Podcast
Questions and Answers
Which of the following is NOT a risk factor for Candida infections?
Which of the following is NOT a risk factor for Candida infections?
What is a common subjective finding in patients with Trichomoniasis?
What is a common subjective finding in patients with Trichomoniasis?
Which microscopy finding is associated with Candida infection?
Which microscopy finding is associated with Candida infection?
What is the recommended treatment for Trichomoniasis in women?
What is the recommended treatment for Trichomoniasis in women?
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Which finding indicates atrophic vaginitis?
Which finding indicates atrophic vaginitis?
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Which of the following is a treatment option for Candida infections?
Which of the following is a treatment option for Candida infections?
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What type of organism causes Trichomoniasis?
What type of organism causes Trichomoniasis?
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Which exam finding is typical in women with atrophic vaginitis?
Which exam finding is typical in women with atrophic vaginitis?
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What is the primary characteristic of bacterial vaginosis?
What is the primary characteristic of bacterial vaginosis?
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Which of the following symptoms is associated with atrophic vaginitis?
Which of the following symptoms is associated with atrophic vaginitis?
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What is a common risk factor for developing bacterial vaginosis?
What is a common risk factor for developing bacterial vaginosis?
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Which vaginal microscopy finding is indicative of bacterial vaginosis?
Which vaginal microscopy finding is indicative of bacterial vaginosis?
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Which treatment option is recommended for bacterial vaginosis?
Which treatment option is recommended for bacterial vaginosis?
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What is the most common cause of vaginitis in the United States?
What is the most common cause of vaginitis in the United States?
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Which demographic is most impacted by atrophic vaginitis?
Which demographic is most impacted by atrophic vaginitis?
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Which of the following is a key educational recommendation for patients with bacterial vaginosis?
Which of the following is a key educational recommendation for patients with bacterial vaginosis?
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What is a key characteristic finding in a female patient diagnosed with Trichomoniasis?
What is a key characteristic finding in a female patient diagnosed with Trichomoniasis?
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Which symptom is least likely to be present in a patient experiencing atrophic vaginitis?
Which symptom is least likely to be present in a patient experiencing atrophic vaginitis?
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What is the primary mode of transmission for Trichomoniasis?
What is the primary mode of transmission for Trichomoniasis?
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Which of the following findings would indicate a normal vaginal flora?
Which of the following findings would indicate a normal vaginal flora?
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What treatment is recommended for acute symptomatic Candida infection?
What treatment is recommended for acute symptomatic Candida infection?
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In what age demographic is atrophic vaginitis most prevalent?
In what age demographic is atrophic vaginitis most prevalent?
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Which of the following risk factors is specifically associated with Candida infections?
Which of the following risk factors is specifically associated with Candida infections?
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Which finding in a cervix examination suggests Trichomoniasis?
Which finding in a cervix examination suggests Trichomoniasis?
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What is a hallmark characteristic of bacterial vaginosis that differentiates it from other types of vaginitis?
What is a hallmark characteristic of bacterial vaginosis that differentiates it from other types of vaginitis?
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Which of the following organisms is predominantly associated with bacterial vaginosis?
Which of the following organisms is predominantly associated with bacterial vaginosis?
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What vaginal pH level is indicative of bacterial vaginosis?
What vaginal pH level is indicative of bacterial vaginosis?
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Which of the following factors is NOT a recognized risk factor for bacterial vaginosis?
Which of the following factors is NOT a recognized risk factor for bacterial vaginosis?
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Which treatment is NOT recommended for bacterial vaginosis according to CDC guidelines?
Which treatment is NOT recommended for bacterial vaginosis according to CDC guidelines?
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What characteristic is typical of the discharge in bacterial vaginosis?
What characteristic is typical of the discharge in bacterial vaginosis?
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In terms of epidemiology, which statement about vaginal discharge is true?
In terms of epidemiology, which statement about vaginal discharge is true?
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What advice is specifically recommended for patients diagnosed with bacterial vaginosis?
What advice is specifically recommended for patients diagnosed with bacterial vaginosis?
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Study Notes
Vaginitis
- Inflammation of the vagina caused by changes in the balance of vaginal microorganisms
- Caused by infection, irritants, or hormonal deficiency
Infectious Vaginitis
- Includes Bacterial Vaginosis (BV), Trichomoniasis, and Vulvovaginal Candidiasis (VVC)
Epidemiology
- The most common gynecological diagnosis seen in primary care
- Results in millions of office visits annually
- Trichomoniasis is one of the most prevalent nonviral STIs in the world
- Approximately 75% of women will have an episode of VVC in their lifetime
- Atrophic vaginitis impacts up to 40% of postmenopausal females
Bacterial Vaginosis (BV)
- A polymicrobial syndrome caused by an overgrowth of anaerobic bacteria in the vagina
- Normal vaginal flora shifts from lactobacilli to anaerobic organisms, primarily Gardnerella vaginalis.
