Vulvovaginal Infections
Bartholinitis (Infection of Bartholin glands)
Caused by E. coli, T. vaginalis, Staphylococcus, Streptococcus, Gonococcus S/S: inflammation around vestibular gland, swelling and edema, abscessed vestibular gland Treatment: -drain the abscess -provide antibiotic therapy -excise gland of patients with chronic bartholinitis
Cervicitis (acute and chronic)
Caused by chalmydia, gonococcus, streptococcus, many pathogenic bacteria. S/S: proguse purulent discharge, backache, urinary frequncy/urgency Treatment: -determine cause: cervical smear and culture -eradicate the gonococcal organism: penicillin or spectinomycin or tetracycline -Tetracycline, doxycycline to eradicate chlamydia
Atrophic Vaginitis
Caused by lack of estrogen or glycogen deficiency S/S: discharge and irritation from alkaline pH of vaginal secretions Treatment: -provide topical vaginal estrogen therapy -improve nutrition -relive dryness through moisturizing medications
Trichomonas vaginalis vaginitis
Common STI often called Trich. S/S: inflammation of vaginal epithelium causing burning/itching, frothy yellow-white or yellow-green discharge Treatment: -Relieve inflammation, restore acidity, and reestablish normal bacterial flora -provide oral metronidazole for patient and partner
Human Papillomavirus (HPV)
Most common STI in the US. Generally self-limiting and without symptoms, and others cause cervical and anogenital cancers. Most common strains (type 6 and 11) usually cause condylomata (warty growths) that appear on the vulva, vagina, cervix, and/or anus. These are often visible and palpable. Vaccination: -most effective if given pre-exposure to HPV -Administered as 3 injections over 6 months (often around 11-12 years of age) -vaccine contraindicated in pregnant women
Herpes virus type 2 (HSV-2)/Herpes Simplex Virus
Recurrent, lifelong viral infection that causes herpetic lesions (blisters) on the external genetalia and occassionally the vagina and cervix. Treatment: currently no cure, symptoms are treated. -oral antivirals: acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) suppress symptoms and shorten course -analgesics and a saline compress can provide relief of symptoms -recurrent episodes are often milder then initial episode Considerations: -abstain from sex during treatment or active disease -avoid sun exposure which can cause recurrence -don't touch lesions during outbreak -transmission is possible even in absence of active lesions
Candidiasis
infection caused by Candida species or yeast, also referred to as monilial vaginitis or yeast infection S/S: inflammation of vagina causing itchiness/redness, white cheese-lie discharge Treatment: -administer antifungal (i.e. miconazole [monistat] or clotrimazole [gyne-lotrimine] -review causative factors: antibiotics, nylon underwear, tight clothing, pregnancy, oral contraceptives -assess for diabetes and HIV if reucurrent
Pelvic Inflammatory Disease (PID)
inflammation and infection of organs in the pelvic region; uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic vascular system. Infection is usually caused by bacteria, with most cases being polymicrobial. Treatment: broad-spectrum antibiotics. Usually a combination of ceftriaxone (Rocephin), doxycycline, and metronidazole (Flagyl). Treatment of sexual partners is necessary to prevent reinfection. Complications: ectopic pregnancy, infertility, recurrent pelvic pain, tubo-ovarian abscess, and recurrent disease.
Endocervicitis
inflammation of the inner lining of the cervix, commonly due to organisms gaining access through sex. Most commonly caused by chlamydia or gonorrhea. Treatment: -Chlamydia: doxycycline (vibramycin) for 1 wk or single dose of azithromycin (Zithromax) -Gonorrhea: Cephalosporins, specifically dual therapy with azithromycin and ceftriaxone is first-line. Complications: tubal disease, ectopic pregnancy, PID, and infertility. All women <25 yrs who are sexually active should be screened annually. Repeat testing should be done 3 mos after treatment
Vaginitis
inflammation of the vagina, usually secondary to infection
Bacterial Vaginosis (BV)/Gardnerella-associated
overgrowth of anaerobic bacteria and Gardnerella vaginalis, normally found in the vagina, and a lack of lactobacilli. Risk factors: douching, smoking, multiple partners, STIs, same-sex female partners S/S: no edema or erythema, gray-white to yellow-white discharge Treatment: -Admin metronidazole (Flagyl) with instructions to avoid alcohol while using this med -if infection is recurrent, treat partner
