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| ==Vaginitis==
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| ==Overview==
| | {{Roseola}} |
| Vulvovaginitis is a common condition for which women seek medical care accounting for approximately 10 million office visits every year. It is defined as symptoms that cause itching, irritation, burning and abnormal vaginal discharge. The three common causes of vaginal discharge in reproductive age group include: most common being Bacterial Vaginosis followed by Candida vulvovaginitis and Trichomoniasis.
| | {{CMG}}:{{AE}}{{DAMI}} |
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| ==Synopsis==
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| ==Symptoms== | | ==[[Roseola overview|Overview]]== |
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| {| class="wikitable" style="border: 2; background: none;"
| | ==[[Roseola historical perspective|Historical Perspective]]== |
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| ! rowspan="2" | Disease
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| ! colspan="6" rowspan="1" | Symptoms
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| ! rowspan="2" | Examination Findings
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| ! rowspan="1" | Discharge || Dysuria || Vaginal odor || Dyspareunia || Genital skin lesion || Genital pruritus
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| | [[Candida Vulvovaginitis]] ||✔ ||✔ ||✔ || ✔
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| ||✔ ||✔✔
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| *Vulvar edema, fissures, excoriations
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| *Thick curdy vaginal discharge
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| | [[Bacterial Vaginosis]] ||✔||||✔|||| ||
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| * Fishy-odor from the [[vagina]]
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| * Thin, white/gray homogeneous [[vaginal discharge]]
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| * Lack of significant vulvovaginal inflammation
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| | [[Trichomoniasis]] ||✔||✔|| ✔
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| * Strawberry cervix: petechial haemorrhages on the ectocervix, specific to trichomoniasis
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| * Frothy, mucopurulent, yellow-green or gray vaginal discharge
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| | [[Atrophic Vaginitis]] ||✔||✔|| ✔
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| *Pale and dry vaginal epithelium
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| *Increased friability of the epithelium with patchy erythema and petechiae
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| *Sparsity of pubic hair, fusion of the [[labia minora]], narrow and a shortened vagina
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| ==Diagnosis== | | ==[[Roseola classification|Classification]]== |
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| ! rowspan="2" | Disease
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| ! colspan="3" rowspan="1" | Investigation
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| ! rowspan="2" | Diagnostic Approach
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| !rowspan="2" | Treatment
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| ! rowspan="1" | pH|| Saline Wet mount preparation|| Gold Standard test
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| | [[Candida Vulvovaginitis]] ||Normal|| Hyphae and pseudohyphae can be demonstrated || Culture
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| *In patients with normal pH and positive microscopy, culture is not neccessary and treatment can be initiated
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| *In patients with normal pH and negative microscopy, culture for candida is done
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| * Topical Azoles for uncomplicated infection
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| * Oral Fluconazole one dose of 150mg for complicated infection
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| | [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated||Gram Stain to determine the relative concentration of lactobacilli, G. vaginalis, Prevotella,Porphyromonas, peptostreptococci and Mobiluncus
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| Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV
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| *Vaginal fluid pH >4.5
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| *>20% of epithelial cells are “clue” cells (cells with unclear borders, dotted with bacteria)
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| *Milky homogenous, adherent vaginal discharge
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| *Positive “whiff” test, which is an amine or “fishy” odor noted after the addition of 10% potassium hydroxide
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| *Correlation of the criteria and gram stain is performed to aid diagnosis
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| |Metronidazole
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| 500 mg orally twice a day for 7 days
| | ==[[Roseola pathophysiology|Pathophysiology]]== |
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| OR
| | ==[[Roseola causes|Causes]]== |
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| Metronidazole
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| gel 0.75%, one full applicator (5 g) intravaginally, once a
| | ==[[Roseola epidemiology and demographics|Epidemiology and Demographics]]== |
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| day for 5 days
| | ==[[Roseola risk factors|Risk Factors]]== |
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| OR
| | ==[[Roseola screening|Screening]]== |
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| Clindamycin
| | ==[[Roseola natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| cream 2%, one full applicator (5 g) intravaginally at
| | ==Diagnosis== |
| | [[Roseola history and symptoms|History and Symptoms]] | [[Roseola physical examination|Physical Examination]] | [[Roseola laboratory findings|Laboratory Findings]] | [[Roseola electrocardiogram|Electrocardiogram]] | [[Roseola chest x ray|Chest X Ray]] | [[Roseola CT|CT]] | [[Roseola MRI|MRI]] | [[Roseola echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Roseola other imaging findings|Other Imaging Findings]] | [[Roseola other diagnostic studies|Other Diagnostic Studies]] |
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| bedtime for 7 days
| | ==Treatment== |
| |- | | [[Roseola medical therapy|Medical Therapy]] | [[Roseola surgery|Surgery]] | [[Roseola primary prevention|Primary Prevention]] | [[Roseola secondary prevention|Secondary Prevention]] | [[Roseola cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Roseola future or investigational therapies|Future or Investigational Therapies]] |
| | [[Trichomoniasis]] ||Normal||Motile Trichomonads | |
| Positive Whiff test
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| || Nucleic acid amplification test(NAAT) | |
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| *NAAT is highly sensitive for the diagnosis of Trichomonas vaginalis.
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| *Treatment is initiated after confirmation of the diagnosis
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| |Metronidazole 2g or Tinidazole2g in a single dose
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| | [[Atrophic Vaginitis]] ||Normal|| Vaginal smear cytology shows increased parabasal cells||Leftward shift of the vaginal maturation index | |
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| *Diagnosis requires the correlation of clinical presentation and vaginal cytology findings.
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| *Other causes causing atrophic changes in the vagina should be ruled out.
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| |Lubricants
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| Topical or Oral estrogen therapy
| | ==Case Studies== |
| |} | | [[Roseola case study one|Case #1]] |