Vulvovaginitis

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

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

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