Women's Health: Bacterial Vaginosis Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is not a recommended action to prevent vaginal candidiasis (thrush)?

Wiping front to back

Using perfumed toiletries (correct)

Wearing tight-fitting underwear (correct)

Applying a moisturiser around the vagina

Which statement about bacterial vaginosis (BV) is true?

The condition is caused by an overgrowth of bad bacteria due to a shortage of lactobacilli. (correct)

BV is always symptomatic and causes significant irritation.

All women with BV experience thick, white discharge.

BV is classified as a sexually transmitted infection (STI).

What is a common risk factor for developing bacterial vaginosis?

Change in sexual partner(s) (correct)

Healthy diet

Regular exercise

Use of cotton underwear

Which of the following symptoms is most commonly associated with bacterial vaginosis?

Clear, greyish discharge Signup and view all the answers

What type of treatment is typically used for bacterial vaginosis?

Over-the-counter (OTC) vaginal pH correctors Signup and view all the answers

Which of the following is a sign of bacterial vaginosis that distinguishes it from other vaginal conditions?

Foul-smelling discharge Signup and view all the answers

Why should caution be exercised when using moisturisers around the vagina?

They can weaken the effectiveness of condoms. Signup and view all the answers

Which of the following can be considered a possible cause of bacterial vaginosis?

Use of bubble baths Signup and view all the answers

Which condition is indicated by discharge that smells fishy?

Bacterial vaginosis Signup and view all the answers

What is the characteristic appearance of discharge in thrush?

Thick and white, like cottage cheese Signup and view all the answers

Which treatment option is an antifungal agent used for vaginal candidiasis?

Miconazole Signup and view all the answers

What is a serious associated symptom that should prompt a referral for possible vaginal candidiasis?

Irregular vaginal bleeding Signup and view all the answers

Which of these options is a potentially caused condition when discharge is accompanied by pelvic pain or bleeding?

Chlamydia or gonorrhoea Signup and view all the answers

Which of the following is NOT an antifungal formulation for treating thrush?

Antibiotic tablet Signup and view all the answers

Which discharge characteristic is typically associated with trichomoniasis?

Green, yellow, or frothy Signup and view all the answers

What is the active ingredient in Canesten cream that is suitable for treating thrush?

Clotrimazole Signup and view all the answers

What is the primary causative agent of vaginal candidiasis, commonly referred to as thrush?

Candida albicans Signup and view all the answers

Which of the following is NOT a known risk factor for developing vaginal candidiasis?

High fiber diet Signup and view all the answers

Which symptom is typically associated with vaginal candidiasis?

Itching Signup and view all the answers

How can vaginal candidiasis potentially affect sexual partners?

Oral sex may increase risk of transmission Signup and view all the answers

What is a differentiating symptom of bacterial vaginosis compared to vaginal candidiasis?

Foul-smelling vaginal discharge Signup and view all the answers

What percentage of women will experience at least one episode of vaginal thrush in their lifetime?

75% Signup and view all the answers

Which condition is likely to present with itching but not with a characteristic discharge associated with vaginal candidiasis?

Chlamydia Signup and view all the answers

Which of these treatments is most likely to cause an increase in the incidence of vaginal candidiasis?

Broad-spectrum antibiotics Signup and view all the answers

Study Notes

Clinical Decision Making - Women's Health

Learning Objectives:
- Identify steps to facilitate decision-making for women's health issues.
- Gather information for structured decision-making processes during differential diagnosis.
- Identify management options for female patients with women's health problems.

Lecture Overview

Women's Health Conditions:
- Vaginal thrush
- Bacterial vaginosis (BV)
- Trichomoniasis
- Dysmenorrhoea (Period Pain)
- Menorrhagia (Heavy periods)
- Polycystic ovary syndrome (PCOS)
- Adenomyosis
- Endometriosis
- Fibroids
- Emergency hormonal contraception (EHC)
- Menopause

Women's Health

Appropriate Questions:
- WWHAM? (and beyond)
Consideration for Condition:
- Nature of the condition
Confidentiality:
- Women's health conditions are associated with:
  - Female reproductive system
  - Urinary system (covered in detail in CDM – renal lecture)

Anatomy of the Female Reproductive System

Diagrams showing different views and components.

Anatomy of Reproductive Systems

Diagrams of the both male and female reproductive systems.