- Not a sexually transmitted infection (STI), but sexually associated
BV Risk Factors
- Multiple sex partners
- Previous female sex partners
- Black or Hispanic race
- Other STIs
- New sexual partner
- Douching
- Unprotected intercourse
- Cigarette smoking
- Intrauterine Device (IUD)
BV Objective Findings
- Fishy or musty vaginal odor: Stronger after sexual intercourse, menstruation, or exercise
- Thin, homogenous discharge: No vaginal or vulvar irritation, normal vulvar and vaginal mucosa (BME)
- Speculum Exam shows thin, homogenous discharge that adheres to the vaginal wall and may be white in color
BV Vaginal Microscopy
- Clue Cells: Vaginal epithelial cells covered in bacteria, described as "pepper on an egg"
- Positive Whiff Test: A strong fishy odor releases upon adding 10% potassium hydroxide (KOH) solution to the specimen
- Vaginal pH >4.5
BV Treatment
- CDC treatment recommendations include:
- Metronidazole 500mg BID for 7 days
- Metronidazole gel 0.75%, 5g intravaginally once daily for 5 days
- Clindamycin cream 2%, 5g intravaginally at bedtime for 7 days
BV Patient Education
- Avoid sexual activity until treatment completion
- STI screening is recommended
- Douching is discouraged
- BV is associated with preterm labor during pregnancy
- Clean sexual toys when shared between women
Vulvovaginal Candidiasis (VVC)
- Second leading cause of vaginitis in the US
- Recurrent VVC: Defined as 4 or more episodes in one year
- Candida albicans is the most common culprit, responsible for 80-90% of cases
- Approximately 50% of women may have asymptomatic Candida as part of their normal vaginal flora
VVC Risk Factors
- Oral contraceptive (OCP) use
- Diaphragm or IUD use
- Receptive oral sex
- Diabetes
- Pregnancy
- Oral antibiotic use
VVC Subjective and Objective Findings
- Pruritus: Itching
- Dysuria: Pain during urination
- Thick, white vaginal discharge: Adheres to vaginal walls
- Vulvar and vaginal erythema, edema, and fissures: Redness, swelling, and cracks
VVC Microscopy
- Normal vaginal pH
- Pseudohyphae or budding yeast cells
- Negative Whiff test
VVC Treatment
- Multiple antifungal topical treatments available (OTC and by prescription):
- Clotrimazole
- Miconazole
- Tioconazole
- Butoconazole
- Terconazole
- Fluconazole 150mg orally once is also used
Trichomoniasis
- A sexually transmitted infection (STI) caused by Trichomonas vaginalis, a flagellated protozoan
- Transmission may involve contact with fomites (inanimate objects)
- While women can acquire the disease, men rarely transmit it to other men
- Accounts for 10-25% of vaginitis cases
Trichomoniasis Risk Factors
- Multiple or new sex partners, as well as history of other STIs
- IUD use
- Cigarette smoking
- 20-50% of cases may be asymptomatic
Trichomoniasis Subjective/Objective Findings
- Malodorous discharge: Foul-smelling discharge
- Copious, yellow-green discharge
- Pruritus and vaginal irritation
- Vulvar and vaginal edema: Swelling
- Strawberry cervix: Punctate hemorrhagic spots on the cervix
- Frothy, purulent discharge on speculum exam
Trichomoniasis Vaginal Microscopy
- Vaginal pH > 4.5
- Motile trichomoniasis
- Whiff test can be positive
Trichomoniasis Treatment
-
CDC Recommendation:
- Metronidazole 500mg bid for 7 days (women)
- Metronidazole 2g in a single dose (men)
-
Alternative Treatment for both men and women:
- Tinidazole 2g in a single dose
Atrophic Vaginitis
- Develops due to estrogen deficiency during menopause
- Diagnosis is based on symptoms
- Thinning of the vaginal epithelium with decreased vaginal rugae (folds)
- Decreased vaginal secretions
Atrophic Vaginitis Presentation
- Common in women who are surgically or naturally menopausal
- Affects 10-50% of postmenopausal women
- Symptoms include:
- Vulvovaginal dryness
- Pruritus (itching)
- Dyspareunia: Pain during intercourse
- Postcoital pain
- The STRAW STAGING system is a tool used for staging the severity.
Atrophic Vaginitis Exam Findings
- Decreased hair distribution and hair pigment changes on the vulva
- Decreased subcutaneous fat on the mons pubis and labia
- Fissuring (cracking) at the introitus (vaginal opening) or on the external genitalia
- Speculum Exam displays hypoestrogenism
Vaginitis
- Inflammation of the vagina resulting from changes to the vaginal environment
- Often caused by infections, irritants, and/or hormonal deficiencies
Infectious Vaginitis
- Includes bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis
Epidemiology
- One of the most common gynecological diagnoses in primary care
- Accounts for approximately 10 million office visits per year
- Trichomoniasis is the most common non-viral STI globally
- At least 75% of women will experience vulvovaginal candidiasis in their lifetime
- Atrophic Vaginitis impacts up to 40% of postmenopausal women
Bacterial Vaginosis (BV)
- Polymicrobial syndrome caused by an overgrowth of anaerobic organisms in the vagina.
