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Vaginal Itching and Discharge

Vaginal Itching and Discharge. CAPT Mike Hughey, MC, USNR. Vaginal or Vulvar Itching. 95% of women with vulvar itching have yeast. Giving an anti-fungal agent (Monistat, Lotrimin, etc.) will cure most of this itching. Treatment failures need further evaluation.

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Vaginal Itching and Discharge

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  1. Vaginal Itching and Discharge CAPT Mike Hughey, MC, USNR

  2. Vaginal or Vulvar Itching • 95% of women with vulvar itching have yeast. • Giving an anti-fungal agent (Monistat, Lotrimin, etc.) will cure most of this itching. • Treatment failures need further evaluation.

  3. Yeast (AKA Monilia, Thrush, Candida) • Itching is hallmark symptom • Red, swollen, tender vulva • Wet Mount confirms

  4. Yeast Treatment • Topical anti-fungal agents work well • Monistat • Gyne Lotrimin • Mycelex G • Oral agents also work well • Diflucan 150 PO once

  5. Chronic Yeast Predisposing Factors: • Heat • Moisture • Diet • Diabetes • Antibiotics Solution: PRN Anti-fungal Agents

  6. Tinea Cruris (Jock Itch) • Raised, reddened intertrigenous lesion • Dx: visual, but may obtain KOH scrapings • Rx: (BID x 2-3 weeks) -Monistat -Lotrimin -Diflucan -Nizoral

  7. Contact Dermatitis • Perfumes • Deodorants • Toilet Paper • Soap • RX: -Stop exposure -Burrow's Solution -Topical Steroids

  8. Crabs (Pubic Lice) Transmitted by: • Sexual contact • Infected bedding • Sharing towels • Close living quarters

  9. Crabs (Pubic Lice) Treatment Nix cream Kwell Shampoo

  10. HPV (Condyloma) • Clinical warts • Flat warts • Soak vulva in vinegar,Exam under 7x power,Red-free light filter • Cryo, TCA, Laser, Cautery, Podo, etc.

  11. Vulvar Dystrophy - Hypertrophic • Skin too thick • Sx: Itching • Dx: Biopsy • Rx: Steroid Cream

  12. Vulvar Dystrophy - Lichen Sclerosis • Skin too thin • Sx: Itching • Dx: Biopsy • Rx: Testosterone Cream or Clobetasol

  13. VIN (Vulvar Intraepithelial Neoplasia) • Itching • Doesn’t respond to anti-fungal agents • May have a white skin discoloration • Need biopsy for diagnosis

  14. VIN (Vulvar Intraepithelial Neoplasia)

  15. Paget's Disease • Slow-growing malignancy • Exzematoid lesion -dry, crusty skin -moist, weepy -contact bleeding • Looks like yeast, but isn’t cured with anti-fungal Rx • Confirm by Bx, treat with local excision

  16. Vaginal Discharge • Does it Itch? • Does it smell bad? • What does it look like? • Wet mount, cultures

  17. Bacterial Vaginosis • Smells bad • “Whiff Test” (KOH) • AKA Gardnerella, BV, Hemophilus Vag. • Anaerobic bacteria • Rx: Flagyl • Rx: Clindamycin • Rx: Amox

  18. Bacterial Vaginosis • Rx: Flagyl • Rx: Clindamycin • Rx: Amox

  19. Trichomonas • Bubbly, frothy discharge • Rx: Flagyl 250 TID x 7 days 500 BID x 5 days 2 gm PO stat

  20. Wet Mount

  21. Cultures • If GC, Chlamydia, Strep suspected • If pelvic pain present • Treatment failures

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