Aetiology

Vagina: Nutrient-rich environment with its own microflora.
Normal Vaginal pH: 3.8-4.5 (Natural resistance to pathogens)
Natural Discharge: Watery, keeps vagina clean, lubricated, and protects from infection (usually clear & odourless).
Discharge Changes: Affected by hormonal changes, pregnancy, and medication.
Discharge During Ovulation: Thicker consistency
Vaginal Glycogen: Found in epithelium, broken down to acids (e.g., lactobacilli) creating a low pH environment unsuitable for pathogens.
Estrogen Regulation: Controls glycogen concentration; decrease in estrogen levels = decrease in glycogen and increase in vaginal pH = increased chance of infection.

Vaginal Candidiasis (Thrush)

Cause: Yeast infection (Candida albicans), normal inhabitant of mouth, vagina, skin, and GI tract. Can multiply due to vaginal pH changes or sex hormone fluctuations.
Epidemiology: 75% of women experience at least one episode, 40-50% experiencing more than one. Affects women of all ages.

Vaginal Candidiasis (Thrush) - Risk Factors

Estrogen exposure (more common during reproductive years & pregnancy)
Immunocompromised state (e.g., HIV positive women)
Poorly controlled diabetes mellitus
Treatment with broad-spectrum antibiotics
Local irritants (e.g., soaps, shower gels, feminine hygiene products, tight fitting synthetic clothing)
Sexual intercourse (can be passed to partners)
Contraception (e.g. spermicides, pills)
Hormone Replacement Therapy (HRT)

Vaginal Candidiasis (Thrush) - Signs and Symptoms

Itching
Soreness / Irritation
Vaginal discharge (creamy/white, non-smelling)
Burning/ stinging on urination
Pain during sexual intercourse
Can be passed to sexual partners occasionally

Vaginal Candidiasis (Thrush) - Differential Diagnosis

Bacterial vaginosis: Itch is not usually prominent. Discharge is usually white.
Chlamydia: vaginal discharge and dysuria (painful urination), but itching is not common.
Gonorrhoea: Rarely presents with itching, but associated with pain and discharge.
Genital herpes: Redness, itching, and open sores/ulcers; discharge is uncommon; and acute vulval pain often is what makes it different.
Vulval eczema or psoriasis: May cause similar itching to thrush.
Allergies (e.g. latex condoms): Can cause itching.
Malignancies: Rare, but sometimes present with vaginal discharge.

Differentiating Discharge

A table showing different types of discharge and their possible causes (Bacterial vaginosis, Thrush, Trichomoniasis).

Vaginal Candidiasis (Thrush) - Referral

First-time sufferers
More than 2 cases in 6 months
Pregnant/breastfeeding women
Women below 16 or over 60 years old
Blood-stained discharge
Irregular vaginal bleeding
Symptoms like abdominal pain, painful urination, fever, diarrhea, nausea, or vomiting
Ulcers on vulva/vagina
Immunocompromised patients (e.g., diabetes)
No improvement in 7 days

Vaginal Candidiasis (Thrush) - Treatment Options

Antifungals (imidazoles): clotrimazole, miconazole, fluconazole
Anti-itch/irritation: Benzocaine, Lidocaine
Formulation options: topical cream, internal cream, pessary, oral capsule

Vaginal Candidiasis (Thrush) - Treatment

Antifungals (imidazoles) inhibit yeast cell replication by affecting ergosterol.
Treatments: External Cream (2%), Internal Cream (10%), Pessaries (500 mg) clotrimazole, Fluconazole (150mg capsule).

Vaginal Candidiasis (Thrush) - Anti-itch/irritation Treatment

Active Ingredients: Benzocaine, Lidocaine
Pharmaceutical Products: examples include Lanacane cream (benzocaine), Vagisil medicated cream (lidocaine)
Associated Advice: external use only, short-term use. Consult for prolonged issues or worsening symptoms

Vaginal Candidiasis (Thrush) - Treatment Summary

First-line (1st): topical imidazoles (e.g., clotrimazole 2%). Duration is usually 7 days.
Second-line (2nd): Systemic therapy (e.g., fluconazole 150 mg). Usually a single dose.

Vaginal Candidiasis (Thrush)- Who is it For?

OTC treatments aren't suitable for under-16s or over-60s, first-time sufferers, pregnant, or those with diabetes.
Important information about discharge (smelly, color).
Recurring episodes, duration, symptoms, etc.
Information about the prior medications & efficacy.
Any current medications.

