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Vaginitis

Vaginitis. Christie Brough Feb 23, 2014 Capstone. Learning Objectives. Differentiate between clinical presentations of vaginitis Understand the treatment for each type of vaginitis. Atrophic Vaginitis. Defined:

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Vaginitis

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  1. Vaginitis Christie Brough Feb 23, 2014 Capstone

  2. Learning Objectives • Differentiate between clinical presentations of vaginitis • Understand the treatment for each type of vaginitis

  3. Atrophic Vaginitis • Defined: • Vaginal epithelial thinning due to estrogen deficiency  vaginal dryness & inflammation • Most commonly seen in menopausal or postmenopausal women

  4. Atrophic Vaginitis • Signs & Symptoms: • Most commonly asymptomatic • Itching • Dryness • Pain with intercourse • Yellow malodorous vaginal discharge

  5. Atrophic Vaginitis • Physical Exam • External genitalia: loss of labial fullness & sparsity of pubic hair, dryness of labia • Vaginal: Pallor & decreased moisture; smooth, shiny vaginal epithelium • Treatment • Estrogen replacement • Moisturizers & lubricants

  6. Bacterial Vaginosis • Defined • Clinical syndrome caused by replacement of vaginal hydrogen peroxide-producing Lactobacillus species • Most frequent cause of vaginal discharge

  7. Bacterial Vaginosis • Signs & Symptoms • Thin, white-gray vaginal discharge • “Fishy smell” following menses • Itching • Burning • Inflammation

  8. Bacterial Vaginosis • Physical Exam/Diagnosis • Thin, homogenous discharge • Clue cells on wet prep • pH greater than 4.5 • Treatment • Metronidazole 500 mg PO BID for 7 days

  9. VulvovaginalCandidiasis • Defined • Typically presents as an acute inflammation of the vagina and vulva • Most often caused by Candida species

  10. VulvovaginalCandidiasis • Signs & Symptoms • Itching • Burning • Pain with intercourse • Milky, white, clumpy discharge

  11. VulvovaginalCandidiasis • Physical Exam/Diagnosis • Vaginal & vulvar edema & erythema • Clumpy, white adherent discharge • Normal pH (4 – 4.5) • Microscopy shows hyphae • Treatment • Fluconazole 150 mg PO (single dose)

  12. Trichomoniasis • Defined • An STD caused by a pear-shaped, motile protozoa, known as trichomonas • Most common treatable STD in the US

  13. Trichomoniasis • Signs & Symptoms • 90% are asymptomatic • Burning/pain with urination • Vaginal discharge, itching, or odor

  14. Trichomoniasis • Physical Exam • Inflammation of the vagina • Frothy, green or pink-tinged discharge • Cervix may be normal or friable (strawberry cervix seen in less than 2%) • Saline wet mount shows motile trichomonads • Treatment • Metronidazole 2 g PO (single dose)

  15. A 27 y/o WF presents for her annual checkup. She has a history of asthma and uncontrolled diabetes. Today, she complains of vaginal itching and pain with intercourse, which started a few days earlier.  She denies any new sexual partners or any history of STDs. She is currently sexually active with 1 partner for the past 3 years.Physical exam is within normal limits except for the speculum exam which shows an erythematous vagina with a clumpy white discharge. Vaginal pH is 4.2. Saline microscopy shows pseudohyphae.Which of the following is the correct diagnosis? • Atrophic vaginitis • Bacterial vaginosis • Trichomoniasis • Vulvovaginal candidiasis

  16. References • Adams Hillard, P. The 5-minute Obstetrics and Gynecology Handbook. Philadelphia: Lippincott Williams & Wilkins, 2008. • UpToDate

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