Benign/Infectious Diseases of the Vagina/Vulva

Benign/Infectious Diseases of the Vagina/Vulva

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  Vaginal pH usually 3.5 – 4.5
  
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  Normal ecosystem consists of a variety of bacterium
  
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    Affected by antibiotics, hormones, douching, intercourse, STDs
    

Vaginal Infections

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  Trichomonas
  
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    Protozoan flagellate
    
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    Sx: Vag. Discharge, pruritis
    
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    Signs: thin, bubbly, gray/green D/C, strawberry patches, pH 5 – 6.5
    
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    Dx: wet prep
    
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    Tx: metronidazole
    

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  Candidiasis
  
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    Risk factors: DM, pregnancy OCP use, immunosuppression
    
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    SX: pruritis, buring, “cottage cheese” d/c
    
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    Signs: pH 4 – 4.5, vulvar erythema
    
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    Dx: wet prep of spores and hyphae
    
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    Tx: imidazole creams/suppositories, diflucan, ketoconazole
    

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  Bacterial Vaginosis
  
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    Gardnerella vaginalis Vaginitis; an anaerobic infection
    
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    Sx: malodorous D/C
    
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    Sign: gray d/c usually visible at introitus, pH 5 – 6.5
    
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    Dx: wet prep with clue cells
    
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    Tx: metronidazole/clindamycin p.o. or topical cream
    

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  Atrophic Vaginitis
  
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    Postmenopausal secondary to low estrogen, be wary of dystrophies
    
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    Sx: vulvar irritation, d/c
    
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    Signs: clear d/c, pale epithelium
    
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    Dx: vaginal basal cells replace superficial epith. Cells on pap
    
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    Tx: estrogen
    

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  Toxic Shock Syndrome
  
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    Staph. Aureus endotoxin causing rare, highly lethal infection
    

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  Molluscum Contagiosum
  
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    Transmitted via direct/indirect contact
    
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    Multiple small domer shaped nodules with umbilicated center
    
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    Tx: expression of caseous material and cauterization of base
    

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  Herpes
  
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    DNA virus
    
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    Sx: Appear 3 – 7 days post-exposure, severe vulvar pain, lymphadenopathy, malaise
    
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    Signs: tender vesicles that rupturein 1 – 7 days and form ulcers
    
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    Dx: culture, Tzank smear
    
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    Tx: no curative agent; acyclovir for symptoms
    

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  Syphilis
  
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    Treponema pallidum spirochete
    
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    Firm, painless chancre 10 – 60 days post exposure heals in 3 – 9 weeks without tx.
    
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    8 weeks after infection, secondary syphilis: malaise, skin rash, condyloma late
    
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    tertiary syphilis if left untreated
    
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    Dx: spirochete on dark-field microscopy
    
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    Tx: benzathine PCN for primary/secondary syphilis
    

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  Chancroid
  
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    Papule that ulcerates 3 – 5 days post exposure, painful
    
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    Dx: gram stain, culture, bx
    
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    Tx: p.o. erythro, ceftriaxone I.M.
    

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  Lymphogranuloma Venereum
  
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    Chlamydia trachomatis
    
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    Painless vulvovaginal ulcer followed in 1 month by adenitis
    
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    Chronic progressive disease with fistula formation, abcesses
    
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    Tx: erythro or tetracycline for 2 -3 weeks
    

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  Granuloma Inguinale
  
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    Calymmatocacterium granulomatis
    
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    Papule several weeks post exposure that ulcerates with rugged borders, painless
    
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    Dx: Donovan bodies on smear
    
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    Tx: tetracycline for 10 – 21 days