Preventing Vaginal Thrush - Associated Advice

Avoid tight-fitting underwear/ tights (cotton instead).
Avoid highly-perfumed toiletries, vaginal deodorants, douches.
Wipe front to back
Use water and emollient for cleaning vagina.
Apply greasier moisturizer (caution with condoms).
Use pessaries at night to prevent 'leak back'.
Topical treatments can damage latex condoms.

Bacterial Vaginosis (BV)

Cause: Change in the natural vaginal bacteria's balance (lack of good lactobacilli).
- Vagina contains lactobacilli that produce lactic acid (slightly acidic), preventing other bacteria's growth.
- A shortage of lactobacilli leads to excess of other bacteria, such as Gardnerella vaginalis, Prevotella species, Mycoplasma hominis, and Mobiluncus species.
- Vaginal pH increases above 4.5.
- Not a sexually transmitted infection (STI); higher prevalence is linked with frequent sexual activity

Bacterial Vaginosis (BV) - Risk Factors

Change in sexual partners
Bubble baths/perfumed products around the vagina
Intrauterine devices (IUDs)
Smoking

Bacterial Vaginosis (BV) - Signs and Symptoms

50% of women with BV are asymptomatic
Clear/greyish discharge
Foul smelling discharge (fishy odour)
No soreness, itching or irritation

Bacterial Vaginosis (BV) - Treatment

OTC vaginal pH correctors
Canesbalance BV gel (relieves odour & abnormal discharge, limits bad bacteria's growth & supports good bacteria).
Contains: lactic acid, glycogen, propylene glycol, methylhydroxypropyl cellulose, sodium lactate, water.
7 day treatment (symptoms usually soothe in 2-3 days).
Antibiotics like metronidazole (tablets, gel).

Trichomoniasis

Cause: Sexually transmitted infection (STI) caused by a parasite called Trichomonas vaginalis.
Signs and Symptoms:
- Symptoms develop within one month of infection.
- Can affect men and women (up to half may not show symptoms);
- Abnormal vaginal discharge (thick, thin, or frothy, yellow-green in color).
- More discharge than usual.
- Discharge may have an unpleasant fishy odor.
- Soreness, inflammation, itching around vagina.
- Pain or discomfort during urination or sex.
Referral: Any symptom requires referral to provider.
Treatment: Doctor will usually prescribe antibiotics (e.g., metronidazole).

Dysmenorrhoea (Period Pain)

Cause: Uterine muscle contractions to shed the womb lining during menstruation, caused by uterine prostaglandins.
Primary dysmenorrhoea: Absence of underlying pelvic pathology.
Secondary dysmenorrhoea: Caused by underlying pelvic pathology (e.g., endometriosis, fibroids, endometrial polyps).

Dysmenorrhoea (Period Pain) - Signs and Symptoms

Pain in lower abdomen, radiating to back and legs.
Spasmodic/cramp-like pain, sometimes dull ache.
Possible nausea and vomiting.
Start 1-2 days before period and may last 2-3 days during bleeding.
Fatigue, headache, mood changes.
Secondary symptoms can include: Heavy periods, Irregular periods, Bleeding between periods, and Painful Intercourse/ Bleeding after intercourse.

Dysmenorrhoea (Period Pain) - Treatment

Pain relief
- Paracetamol
- NSAIDs (ibuprofen, naproxen, diclofenac, aspirin) reduce prostaglandin production
- Tranexamic acid reduces excessive blood loss.

Dysmenorrhoea (Period Pain) - Other Treatment Options

Other medicines: Antispasmodics (Hyoscine butylbromide, Alverine citrate), Combined oral contraceptives
Non-pharmacological treatments: Hot water bottle/heat patch, TENS machines (transcutaneous electrical nerve stimulation), Acupuncture, Exercise, Dietary modifications (avoid caffeine, consider vitamins)

Menorrhagia (Heavy Periods)

Causes: Multiple conditions, including PCOS, PID, Fibroids, Endometriosis, Adenomyosis, Underactive thyroid, Cervical/endometrial polyps, Blood clotting disorders, Cancer of the womb
Diagnosis: Patient description (interferes with daily activities).
- Frequent changes of sanitary towels (every 1 to 2 hours).
- Using multiple sanitary products together
- Blood clots over 2.5 cm (10p coin)
- Periods lasting 7+ days
- Feeling tired/ short of breath

Menorrhagia (Heavy Periods) - Treatment

Combined contraceptive/intrauterine device (IUD)
Pain relief: Paracetamol, NSAIDs (ibuprofen/naproxen), mefenamic acid.
Medicines to reduce clotting: tranexamic acid.
Check iron levels (anaemia).

