Which vaginal condition has a positive whiff test?
Bacterial vaginitis.
Which vaginal disorder has discharge that is off-white in colour, frothy, and an unpleasant odor, with pH over 4.5?
Trichomonas
Which vaginal disorder has a FISHY odor, with gray and milky thin discharge, with a vaginal pH of more than 4.5?
Bacterial vaginosis
which vaginal condition typically has a negative whiff test?
vaginal candidiasis
which vaginal condition typically has no odor, only white/clumpy discharge cottage-cheese like, which a vaginal pH of less than 4.5?
Vaginal candidiasis
A patient presents to the pharmacy with vaginal candidiasis. When would you refer this patient to the doctor?
if first time with the symptoms, pregnant, diabetes, recurrence within less than 2 months, HIV, and age is < 12 years
Amongst: BV, vaginal candidiasis and Trichomonas, which requires sexual partner to also be treated?
- Trichomonas
(and avoid sexual intercourse until treatment is finished for both partners + asymptomatic) - Recurrent yeast infxn (4 episodes / yr)
Treatment for trichomonas?
Oral metronidazole: 2g single dose, OR 500 mg BID x 7 days
Patient has trichomonas + is pregnant. What medication can she take for treatment?
metronidazole po.
Patient has trichomonas + is breastfeeding. What medication can she take for treatment?
metronidazole po
Treatment for BV?
- metronidazole 500 mg bid x 7 days OR
- clindamycin (vaginal)
Patient has recurrent BV with 3+ episodes per year. What do you recommend?
metronidazole 500 mg BID x 10-14 days
treatment options for vaginal candidiasis
- internal creams - clotrimazole 1% x 6 days, 2% for 3 days, or 10% x 1 day
- PO - fluconazole 150 mg stat
DDI with fluconazole?
potent cyp2c9 and mod cyp3a4 inhibitor*
so all drugs that are 2C9/3A4 substrates
What is considered a recurrent yeast infection?
at least 4 episodes per year
Treatment for recurrent yeast infection?
fluconazole 150 mg once weekly x 6 months after induction therapy
Treatment options for pregnancy + yeast infection?
clotrimazole or miconazole x 7-14 days***
*Vaginal preps are safe
*avoid fluconazole in pregnancy, NOT SAFE!
non-pharms for prevention of yeast infection?
reduce sugar intake
eat yogurt (unsweetened)
cotton underwear
avoid tights every day
wipe from front to back
change wet/damp clothes asap
avoid irritants: sprays, douches, deodorants, tampons, bubble bath, perfumed toilet
Treatment options for RECURRENT yeast infection (>4/yr)?
- fluconazole 150 mg PO q 3 days , then once weekly for 6 months.
- clotrimazole: treat acute ep for 10-14 days, then 500 mg pv qmonth x 6 months
- itraconazole: 200-400 mg monthly x 6 months
In what population is a single dose of fluconazole 150 mg PO suitable for?
pregnant, breastfeeding females, those without DDIs, and women > 12 yrs
Causative bacteria for gonorrhea and chlamydia?
- gonococcal - N. gonorrhea, chlamydia
- Non-gonococcal - mycoplasma genitalium, ureaplasma urealyticam, T. vaginalis, HSV, herpes zoster virus, adenovirus
What are the symptoms of Gonorrhea/chlam in men?
purulent discharge
severe dysuria
Symptoms of gonorrhea/chlamydia in women?
vaginal discharge
severe dysuria
1st line treatment for gonorrhea and chlamydia?
- Cefixime 800 mg PO STAT OR Ceftriaxone IM 250 mg STAT (these cover gonorrhea)
AND
- Azithromycin 1g STAT OR
doxycycline 100 mg BID x 7 days (These cover for chlamydia)
