Vaginitis Presentation PDF

VAGINITIS JULIE A. BRINZO, DNP, APRN, MBA, FNP-C  VAGINITIS INFLAMMATION OF THE VAGINA DUE TO CHANGES IN THE COMPOSITION OF THE VAGINAL MICROENVIRONMENT INFECTION IRRITANTS HORMONAL DEFICIENCY  INFECTIOUS VAGINITIS BA...

VAGINITIS JULIE A. BRINZO, DNP, APRN, MBA, FNP-C  VAGINITIS INFLAMMATION OF THE VAGINA DUE TO CHANGES IN THE COMPOSITION OF THE VAGINAL MICROENVIRONMENT INFECTION IRRITANTS HORMONAL DEFICIENCY  INFECTIOUS VAGINITIS BACTERIAL VAGINOSIS TRICHOMONIASIS VULVOVAGINAL CANDIDIASIS  EPIDEMIOLOGY MOST COMMON GYN DIAGNOSIS SEEN IN PRIMARY CARE; VAGINAL DISCHARGE VAGINAL DISCHARGE ACCOUNTS FOR APPROXIMATELY 10 MILLION OFFICE VISITS PER YEAR TRICHOMONIASIS IS THE MOST PREVALENT NONVIRAL STI IN THE WORLD ESTIMATED AT LEAST 75% OF WOMEN WILL EXPERIENCE AN EPISODE OF VVC IN THEIR LIFETIME ATROPHIC VAGINITIS IMPACTS UP TO 40% OF POSTMENOPAUSAL FEMALES  BACTERIAL VAGINOSIS POLYMICROBIAL SYNDROME RESULTING FROM AN OVERGROWTH OF ANAEROBIC ORGANISMS IN THE VAGINA SHIFT IN THE NORMAL FLORA FROM LACTOBACILLI TO ANAEROBIC ORGANISM; GARDNERELLA VAGINALIS IS THE PREDOMINANT ORGANISM ASSOCIATED WITH BV NOT A STI BUT SEXUALLY ASSOCIATED  RISK FACTORS MULTIPLE SEX PARTNERS/PREVIOUS FEMALE SEX PARTNERS BLACK OR HISPANIC ETHNICITY STI INFECTIONS NEW SEX PARTNER DOUCHING UNPROTECTED INTERCOURSE CIGARETTE SMOKING IUD  OBJECTIVE FINDINGS FISHY OR MUSTY VAGINAL ODOR MORE PROMINENT AFTER SEX, MENSES, OR EXERCISE THIN, HOMOGENOUS DISCHARGE NO VAGINAL OR VULVAR IRRITATION NORMAL BME SPECULUM EXAM Thin, homogonous discharge Adheres to vaginal wall White in color  VAGINAL MICROSCOPY PRESENCE OF CLUE CELLS “PEPPER ON AN EGG” POSITIVE WHIFF TEST WHEN 10% KOH SOLUTION IS APPLIED TO THE SPECIMEN VAGINAL PH >4.5  TREATMENT CDC TREATMENT RECOMMENDS METRONIDAZOLE 500 MG BID FOR 7 DAYS OR METRONIDAZOLE GEL 0.75% 5 GRAMS IV ONCE A DAY FOR 5 DAYS OR CLINDAMYCIN CREAM 2% 5 GRAMS IV AT BEDTIME FOR 7 DAYS  PATIENT EDUCATION AVOID SEXUAL ACTIVITY UNTIL TREATMENT COMPLETE STI SCREENING RECOMMENDED AVOID DOUCHING BV IS ASSOCIATED WITH PRETERM LABOR IN PREGNANCY CLEANING OF SEXUAL TOYS SHARED BETWEEN WSW  VAGINITIS-VULVOVAGINAL CANDIDIASIS SECOND MOST COMMON CAUSE OF VAGINITIS IN THE US CAN BE A REOCCURRING PROBLEM DEFINED AS 4 OR MORE EPISODES IN ONE YEAR CANDIDA ALBICANS IS THE INFECTING AGENT IN 80-90% OF CASES ESTIMATED UP TO 50% OF WOMEN HAVE ASYMPTOMATIC CANDIDA ORGANISMS AS PART OF THEIR NORMAL VAGINAL FLORA  RISK FACTORS OCP USE DIAPHRAGM OR IUD USE RECEPTIVE ORAL SEX DIABETES PREGNANCY ORAL ANTIBIOTIC USE  SUBJECTIVE/OBJECTIVE FINDINGS PRURITUS DYSURIA THICK, WHITE VAGINAL DISCHARGE; ADHERES TO VAGINAL WALLS VULVAR AND VAGINAL ERYTHEMA, EDEMA, FISSURES SPECULUM FINDINGS  MICROSCOPY FINDINGS NORMAL VAGINAL PH PSEUDOHYPHAE OR BUDDING YEAST CELLS NEGATIVE WHIFF TEST  TREATMENT MULTIPLE ANTIFUNGAL