Polycystic Ovary Syndrome (PCOS)

Cause: Abnormal hormone levels (though exact cause is unknown).
Hormonal imbalances often associated with reproductive age.
Irregular periods, often without ovulation; A leading cause of infertility.
Symptoms may include excess androgen levels and cysts in the ovaries.
May be genetic or related to lifestyle or stress.

Polycystic Ovary Syndrome (PCOS) - Causes - Hormone Imbalance

High testosterone (androgen)
High luteinizing hormone (LH)
Low sex hormone-binding globulin (SHBG).
Raised prolactin levels (only in some cases)

Polycystic Ovary Syndrome (PCOS) - Causes - Insulin Resistance

Insulin is a hormone produced by the pancreas to control blood sugar.
Insulin resistance is where body tissues are resistant to insulin's effects.
The body compensates by producing more insulin.
High insulin stimulates ovaries to produce more testosterone, hindering follicle development and ovulation.
Insulin resistance can lead to weight gain, worsening symptoms.

Polycystic Ovary Syndrome (PCOS) - Causes - Genetics

PCOS tends to run in families, suggesting a possible genetic component. Genes linked to the condition have not always been identified.

Polycystic Ovary Syndrome (PCOS) - Symptoms

Irregular/absent periods
Oily skin/acne
Excess hair growth (hirsutism)
Hair thinning/loss
Weight gain, especially abdominal
Type 2 diabetes
High blood pressure (hypertension)
High Cholesterol
Heart disease
Endometrial cancer
Pregnancy risks (higher chance of complications).

Polycystic Ovary Syndrome (PCOS) - Treatment

Lifestyle changes: Healthy diet, weight loss, exercise.
Medications:
- Contraceptive pills (IUDs) to manage hormone imbalance.
- Metformin (often used for type 2 diabetes, but can lower insulin & blood sugar). Helpful in managing hormone imbalance.
- Fertility treatments: clomiphene or letrozole to stimulate ovulation.
- Medications or surgery (e.g., finasteride or spironolactone, or laparoscopic ovarian drilling (LOD) for excessive hair growth.

Adenomyosis

Definition: Lining of the womb (uterus) grows into the muscle wall.
Diagnosis: Often diagnosed following 30.
Symptoms: Increased painful periods, heavy bleeding, pelvic pain, bloating, fullness in abdomen. Pain during intercourse.

Adenomyosis - Treatment

Treatment for painful periods (e.g., painkillers, contraceptives). Severe cases may need hysterectomy.

Endometriosis

Definition: Tissue similar to the womb lining grows elsewhere in the body, particularly in the ovaries and fallopian tubes. Can affect the bladder or bowel, also potentially causing pain during other functions.
Symptoms: Painful periods, particularly severe pelvic pain with periods, heavy periods, pain during intercourse, pelvic pain outside of periods, pain during urination & bowel movements.

Fibroids

Definition: Non-cancerous growths in or around the womb (uterus), made of muscle and fibrous tissue, sometimes called uterine Myomas or Leiomyomas.
Cause: Exact cause is unknown, but linked to the hormone estrogen.
Symptoms: Often asymptomatic (many women are unaware they have them).
Heavy/painful periods, Tummy pain (abdominal), Lower back pain, Frequent need to urinate, Constipation, Pain or discomfort during sex.
Treatment: Same as for painful/heavy periods (painkillers/contraceptives); often shrink after menopause. Treatment includes: Ulipristal acetate and Gonadotropin releasing hormone analogues (GnRHas) such as Goserelin, administered by specialists.

