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INFECTIOUS VULVOVAGINITIS Part 02

INFECTIOUS VULVOVAGINITIS

Bacterial Vaginosis

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  1. Gardnerella vaginalis overgrowth in presence of vaginal anaerobes and scant lactobacilli (Bacteroides, Mobiluncus) 
  2. especially susceptible when post-menstrual or post-coital, with IUD

 

Symptoms

  1. fishy odour especially after coitus
  2. profuse, thin greyish discharge
  3. vulva rarely itchy or inflamed not necessarily sexually transmitted, although can see “ ping-pong “ transmission

 

Diagnosis

  1. saline wet mount
    • > 20% clue cells = squamous epithelial cells dotted with coccobacilli (Gardnerella bacilli)
    • paucity of WBC
    • paucity of lactobacilli
  2. amine ìwhiffî test = rotten, fishy odour with addition of KOH to slide
  3. pH 5-5.5

 

Treatment

  1. no treatment required in non-pregnant, asymptomatic women unless scheduled for pelvic surgery or procedure
  2. must treat all asymptomatic cases in pregnancy; higher incidence of PTL, PPROM and miscarriage if left untreated
  3. oral
    • metronidazole 500 mg bid for 7 days or 2 g once
    • clindamycin 300 mg bid for 7 days
  4. topical
    • clindamycin 2% vaginal cream qhs x 7 days
    • flagystatin vaginal suppository (also covers yeast)
  5. ampicillin or amoxicillin if pregnant
  6. for repeated infection one capsule or tablet of lactobacillus acidophilus daily in vagina
  7. controversy exists regarding treatment of partner

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Trichomonas Vaginalis

 

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  1. a flagellated protozoan, anaerobic
  2. often co-exists with bacterial forms
  3. sexually transmitted (men asymptomatic)
  4. more frequent with multiple sexual partners
  5. possibly via hot tubs, whirlpools, saunas

 

Symptoms

  1. profuse, thin, frothy yellow-green discharge
  2. may be foul-smelling discharge
  3. often seen post-menstrual
  4. occasionally irritated, tender vulva
  5. dysuria,abdominal pain
  6. petechiae on vagina and cervix (10%)
  7. asymptomatic (25%)

 

Diagnosis

  1. saline wet mount
    • many WBC
    • motile flagellated organisms
    • inflammatory cells
  2. pH 5 - 6.5

 

Treatment

  1. metronidazole 500 mg bid for 7 days or 2 g once
  2. treat partner(s)
  3. also topical clindamycin or metronidazole

INFECTIOUS VULVOVAGINITIS Part 02 INFECTIOUS VULVOVAGINITIS Part 02 Reviewed by Radiology Madeeasy on August 24, 2010 Rating: 5
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