TOPICAL TREATMENTS AVAILABLE (OTC AND BY RX) CLOTRIMAZOLE MICONAZOLE TIOCONAZOLE BUTOCONAZOLE TERCONAZOLE FLUCONAZOLE 150 MG PO X ONE DOSE  TRICHOMONIASIS SEXUALLY TRANSMITTED INFECTION CAUSED BY TRICHOMONAS VAGINALIS; PROTOZOAN; MOTILE ORGANISM WITH 4 FLAGELLA TRANSMISSION VIA FOMITE IS POSSIBLE WSW CAN ACQUIRE DISEASE BUT MSM RARELY INFECT OTHER MEN ACCOUNTS FOR 10-25% OF VAGINITIS  RISK FACTORS MULTIPLE OR NEW SEX PARTNER HISTORY OF OTHER STIS IUD CIGARETTE SMOKING 20-50% MAYBE ASYMPTOMATIC  SUBJECTIVE/OBJECTIVE FINDINGS MALODOROUS DISCHARGE; COPIOUS YELLOW-GREEN IN COLOR PRURITUS VAGINAL IRRITATION VULVAR AND VAGINAL EDEMA STRAWBERRY CERVIX (PUNCTATE HEMORRHAGIC SPOTS ON THE CERVIX) FROTHY, PURULENT DISCHARGE ON SPECULUM EXAM SPECULUM EXAM  VAGINAL MICROSCOPY VAGINAL PH >4.5 MOTILE TRICHOMONADS WHIFF CAN BE POSITIVE  TREATMENT CDC RECOMMENDATION: METRONIDAZOLE 500 MG BID FOR 7 DAYS (WOMEN) METRONIDAZOLE 2 GRAMS IN A SINGLE DOSE (MEN) ALTERNATIVE TREATMENT FOR WOMEN AND MEN TINIDAZOLE 2 GRAMS IN A SINGLE DOSE  ATROPHIC VAGINITIS DEVELOPS DUE TO LACK OF ESTROGEN IN MENOPAUSE DIAGNOSIS BASED UPON SYMPTOMS THINNING OF VAGINAL EPITHELIUM DECREASED VAGINAL RUGAE DECREASED VAGINAL SECRETIONS  PRESENTATION WOMEN WHO ARE SURGICALLY OR NATURALLY MENOPAUSAL IMPACTS 10-50% OF ALL MENOPAUSAL WOMEN VULVOVAGINAL DRYNESS PRURITIS DYSPAREUNIA POST COITAL PAIN STRAW STAGING SYSTEM MAYBE A USEFUL TOOL  EXAM FINDINGS DECREASE IN HAIR DISTRIBUTION AND HAIR PIGMENT CHANGES DECREASE SUBCUTANEOUS FAT OF THE MONS PUBIS AND LABIA FISSURING AT THE INTROITUS OR EXTERNAL GENITALIA SPECULUM EXAM SHOWS HYPOESTROGENIC TISSUE (PALE PINK WITH DECREASED SECRETIONS)  TREATMENT TRIAL OF INTRAVAGINAL ESTROGEN PRODUCTS CREAMS TABLETS RINGS TRANSDERMAL PATCH EVALUATE FOR CONTRADICTIONS TO ESTROGEN THERAPY SUCH AS HISTORY OF ESTROGEN-DEPENDENT CANCERS, THROMBOEMBOLIC DISORDERS, LIVER DISEASE, UNDIAGNOSED UTERINE BLEEDING, ETC. PATIENT EDUCATION  REFERENCES CENTER FOR DISEASE CONTROL (2022). BACTERIAL VAGINOSIS. RETRIEVED FROM HTTPS://WWW.CDC.GOV/STD/TREATMENT-GUIDELINES/BV.HTM CENTER FOR DISEASE CONTROL (2022). TRICHOMONIASIS. RETRIEVED FROM HTTPS://WWW.CDC.GOV/STD/TREATMENT-GUIDELINES/TRICHOMONIASIS.HTM EGAN, M.E. (2000). DIAGNOSIS OF VAGINITIS. AMERICAN FAMILY PHYSICIAN; 62(5): 1095-1104. FLORES, S.A. & HALL, C.A. (2022). ATROPHIC VAGINITIS. RETRIEVED FROM HTTPS://WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK564341/#:~:TEXT=ATROPHIC%20VAGINAL%20CHANGES %20ARE%20CAUSED,%25%20OF%20POST%2DMENOPAUSAL%20WOMEN. DUNPHY, L. M., WINLAND-BROWN, J.E., PORTER, B.O., & THOMAS, D.J. (2019). PRIMARY CARE: THE ART AND SCIENCE OF ADVANCED PRACTICE NURSING-AN INTERPROFESSIONAL APPROACH. F.A. DAVIS COMPANY: PHILADELPHIA. HOLLIER, A. (2021). CLINICAL GUIDELINES IN PRIMARY CARE (4TH ED.). ADVANCED PRACTICE EDUCATION ASSOCIATES: LAFAYETTE, LA.