Vaginitis

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					Disease: Vaginitis

General Info: Inflammation and infection of the vagina are common. Normal vaginal Ph is 3.8-4.2,
and lactobacillus is the predominant organism. In Luteal phase and during pregnancy, vaginal secretions
are thicker, white, and sometimes adherent to the vaginal walls – these can be confused with Vaginitis.
Candidiasis -
Trichomonas -
Bacterial Vaginosis -

Cause:
Candidiasis – Pregnancy, diabetes and use of broad-spectrum antibiotics or corticosteroids. Heat,
moisture and occlusive clothing also contribute to risk.
Trichomonas – Protozoal infects the vagina, Skene’s ducts, and Lower urinary tract in women and lower
urinary tract in men. Transmitted via coitus.
Bacterial Vaginosis – Polymicrobial disease that is not sexually transmitted. An overgrowth of
gardenerella and other anaerobes.


Signs / Symptoms:
Candidiasis – Itching/burning discharge
              Ph ≤ 4.5, White, curdy “cottage cheese” discharge, - odor from KOH
Trichomonas – Excessive discharge, bad odor, vulvar pruritus, Dysuria, erythema, red macular lesions
              on the cervix in severe cases.
              Ph > 4.5, Yellow, green, frothy adherent discharge often increased
Bacterial Vaginosis – Discharge, bad odor, possibly worse after intercourse, itching may be present
              Ph 5.0 – 5.5, Thin, homogeneous, milky-white/gray, adherent discharge often increased
              Clue Cells with adherent coccoid bacteria – no WBC – “Fishy” odor

Treatment:
Candidiasis – uncomplicated 1-3 day regiment, complicated 7-14 day regiment
1 – Clotrimazole or Tioconazole & Fluconazole
3 – Butoconazole, Clotrimazole, Terconazole or Miconazole once a day
7 – Clotrimazole, Miconazole or Terconazole once a day (cream or tablet)
14 – Nystatin (100,000 units) vaginal tablet once a day

Trichomonas – Treat both partners
Metronidazole (Flagyl) 2 g as a single dose or 500mg BID x 7 days.
If treatment failure give Metronidazole (several more times)

Bacterial Vaginosis -
Metronidazole 500 mg BID x 7 days, Clindamycin Vaginal Cream 2%, 5g QD x 7 days or
Metronidazole gel 0.75% 5g BID x 5 days

				
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posted:2/5/2013
language:English
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