Vaginitis (Final)

Question 1

this is any condition with symptoms of abnormal vaginal discharge, odor, irritation or burning

Answer 1

vaginitis

Question 2

what are the 3 infectious causes of vaginitis

Answer 2

• bacterial vaginosis
• vulvovaginal candidiasis (yest infection)
• trichomoniasis

Question 3

what are the 4 noninfectious causes of vaginitis

Answer 3

• atrophic
• allergic
• irritant
• inflammatory

Question 4

what bacteria is involved at the vaginal level in a normal situation

Answer 4

lactobacilli

Question 5

what is the normal vaginal pH

Answer 5

3.5-4.5

Question 6

in bacterial vaginosis, what bacteria is present, that overrules the normal lactobacilli

Answer 6

g. vaginalis

Question 7

what symptoms are present in someone who has bacterial vaginosis

Answer 7

• fishy odor
• thin discharge (worsens after sex)
• may have pelvic discomfort

Question 8

true or false: inflammation is present in bacterial vaginosis

Answer 8

false

Question 9

what is the vaginal pH in someone with bacterial vaginosis

Answer 9

> 4.5

Question 10

what bacteria is present in someone with vulvovaginal candidiasis

Answer 10

candida albicans or other candida species

Question 11

what are the symptoms associated with vulvovaginal cadidiasis

Answer 11

• white, thick, curdy, discharge
• itching and burning
• dyspareunia (genital pain during or after sex)
• dysuria
• NO ODOR

Question 12

true or false: inflammation is present in vulvovaginal candidiasis

Answer 12

true

Question 13

what is vaginal pH in vulvovaginal candidiasis

Answer 13

3.5 - 4.5 (normal)

Question 14

what bacteria is present in trichomoniasis

Answer 14

trichomonas vaginalis

Question 15

what are the symptoms associated with trichmoniasis

Answer 15

• green/yellow frothy discharge
• foul odor
• vaginal pain or soreness

Question 16

true or false: inflammation is present in trichomoniasis

Answer 16

true

Question 17

what is the vaginal pH in trichomoniasis

Answer 17

> 4.5

Question 18

what diagnostic testing can be done for vaginitis

Answer 18

1. microscopy and
2. vaginal pH and
3. amine (whiff) test

or

4. NAAT

Question 19

what type of cells are present in the normal vaginal environment

Answer 19

squamous epithelial cells

parabasal cells (most common in premenarchal and postmenopausal patients)

Question 20

what type of cells are present and may be indicative of bacterial vaginosis

Answer 20

clue cells (squamous epithelial cells studded with many coccobacilli)

Question 21

what is the Amsel Diagnostic criteria for bacterial vaginosis

Answer 21

1. thin, homogenous discharge
2. positive whiff test
3. clue cells present on microscopy
4. vaginal pH > 4.5

three out of four criteria must be met

Question 22

what are the 3 initial tx options for bacterial vaginosis

Answer 22

1. metronidazole 500mg BID x7/7
2. metronidazole 0.75 gel PV daily x5/7
3. clindamycin 2% vaginal cream OV x7/7

Question 23

what is another oral option used to treat BV if metronidazole does not work

Answer 23

Clindamycin 300mg PO BID x 7/7

Question 24

what are the 3 treatment options for BV in pregnancy

Answer 24

1. metronidazole 500mg BID x 7/7
2. metronidazole 250mg TID x 7/7 (if pt cant tolerate 500mg dose)
3. clindamycin 300mg BID x 7/7

Question 25

true or false: sexual partners of a patient with BV also need to be treated

Answer 25

false - not recommended

Question 26

how should a reoccurence of BV be treated

Answer 26

first recurrence: retrial of same regimen or trial of different regimen

Question 27

true or false: BV is only treated in symptomatic patients

Answer 27

true only treat asymptomatic if - prior to IUD insertion - prior to gynecologic surgery - prior to therapeutic abortion - high risk pregnancy

