Sandbox: Reddy: Difference between revisions
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* Oral Fluconazole one dose of 150mg for complicated infection | * Oral Fluconazole one dose of 150mg for complicated infection | ||
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| [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated||Gram Stain | | [[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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500 mg orally twice a day for 7 days | 500 mg orally twice a day for 7 days | ||
OR | OR | ||
Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days | |||
Metronidazole | |||
gel 0.75%, one full applicator (5 g) intravaginally, once a | |||
day for 5 days | |||
OR | OR | ||
Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days | |||
Clindamycin | |||
cream 2%, one full applicator (5 g) intravaginally at | |||
bedtime for 7 days | |||
|- | |- | ||
| [[Trichomoniasis]] ||Normal||Motile Trichomonads | | [[Trichomoniasis]] ||Normal|| | ||
Positive Whiff test | *Motile Trichomonads | ||
*Positive Whiff test | |||
|| Nucleic acid amplification test(NAAT) | || Nucleic acid amplification test(NAAT) | ||
| | | | ||
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*Diagnosis requires the correlation of clinical presentation and vaginal cytology findings. | *Diagnosis requires the correlation of clinical presentation and vaginal cytology findings. | ||
*Other causes causing atrophic changes in the vagina should be ruled out. | *Other causes causing atrophic changes in the vagina should be ruled out. | ||
|Lubricants | | | ||
*Lubricants and moisturizers for mild symptoms | |||
Topical or Oral estrogen therapy | *Topical or Oral estrogen therapy for moderate to severe symptoms | ||
|} | |} |
Revision as of 21:57, 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
Symptoms
Disease | Symptoms | Examination Findings | |||||
---|---|---|---|---|---|---|---|
Discharge | Dysuria | Vaginal odor | Dyspareunia | Genital skin lesion | Genital pruritus | ||
Candida Vulvovaginitis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔✔ |
|
Bacterial Vaginosis | ✔ | ✔ |
| ||||
Trichomoniasis | ✔ | ✔ | ✔ | ✔ | ✔ |
| |
Atrophic Vaginitis | ✔ | ✔ | ✔ | ✔✔ | ✔ | ✔ |
|
Diagnosis and Treatment
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 |
|
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 |
|
|