vaginitis

Question 1

how do you diagnose BV?

Answer 1

Amsel’s criteria: 3 of 4

• white thin discharge
• 20% clue cells
• vaginal pH > 4.5
• positive whiff test

Nugent score 7-10

Question 2

How do you diagnose trichomonas?

Answer 2

• microscopy (sensitivity 50-60%)
• NAAT preferred
• culture takes up to 5 days

Question 3

How do you diagnose vulvovaginal candidiasis?

Answer 3

• microscopy: spores, hyphae, pseudohyphae
• yeast culture
• PCR is fast and sensitive but expensive

Question 4

options for tx of BV?

Answer 4

• metronidazole 500 mg PO BID x 7d
• metronidazole gel 0.75% qday x 5 days
• clindamycin cream 2% IV x 7 days

alternative:

• tinidazole
• secindazole
• PO clinda
• clinda ovules

CDC recommends STD and HIV testing if treating for BV

Question 5

tx for trichomonas?

Answer 5

• po metronidazole 500 mg BID x 7 days
• retest in 3 months

alternative tinidazole 2 g x 1

Question 6

what is classification for clinical candidiasis?

Answer 6

• uncomplicated

- complicated
A) recurrent (4 or more in a year)
B) severe symptoms
C) immunocompromised
D) non C. albicans strain

Question 7

tx of uncomplicated candidiasis?

Answer 7

OTC vs Rx options
OTC:
clomitrazol cream (all 5 g) 3-7 days
miconazole suppositories (100-1200)

Rx:
teroconazole cream or suppository
PO fluconazole 150 mg x 1

Question 8

tx for uncomplicated candidiasis?

Answer 8

recurrent:
- weekly 150 mg PO fluconazole x 6 months
- vag clomitrazole 500 mg weekly, 200 mg biweekly

severe sx:

• intravaginal azole for 10-14 days
• 2-3 doses of PO fluconazole 3 days apart

non-albicans/resistant

• boric acid 600 mg capsules intra-vag x 14 days
• flucytosine but too expensive

Question 9

misc things to remember

Answer 9

• OTC okay, but counsel on mild reactions
• empiric tx not recommended
• pap smear not reliable way to diagnose vaginitis

Question 10

clinical signs and diagnosis of desquamative vaginitis? tx?

Answer 10

• pruritis, vaginal discharge, perimenopause
• erythema/firey red on exam. discharge +
• microscopy: increased parabasal cells, PMNs. 1:1 epithelial to inflammatory cells.
• no formal guidelines for tx available: intravaginal clinda vs steroids