Vulvovaginitis: Difference between revisions
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*Atrophic vaginitis may occur in postmenopausal women | *Atrophic vaginitis may occur in postmenopausal women | ||
==Bacterial Vaginosis== | ==[[Bacterial Vaginosis]]== | ||
===Background=== | ===Background=== | ||
*Accounts for up to 50% of cases | *Accounts for up to 50% of cases | ||
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*Metronidazole 250mg PO TID x7d - pregnancy treatment | *Metronidazole 250mg PO TID x7d - pregnancy treatment | ||
==Candida Vaginitis== | ==[[Candida Vaginitis]]== | ||
===Background=== | ===Background=== | ||
*Not considered an STI although it can be transmitted by sexual intercourse | *Not considered an STI although it can be transmitted by sexual intercourse | ||
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**Topical azole therapy x7d (for pregnant pts) | **Topical azole therapy x7d (for pregnant pts) | ||
==Trichomonas== | ==[[Trichomonas]]== | ||
===Background=== | ===Background=== | ||
*Considered an STI | *Considered an STI | ||
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**Metronidazole 500mg PO BID X 7d | **Metronidazole 500mg PO BID X 7d | ||
==Contact Vulvovaginitis== | ==[[Contact Vulvovaginitis]]== | ||
*Due to exposure of vulvar epithelium and vaginal mucosa to chemical irritant or allergen | *Due to exposure of vulvar epithelium and vaginal mucosa to chemical irritant or allergen | ||
*Diagnosis of exclusion; rule-out infectious cause first | *Diagnosis of exclusion; rule-out infectious cause first | ||
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[[Category:OB/GYN]] | [[Category:OB/GYN]] | ||
[[Category:ID]] | |||
Revision as of 23:54, 7 March 2014
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 and premature rupture of membranes
- 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
- Clindamycin 300mg PO BID x7d
- Metronidazole 250mg PO TID x7d - pregnancy treatment
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 other vaginitides or 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
- Metronidazole 500mg PO BID X 7d
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