral • On GP advice • Appointment service

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