Pelvic Inflammatory Disease (PID)

Definition: Inflammation of the female reproductive organs (uterus, fallopian tubes, ovaries). Caused by infection.
Cause: Sexually transmitted infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae.
Types: Acute PID (sudden, severe inflammation) and Chronic PID (persistent inflammation).
Symptoms: Lower abdominal or pelvic pain, vaginal discharge, abnormal vaginal bleeding, dyspareunia (painful intercourse), Upper right abdominal pain, increased temperature, painful urination, bleeding and spotting after intercourse.
Treatment: Antibiotics

Differential Diagnosis of Women's Health Issues

List of conditions: Adenomyosis, Endometriosis, Fibroids, Irritable bowel syndrome, Heavy/painful periods/dysmenorrhea, Pelvic inflammatory disease, Polycystic ovary syndrome (PCOS) are useful for differentiating diagnosis.

Referring Women with Menstrual Problems

Conditions Requiring Referral:
- Severe symptoms
- Older patients with new painful/heavy periods
- Worsening pain with each period
- Abnormal discharge/ bleeding/ fever
- Irregular periods
- Bleeding between cycles
- Heavy periods despite fitted contraception
- Pregnant/ breastfeeding

Emergency Hormonal Contraception (EHC)

Options:
- Levonorgestrel (e.g., Levonelle)
- Ulipristal acetate (e.g., ellaOne)
Mechanism: Stops or delays ovulation.
Levonorgestrel: synthetic progestogen.
- Works within 72 hours of intercourse.
Ulipristal acetate: selective progesterone receptor modulator
- Works within 120 hours of intercourse.
Timing: The sooner taken after unprotected sex, the more effective.
Alternatives/Further Action:
- If sick (vomiting) within 2 hours of Levonelle or 3 hours of ellaOne, see a doctor, pharmacist, or GUM clinic.
Note: Not for protection after taking emergency pill.
Side Effects: Possible changes in next period (earlier, later, heavier), nausea, headache, vomiting.

Emergency Hormonal Contraception (EHC) - Considerations

Patient allergies or other conditions interfering with hormonal contraception.
Can't use hormonal contraception (previous health issues/ allergies).
Severe asthma or similar conditions.
Taking other medications that might interact. (Ex: St John's Wort).
The use of antibiotics & other medications that may affect the pill

Menopause

Definition: Natural end of fertility, 12 months after the last menstrual period, cessation of reproductive hormones produced by the ovaries.
Stages: Premenopause, Perimenopause, Menopause, Postmenopause.
Symptoms: Irregular/absent periods, hot flushes/night sweats, vaginal dryness, mood changes, anxiety/depression, low self-esteem, fatigue, sleep issues, dry eyes, itchy skin, brain fog, headaches, migraines, vertigo, burning mouth, change in libido, palpitations, shortness of breath, frequent UTIs, weight gain, acne, body odor changes, tingling limbs and physical/emotional changes.

Menopause - Management

Lifestyle:
- Healthy diet (nutrition), hydration, exercise, rest, sleep.
Relaxation:
Vaginal dryness: Lubricants/moisturisers, consider estrogen replacement therapy (HRT)
Hot flushes & mood changes: Cognitive behavioural therapy (CBT) or medication, consider hormone replacement therapy (HRT) or supplements: black cohosh, valerian, flax seeds, Red Clover, St John's wort, sage, chamomile for managing symptoms.
Weak Bones: Foods high in calcium and vitamin D, sunlight exposure.
Supplements: (Consider supplements for symptom management).

Menopause - Treatment

Hormone Replacement Therapy (HRT): Replaces lost estrogen; various forms (tablets, patches, gel, sprays, rings, pessaries, creams). Progesterone often included for women with a uterus to reduce estrogen's effects on the uterus.
Testosterone: May be used to increase libido.
Vaginal Dryness: topical estrogen creams.
Mood: Antidepressants for managing mood changes.
Hot Flushes: Clonidine or gabapentin.

Things to Consider When Assessing Women's Health

Patient Demographics: Age, pregnancy status, breastfeeding.
Treatment appropriateness: Patient's age and any previous health conditions, product licensing.
Symptom severity & onset: Important to understand how long the symptoms have been experienced.
Prior treatment attempts: Any previous OTC treatments tried, and how effective/tolerated they were, plus any failure to do so.
Other medical conditions: diabetes, asthma, other conditions may influence the treatment path.
Medication use: Other medicines, including medications to be taken regularly, and their possible interactions.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on bacterial vaginosis and its prevention methods. This quiz covers common risk factors, symptoms, and treatment options related to this vaginal condition. Enhance your understanding of women's health and learn about the important distinctions in vaginal conditions.