questions 2

Vaginitis

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Topic updated on 02/04/17 5:55pm

Snapshot
  • A 30-year-old woman with diabetes mellitus comes to the office complaining of pruritic and grayish vaginal discharge.  She has not had sexual intercourse for the past six months. On KOH prep you notice a fishy smell with the presence of clue cells on microscopy. The vaginal pH is 5.5. (Vaginitis due to Gardnerella vaginalis)
Introduction
  • The normal vagina contains
    • mixed bacterial flora
    • acidic environment maintained by lactic acid producing lactobacilli
    • any change in the pH can lead to an overgrowth of other bacterial species
  • Etiology
    • Gardnerella vaginalis
      • most common cause of vaginitis
      • Gram-negative rod
      • no inflammation
    • Trichomonas vaginalis
      • protozoa with "jerky" motility
      • sexually transmitted
    • Candida
      • pseudohyphic yeast
      • risk factors
        • diabetes, antibiotics, and pregnancy
Presentation
  • Symptoms
    • vulvovaginal pruritus
    • burning sensation
    • odor
      • fishy = G. vaginosis
      • foul-smelling = T. vaginalis
    • increased vaginal discharge
      • cottage cheese = Candida
      • yellow/green = T. vaginalis
      • watery/grayish = G. vaginosis
Evaluation
  • Vaginal discharge slide smear
    • KOH prep
      • clue cells = G. vaginosis 
        • organism adherent to squamous cells
      • motile trichomonads = T. vaginalis
        • also strawberry cervix on speculum exam
      • psuedohyphae = C. albicans
    • Gram-stain
Differential
  • Sexually transmitted infections
    • e.g., chlamydia and gonorrhea
  • Atrophic vaginitis
  • Contact dermatitis
Treatment
  • G. vaginosis
    • metronidazole
  • T. vaginalis
    • metronidazole
    • treat sexual partner(s)
  • Candida
    • fluconazole 
Prognosis, Prevention, and Complications
  • Prevention
    • avoid douching
    • use of barrier contraception
    • better glycemic control if diabetic
  • Complications
    • recurrent vaginitis
    • increased risk of STIs, PID, and pre-term labor


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Qbank (1 Questions)

TAG
(M1.RP.75) A 24-year-old woman presents complaining of a new onset vaginal odor. She reports that she is sexually active in a monogamous relationship with the same partner for two years. You perform a KOH prep, and notice an abnormal smell. On microscopy in your office, you observe the findings in figure A.

What is the most likely causative organism? Topic Review Topic
FIGURES: A          

1. Trichomonas vaginalis
2. Candida albicans
3. Escherichia coli
4. Gardnerella vaginalis
5. Neisseria gonorrhoeae

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