Vulvovaginitis: Difference between revisions
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*Odor is unusual (if present favors dx of BV) | *Odor is unusual (if present favors dx of BV) | ||
*Wet mount shows hyphae and yeast buds | *Wet mount shows hyphae and yeast buds | ||
**Candida does not cause WBCs on wet mount, think about co-infection with STI | |||
===Treatment=== | ===Treatment=== |
Revision as of 15:22, 24 October 2013
Background
- Candidiasis and contact vaginitis may occur in virgins
- Atrophic vaginitis may occur in postmenopausal women
Bacterial Vaginosis
Background
- Accounts for up to 50% of cases
- Associated w/ preterm labor
- Treat all symptomatic women (including pregnant)
- Do not treat asymptomatic women (including pregnant)
Diagnosis
- Whitish-discharge and odor
- Lack of discharge makes diagnosis less likely
- Wet mount shows clue cells
Treatment
- Do NOT need to treat sexual partner
- Metronidazole 500mg PO BID x7d
- Single dose tx not as efficacious; not recommended by CDC
Candida Vaginitis
Background
- Not considered an STI although it can be transmitted by sexual intercourse
- May occur in premarnarcheal girls (rare)
- Types
- Uncomplicated
- Sporadic infxn, mild-moderate sx, due to Candida albicans, immunocompetent
- Complicated
- Recurrent infxn, severe sx, uncontrolled DM, immunosuppression, pregnant
- Uncomplicated
Diagnosis
- Vaginal pruritus is the most common and specific symptom
- Dischrage varies from little to copious and from watery to cottage-cheese like
- Odor is unusual (if present favors dx of BV)
- Wet mount shows hyphae and yeast buds
- Candida does not cause WBCs on wet mount, think about co-infection with STI
Treatment
- Do not treat if asymptomatic
- Sexual partners should not be treated unless the pt has frequent recurrences
- Single-dose tx w/ oral flucon is as effective as topical tx but can't use in pregnancy
- Uncomplicated
- Clotrimazole 100mg vaginal tablet; 2 tablets/d x3d OR
- Fluconazole 150mg PO x1dose
- Complicated
- Fluconazole 150mg PO on days 1 and 3 (not recommended for pregnant pts)
- Topical azole therapy x7d (for pregnant pts)
Trichomonas
Background
- Considered an STI
- A/w preterm birth, PID, cervical cancer, increased transmission of other STIs
Diagnosis
- Yellow, malordorous discharge
- Vaginal erythema or edema
- Wet mount shows mobile trichomonads
Treatment
- Treat sexual partners
- Metronidazole 2gm PO in single dose
- If pregnant d/w OB prior to TX, Flagyl associated with preterm labor
Contact Vulvovaginitis
- Due to exposure of vulvar epithelium and vaginal mucosa to chemical irritant or allergen
- Diagnosis of exclusion; rule-out infectious cause first
- Consider tx w/ topical corticosteroids applied BID-TID x2-3d
Source
Tintinalli