Benign/Infectious Diseases of the Vagina/Vulva



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Benign/Infectious Diseases of the Vagina/Vulva


  • Vaginal pH usually 3.5 – 4.5

  • Normal ecosystem consists of a variety of bacterium

    • Affected by antibiotics, hormones, douching, intercourse, STDs



Vaginal Infections


  • Trichomonas

    • Protozoan flagellate

    • Sx: Vag. Discharge, pruritis

    • Signs: thin, bubbly, gray/green D/C, strawberry patches, pH 5 – 6.5

    • Dx: wet prep

    • Tx: metronidazole




  • Candidiasis

    • Risk factors: DM, pregnancy OCP use, immunosuppression

    • SX: pruritis, buring, “cottage cheese” d/c

    • Signs: pH 4 – 4.5, vulvar erythema

    • Dx: wet prep of spores and hyphae

    • Tx: imidazole creams/suppositories, diflucan, ketoconazole




  • Bacterial Vaginosis

    • Gardnerella vaginalis Vaginitis; an anaerobic infection

    • Sx: malodorous D/C

    • Sign: gray d/c usually visible at introitus, pH 5 – 6.5

    • Dx: wet prep with clue cells

    • Tx: metronidazole/clindamycin p.o. or topical cream




  • Atrophic Vaginitis

    • Postmenopausal secondary to low estrogen, be wary of dystrophies

    • Sx: vulvar irritation, d/c

    • Signs: clear d/c, pale epithelium

    • Dx: vaginal basal cells replace superficial epith. Cells on pap

    • Tx: estrogen




  • Toxic Shock Syndrome

    • Staph. Aureus endotoxin causing rare, highly lethal infection




  • Molluscum Contagiosum

    • Transmitted via direct/indirect contact

    • Multiple small domer shaped nodules with umbilicated center

    • Tx: expression of caseous material and cauterization of base



  • Herpes

    • DNA virus

    • Sx: Appear 3 – 7 days post-exposure, severe vulvar pain, lymphadenopathy, malaise

    • Signs: tender vesicles that rupturein 1 – 7 days and form ulcers

    • Dx: culture, Tzank smear

    • Tx: no curative agent; acyclovir for symptoms




  • Syphilis

    • Treponema pallidum spirochete

    • Firm, painless chancre 10 – 60 days post exposure heals in 3 – 9 weeks without tx.

    • 8 weeks after infection, secondary syphilis: malaise, skin rash, condyloma late

    • tertiary syphilis if left untreated

    • Dx: spirochete on dark-field microscopy

    • Tx: benzathine PCN for primary/secondary syphilis




  • Chancroid

    • Papule that ulcerates 3 – 5 days post exposure, painful

    • Dx: gram stain, culture, bx

    • Tx: p.o. erythro, ceftriaxone I.M.




  • Lymphogranuloma Venereum

    • Chlamydia trachomatis

    • Painless vulvovaginal ulcer followed in 1 month by adenitis

    • Chronic progressive disease with fistula formation, abcesses

    • Tx: erythro or tetracycline for 2 -3 weeks




  • Granuloma Inguinale

    • Calymmatocacterium granulomatis

    • Papule several weeks post exposure that ulcerates with rugged borders, painless

    • Dx: Donovan bodies on smear

    • Tx: tetracycline for 10 – 21 days


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