Question 28

what is an option for supressive therapy for BV

Answer 28

metronidazole 0.75% PV weekly x 4-6 months

Question 29

which diagnostic test is suggested to be used for diagnosing trichmoniasis

Answer 29

NAAT

Question 30

when should a patient who had trichomoniasis be tested for reinfection after tx

Answer 30

2 weeks up to 3 months

Question 31

what is the 2 options for initial tx for trichomoniasis

Answer 31

1. metronidazole 2g PO as a single dose 2. metronidazole 500mg PO BID x 7/7 (rec regimen for females)

Question 32

what is a tx option for trichmoniasis in pregnancy

Answer 32

metronidazole 2g as a single dose

Question 33

true or false: 2g dose of metronidazole is safe in BF

Answer 33

false - should withhold BF for 24-48 hours

Question 34

true or false: sexual partners of a patient with trichomoniasis need to be treated

Answer 34

true + no sex until both partners are sx free

Question 35

what are some a/e of oral metronidazole

Answer 35

- GI upset - metallic taste - dark discoloration of urine - urethral burning + severe interaction with alcohol - do not drink alcohol while taking this medication + 3 days after

Question 36

what are some a/e of topical metronidazole

Answer 36

- vaginal discharge - yeast infection - irritation - pain and discomfort * avoid tampons during tx

Question 37

topical clindamycin contains this ingredient which may decrease effectiveness of condoms for up to 5 days after use

Answer 37

mineral oil

Question 38

what types are cells are present in vulvovaginal candidiasis

Answer 38

- budding yeast - pseudohyphae - hyphae

Question 39

what are sone risk factors to getting a yeast infection (vulvovaginal candidiasis)

Answer 39

- recent Abx use - pregnancy - uncontrolled DM - aids - immunosuppression - corticosteroid use

Question 40

true or false: pharmacists can prescribe for BV, trichmoniasis and vulvovaginal candidiasis

Answer 40

false - only vulvovaginal candidiasis

Question 41

whar are some red flags where patients would need to be referred for furhter investigation

Answer 41

- prepubertal (rare in this pop) - 1st time vaginal sxs - has underlying illness such as DM - pregnant - has a reoccurence of vulvovaginal candidiasis within 2 months of the last episode - is immunosupressed - is at risk of an STI (e.g. hx of unprotected sex, mutliple partners)

Question 42

what are the 3 options for intial treatment of vulvovaginal candidiasis

Answer 42

1. topical azole therapy (e.g. clotrimazole / Canestan) 2. fluconazole 150mg PO as a single dose 3. teraconazole 0.4 or 0.8% vaginal cream hs x 7/7

Question 43

what option is used as tx for vulvovaginal candidiasis in pregnancy

Answer 43

topical azole PV x 7-14 days * NO FLUCONAZOLE * - risk of spontaneous abortion

Question 44

what are the 2 treatment options for recurrent vulvovaginal candidasis

Answer 44

1. topical azole therapy x 7-14 days 2. fluconazole 150mg q 3 days for 3 doses (9 days total)

Question 45

true or false: sexual partners of a patient with vulvovaginal candidiasis need to be treated

Answer 45

false - only if partner has sxs

Question 46

what are some a/e of PO fluconazole

Answer 46

- nausea - abdominal discomfort - h/a

Question 47

what is the treatment options for complicated or recurrent VVC

Answer 47

- Fluconazole 150mg po q 3 days for 3 doses then weekly x 6 months or may use boric acid 300-600mg gel caps PV daily x 14 days

Question 48

what are some possible maintenance treatments for complicated VVC in patients with high reoccurence of yeast infections

Answer 48

- ketoconazole 100mg daily - clotrimazole 500mg PV monthly - boric acid 300mg cap PV 5 days each month beginning the first day of the menstrual cycle

Question 49

true or false: boric acid is safe to use in pregnancy

Answer 49

false

Question 50

what is the most common treatment option in complicated yeast infections that are not caused by c albicans

Answer 50

boric acid 300mg PV x 14 days

Question 51

how are the non-infectiois causes of vaginitis usually treated

Answer 51

generally directed at the underlying cause (hormonal therapies, lubricants/moisturizers) <- require referral