Vulvovaginitis
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vulvovaginitis definition& causes, bacterial vaginosis, candidiasis, Trichomonas vaginalis, HSV and how to take a vaginal swab
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Vulvovaginitis
- 1. Vulvovaginitis By D. Ahmed Mohamed Nasef Assistant lecturer in obstetrics & gynecology department Benha University
- 2. What is Vulvovaginitis? Inflammation of vulva and vagina It’s a common condition in all ages across female life span It has many causes
- 3. Causes of Vulvovaginitis Primary causes bacterial bacterial vaginosis, syphilis, TB Fungal candidiasis Parasitic Trichomonas vaginalis Chlamydia LGV Viruses HSV, CMV, HPV Secondary causes Cervical& vaginal discharge Urinary conditions incontinence, fistula, glucosuria, pyuria Rectal conditions rectovaginal fistula, complete perineal tear Chemical douches, sprays, perfumes Physical scratching, irradiation Traumatic FB, prolapse, Pessary Senile atrophic Vulvovaginitis
- 4. Presentation of Vulvovaginitis Pain Pruritis vulvae Dysuria Dyspareunia Discharge And every cause has its specific criteria
- 5. 3 classic entities of vaginitis include Bacterial vaginosis Trichomonas infection Candidiasis
- 6. Bacterial vaginosis Means replacement of normal vaginal flora (lactobacilli) which maintain acidity of vagina by other bacteria as G Vaginalis, mycoplasma hominis, ureaplasma urealyticum It accounts for about 60% of all causes of Vulvovaginitis
- 7. What predispose to bacterial vaginosis? Any condition which change PH of vagina from acidic to alkaline Frequent sexual intercourse Frequent use of alkaline vaginal douches
- 8. Presentation Asymptomatic (50%) Mild Vulvovaginitis with no pain, pruritis, dyspareunia nor discharge Vaginal discharge (profuse, thin, greyish, malodorous) characteristic fishy odor due to formation of amines by anaerobic bacteria from amino acids
- 9. How to diagnose? AMSEL criteria Characteristic vaginal discharge Vaginal PH >4.5 Clue cell Whiff test (adding 10% KOH to discharge gives fishy odor) Only 3 of these 4 are needed to diagnose BV
- 10. What is clue cell? Granular appearance of vaginal epithelial cells Due to adherence of bacteria to their surface on gram stain
- 11. Complications In non pregnant women PID UTI Salpingitis Endometritis Wound infections In pregnant women Chorioamnionitis PROM PTL
- 12. Treatment of BV General principles Keep vulva dry and clean If using douches should be neutral (better to avoid) Use cotton, loose, dry underwear BV occurring in pregnant women should be treated Medical Metronidazole local or oral Or clindamycin oral or local Antipruritic antihistaminic, corticosteroids
- 13. Candidiasis Also called moniliasis or monilia thrush Caused by candida organism
- 14. Predisposing factors Increased vaginal acidity Moisture Increased vaginal epithelial glycogen (COCs, pregnancy) Decreased resistance (DM, steroids) Prolonged use of antibiotics Contamination from STDs, hands, towels, instruments
- 15. Presentation Premenstrual Severe Vulvovaginitis (pain, pruritis, dyspareunia& discharge) Discharge is odorless, whitish, thick, curdy- cheese, scanty
- 16. Investigations PH acidic Smear gram positive, hyphae, spores Culture on sabarouds agar
- 17. Management Prophylaxis Eliminate pdfs Avoid vaginal douches Treat husband Keep vulva dry and clean Use cotton, loose, dry underwear Medical Local clotrimazole, miconazole Oral (in virgins, in resistant to local treatment) Ketoconazole, fluconazole
- 20. Predisposing factors Increased vaginal alkalinity Frequent use of alkaline douches Frequent sexual intercourse Decreased resistance (DM, steroids) Prolonged use of antibiotics Contamination from STDs, hands, towels, instruments
- 21. Presentation Postmenstrual Severe Vulvovaginitis Discharge (malodorous, greenish, frothy, profuse) On examination Red edematous punctate hemorrhage (strawberry vagina)
- 23. Investigations PH alkaline Gram negative Motile flagellated organisms
- 24. Management Prophylaxis Eliminate pdfs Avoid vaginal douches Treat husband Keep vulva dry and clean Use cotton, loose, dry underwear Medical Local Metronidazole Oral (in virgins, in resistant to local treatment) Metronidazole Tinidazole
- 26. Genital herpes Genital herpes is a sexually transmitted infection (STI) May be transmitted orogenital Two types of the herpes simplex virus (HSV) cause genital herpes: HSV 1 & 2
- 27. Presentation Asymptomatic Pain or itching Small red bumps or tiny white blisters or vesicles Ulcers (These may form when blisters rupture and ooze or bleed. Ulcers may make it painful for the patient to urinate Secondary bacterial infections
- 28. Complications of HSV Other sexually transmitted infections Newborn infection Bladder problems Meningitis Rectal inflammation (proctitis)
- 29. Diagnosis Viral culture Polymerase chain reaction (PCR) test
- 30. Treatment Antiviral medications used for genital herpes include: Acyclovir Valacyclovir
- 31. How to take vaginal swab?