- A shift in the normal vaginal flora from Lactobacilli to anaerobic organisms, primarily Gardenerella vaginalis.
- Not classified as a sexually transmitted infection, but is sexually associated.
BV Risk Factors
- Multiple sex partners/previous female sex partners
- Black or Hispanic ethnicity
- STI infections
- New sexual partners
- Douching
- Unprotected intercourse
- Cigarette smoking
- IUD
BV Objective Findings
- Fishy or musty vaginal odor more pronounced after sex, menses, or exercise.
- Thin, homogeneous vaginal discharge.
- No vaginal or vulvar irritation.
- Normal vulvar and perineal mucosa.
BV Speculum Findings
- Thin, homogeneous discharge.
- Discharge adheres to vaginal walls.
- Discharge appears white in color.
BV Microscopic Findings
- Presence of "clue cells" ("pepper on an egg").
- Positive Whiff test with 10% KOH solution application.
- Vaginal pH above 4.5.
BV Treatment
- CDC treatment recommendations include:
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75% 5 grams intravaginally once daily for 5 days
- Clindamycin cream 2% 5 grams intravaginally at bedtime for 7 days
BV Patient Education
- Avoid sexual activity until treatment is complete.
- Consider STI screening.
- Avoid douching.
- Bacterial vaginosis can increase the risk of preterm labor in pregnancy.
- Cleaning of sexual toys shared between women who have sex with women is recommended.
Vulvovaginal Candidiasis (VVC)
- Second most common cause of vaginitis in the US.
- Can be a recurring problem, defined as 4 or more episodes in a year.
- Candida Albicans is the infecting agent in 80-90% of cases.
- Up to 50% of women may have asymptomatic Candida organisms as part of their normal vaginal flora.
VVC Risk Factors
- Oral contraceptive use.
- Diaphragm or IUD use.
- Receptive oral sex.
- Diabetes.
- Pregnancy.
- Oral antibiotic use.
VVC Subjective/Objective Findings
- Pruritus.
- Dysuria.
- Thick, white vaginal discharge that adheres to vaginal walls.
- Vulvar and vaginal erythema, edema & fissures.
VVC Speculum Findings
- Thick, white cottage cheese-like discharge.
VVC Microscopic Findings
- Normal vaginal pH.
- Presence of Pseudohyphae or budding yeast cells.
- Negative Whiff test.
VVC Treatment
- Multiple topical antifungal treatments available (OTC and by RX)
- Clotrimazole
- Miconazole
- Tioconazole
- Butoconazole
- Terconazole
- Fluconazole 150 mg orally in a single dose.
Trichomoniasis
- A sexually transmitted infection (STI) caused by Trichomonas vaginalis, a protozoan with 4 flagella.
- Transmission via fomite is possible.
- Women who have sex with women (WSW) can acquire the infection but men who have sex with men (MSM) rarely infect other men.
- Accounts for 10-25% of vaginitis cases.
Trichomoniasis Risk Factors
- Multiple or new sex partners.
- History of STIs.
- IUD use.
- Cigarette smoking.
- 20-50% may be asymptomatic.
Trichomoniasis Subjective/Objective Findings
- Malodorous discharge, often copious.
- Yellow-green discharge.
- Vaginal pruritus and irritation.
- Vulvar & vaginal edema
- Strawberry Cervix (punctate hemorrhagic spots on the cervix)
- Frothy, purulent discharge on speculum exam.
Trichomoniasis Speculum Findings
- Frothy, purulent discharge.
Trichomoniasis Microscopic Findings
- Vaginal pH greater than 4.5
- Motile Trichomonads.
- Whiff test can be positive.
Trichomoniasis Treatment
- CDC recommendations include:
- Metronidazole 500 mg orally twice a day for 7 days (women)
- Metronidazole 2 grams in a single dose (men)
Trichomoniasis Alternative Treatment
- Tinidazole 2 grams in a single dose (women and men)
Atrophic Vaginitis
- Develops due to a lack of estrogen during menopause.
- Diagnosis is based on symptoms.
- Thinning of the vaginal epithelium occurs.
- Decrease in vaginal rugae.
- Reduced vaginal secretions.
Atrophic Vaginitis Presentation
- Occurs in women who are surgically or naturally menopausal.
- Impacts 10-50% of all menopausal women.
- Vulvovaginal dryness.
- Pruritus.
- Dyspareunia.
- Post coital pain.
- The STRAW staging system can be a useful tool for assessment.
Atrophic Vaginitis Exam Findings
- Decrease in hair distribution and pigment changes.
- Decreased subcutaneous fat on the mons pubis and labia.
- Introitus or external genitalia fissuring.
- Speculum exam shows signs of hypoestrogen.
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Description
Explore the different types of vaginitis, including infectious vaginitis caused by bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Understand the epidemiology and prevalence of these conditions, particularly in various demographics. This quiz covers essential risk factors and common symptoms associated with vaginitis.
