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GYNECOLOGICAL INFECTIONS

Notes

PHYSIOLOGICAL DISCHARGE

clear or white discharge smear contains epithelial cells pH < 4.5 increases with increased estrogen states: pregnancy, BCP, mid-cycle if increased in perimenopausal woman, investigate for other effects of excess estrogen (e.g. endometrial ca)

NON-INFECTIOUS VULVOVAGINITIS

Prepubertal Vaginitis most common causes • foreign objects, trauma (consider child abuse) • poor hygiene (e.g. pinworm infection)

Postmenopausal Vaginitis/Atrophic Vaginitis symptoms • dyspareunia • post-coital spotting • mild pruritus treatment • rule out malignancy • estrogen creams • oral or transdermal hormone replacement therapy • good hygiene

Chemical Vulvovaginitis symptoms and signs of irritation present without infection irritants in vaginal contraceptives, bubble baths, soaps, genital deodorants, coloured or scented toilet paper, detergents, and fabric softeners frequent minipad or tampon use tight synthetic clothing pools, hot tubs

INFECTIOUS VULVOVAGINITIS

Symptoms vaginal discharge odor pruritis lower genital tract pain dyspareunia dysuria

Pathophysiology normal vaginal flora contains a balance of many bacterial organisms flora may be altered by • a change in the environment • introduction of a new pathogen result is an imbalance in the relative number of organisms

Candidiasis (Moniliasis) Candida albicans (90%), Candida tropicalis (< 5%), Torulopsis glabrata (< 5%) 25% of vaginitis symptoms • begin in premenstrual phase • minimal whitish, curd-like, “cottage-cheese” vaginal discharge • intense itch • swollen, inflamed genitals • vulvar burning, dysuria, dyspareunia • asymptomatic (20%) predisposing factors • pregnancy • diabetes • BCP • antibiotic therapy • immunosuppression (primary or secondary) • if frequent recurrences, consider AIDS

Gynecology 24

MCCQE 2000 Review Notes and Lecture Series

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