Vaginitis

Vaginitis
* pathophysiology
* etiology
* diagnosis
* treatment

The dynamic vagina
* vaginal secretions, exfoliated cells, cervical mucosa
* lactobacillus acidophilus
* estrogen
* glycogen
* vaginal pH
* metabolic byproducts of flora and pathogens

Causes of vaginitis
* antibiotics
* contraceptives
* sexual intercourse
* douching
* stress
* hormones
* allergies and chemical irritation

Bacterial vaginosis
* proliferation of Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Peptostreptococcus species
* most common cause
* 1/3 to 2/3 asymptomatic
* 15 to 19% of all women
* 10 to 30% pregnant women

BV misc.
* role of sexual transmission unclear
* risk for preterm labor and PROM
* increased frequency of abnl PAPs, PID, endometritis
* Sxs: profuse malodorous discharge
* Exam: thin grayish discharge, seldom vaginal or vulvar irritation

Risks associated with BV
* Early sexual ‘debut’
* new or multiple sex partners
* IUD (50% contract it over 2y)
* OCP
* Lesbians/receptive oral sex
* no RCT’s but association with douche, c-section and around time of menses

Amsel’s criteria
* thin, homogenous discharge
* positive “whiff” test
* “clue cells” present on microscopy
* vaginal pH > 4.5

BV treatment
* metronidazole 500 mg BID x 7 days
* clindamycin 2% cream qhs x 7 days
* metrogel 0.75% BID x 5 day (vs. QD)
* metronidazole 250 mg TID x 7 days
* metronidazole 2 g po single dose
* metrogel (no previous PTL)

Vulvovaginal Candidiasis
* second most common in U.S.
* Candida albicans predominates
* increasing frequency of non-albicans species (C. glabrata)
* Risks: OCPs, diaphragm, IUD, early intercourse, >4X/month, receptive oral sex, diabetes, recent antibiotics.
* endogenous vaginal flora in 50% women
* not sexually transmitted nor related to number of sexual partners
* treatment of male partner of no benefit
* c/o pruritis, vaginal irritation, dysuria
* vulvovaginal itching not normal in healthy women (lichen sclerosis, vulvar cancer)
* exam: thick white discharge, no odor, normal pH
* vulvar and vaginal erythema

diagnostics
vulvovaginal candidiasis Rx
Trichomoniasis
Evaluation
Trich treatment
Atrophic Vaginitis
Other considerations

Vaginitis.ppt