Sandbox: Reddy: Difference between revisions
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! rowspan="1" | pH|| Saline Wet mount preparation|| Gold Standard test | ! rowspan="1" | pH|| Saline Wet mount preparation|| Gold Standard test | ||
|- | |- | ||
| [[Candida Vulvovaginitis]] ||Normal|| Hyphae and pseudohyphae can be demonstrated || Culture | | [[Candida Vulvovaginitis]] ||Normal|| Hyphae and pseudohyphae can be demonstrated || Culture | ||
| | | | ||
*In patients with normal pH | *In patients with normal pH and positive microscopy, culture is not neccessary and treatment can be initiated | ||
*In patients with normal pH and negative microscopy, culture for candida | *In patients with normal pH and negative microscopy, culture for candida is done | ||
| | | | ||
* Topical Azoles for uncomplicated infection | |||
* Oral Fluconazole one dose of 150mg for complicated infection | |||
|- | |- | ||
| [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated|| | | [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated||Gram Stain to determine the relative concentration of lactobacilli, G. vaginalis, Prevotella,Porphyromonas, peptostreptococci and Mobiluncus | ||
| | | | ||
Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV | Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV | ||
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*Milky homogenous, adherent vaginal discharge | *Milky homogenous, adherent vaginal discharge | ||
*Positive “whiff” test, which is an amine or “fishy” odor noted after the addition of 10% potassium hydroxide | *Positive “whiff” test, which is an amine or “fishy” odor noted after the addition of 10% potassium hydroxide | ||
| | *Correlation of the criteria and gram stain is performed to aid diagnosis | ||
|Metronidazole | |||
500 mg orally twice a day for 7 days | |||
OR | |||
Metronidazole | |||
gel 0.75%, one full applicator (5 g) intravaginally, once a | |||
day for 5 days | |||
OR | |||
Clindamycin | |||
cream 2%, one full applicator (5 g) intravaginally at | |||
bedtime for 7 days | |||
|- | |- | ||
| [[Trichomoniasis]] ||Normal||Motile Trichomonads|| Nucleic acid amplification test(NAAT) | | [[Trichomoniasis]] ||Normal||Motile Trichomonads | ||
Positive Whiff test | |||
|| Nucleic acid amplification test(NAAT) | |||
| | | | ||
*NAAT is highly sensitive for the diagnosis of Trichomonas vaginalis. | |||
*Treatment is initiated after confirmation of the diagnosis | |||
|Metronidazole 2g or Tinidazole2g in a single dose | |||
|- | |- | ||
| [[Atrophic Vaginitis]] ||Normal|| Vaginal smear cytology shows increased parabasal cells|| | | [[Atrophic Vaginitis]] ||Normal|| Vaginal smear cytology shows increased parabasal cells||Leftward shift of the vaginal maturation index | ||
| | | | ||
*Diagnosis requires the correlation of clinical presentation and vaginal cytology findings. | |||
*Other causes causing atrophic changes in the vagina should be ruled out. | |||
|Lubricants | |||
Topical or Oral estrogen therapy | |||
|} | |} |
Revision as of 21:53, 13 January 2017
Vaginitis
Overview
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.
Synopsis
Diagnosis
Candida Vulvovaginitis | Bacterial Vaginosis | Trichomoniasis | Atrophic Vaginitis | |
---|---|---|---|---|
Vaginal pH | Normal | Increased | Normal | |
Wet mount Microscopy | Hyphae and pseudohyphae
can be demonstrated |
Clue cells | Motile trichomonads | |
10% KOH smear | Hyphae and pseudohyphae
can be demonstrated |
|||
Gold Standard diagnostic test | Culture | Vaginal maturation
Index |
Treatment
Candida Vulvovaginitis | Bacterial Vaginosis | Trichomoniasis | Atrophic Vaginitis | |
---|---|---|---|---|
Medical Therapy | ||||
Recurrence | ||||
HIV positive individuals | ||||
Treatment for partner | ||||
Pregnant women |
Symptoms
Disease | Symptoms | Examination Findings | |||||
---|---|---|---|---|---|---|---|
Discharge | Dysuria | Vaginal odor | Dyspareunia | Genital skin lesion | Genital pruritus | ||
Candida Vulvovaginitis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔✔ |
|
Bacterial Vaginosis | ✔ | ✔ |
| ||||
Trichomoniasis | ✔ | ✔ | ✔ | ✔ | ✔ |
| |
Atrophic Vaginitis | ✔ | ✔ | ✔ | ✔✔ | ✔ | ✔ |
|
Diagnosis
Disease | Investigation | Diagnostic Approach | Treatment | ||
---|---|---|---|---|---|
pH | Saline Wet mount preparation | Gold Standard test | |||
Candida Vulvovaginitis | Normal | Hyphae and pseudohyphae can be demonstrated | Culture |
|
|
Bacterial Vaginosis | >4.5 | Clue cells are demonstrated | Gram Stain to determine the relative concentration of lactobacilli, G. vaginalis, Prevotella,Porphyromonas, peptostreptococci and Mobiluncus |
Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV
|
Metronidazole
500 mg orally twice a day for 7 days OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days |
Trichomoniasis | Normal | Motile Trichomonads
Positive Whiff test |
Nucleic acid amplification test(NAAT) |
|
Metronidazole 2g or Tinidazole2g in a single dose |
Atrophic Vaginitis | Normal | Vaginal smear cytology shows increased parabasal cells | Leftward shift of the vaginal maturation index |
|
Lubricants
Topical or Oral estrogen therapy |