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Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
Diseases of vulva
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Diseases of vulva

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  • 1. Diseases of vulva www.freelivedoctor.com
  • 2. Bartholin Gland
    • Normally not seen nor felt
    • If enlarged, can be a painless cyst or painful abscess
    www.freelivedoctor.com
  • 3. Bartholin Duct Cyst Video www.freelivedoctor.com
  • 4. Bartholin's Abscess
    • Must be drained
    • Simple I&D
    • Marsupialization
    • Word Catheter
    www.freelivedoctor.com
  • 5. Don’t Confuse it with These: Inclusion Cyst of the Vulva Right Vaginal Wall Cyst www.freelivedoctor.com
  • 6. Skene's Gland
    • Each side of urethra
    • Normally neither seen nor felt
    • May become swollen and tender, particularly with GC or chlamydia
    • Culture
    • I&D if pointing
    www.freelivedoctor.com
  • 7. Skenitis
    • Will need I&D
    • Culture for GC, Chlamydia
    www.freelivedoctor.com
  • 8. Herpes Vulvitis
    • Prodrome of itching or tingling
    • Multiple, small, painful blisters
    • Shallow ulcers filled with gray material
    • Crusts over in 7-10 days
    • Recurrences in 50%
    www.freelivedoctor.com
  • 9. Herpes Vulvitis Treatment
    • Spontaneous resolution in 10 days
    • Zovirax 200 mg PO Q 4 hours while awake #50
    • May need to place Foley cather
    • Recurrences are not as severe
    www.freelivedoctor.com
  • 10. Molluscom Contagiosum
    • Multiple, 1-2 mm raised, painless lesions
    • Dome-shaped with central dimple
    • Contain cheesy-white material
    • Sexually transmitted
    www.freelivedoctor.com
  • 11. Molluscom Contagiosum Treatment
    • Cryosurgery (just the lesion)
    • Bichloracetic acid (just the lesion)
    • Dermal curette (AgNO3 to base)
    • Electrocute the lesion (local anes.)
    Video www.freelivedoctor.com
  • 12. HPV (Condyloma)
    • Clinical warts
    • Flat warts
    • Soak vulva in vinegar, Exam under 7x power, Red-free light filter
    • No specific treatment
    www.freelivedoctor.com
  • 13. Tinea Cruris (Jock Itch)
    • Raised, reddened intertrigenous lesion
    • Dx: visual, but may obtain KOH scrapings
    • Rx: (BID x 2-3 weeks) -Monistat -Lotrimin -Diflucan -Nizoral
    www.freelivedoctor.com
  • 14. Runner’s Rash
    • Chafing from running, walking or other exercise
    • Lubricate with vaseline
    • Avoid cotton underwear
    • Local treatment
    www.freelivedoctor.com
  • 15. Vulvar Dystrophy - Hypertrophic
    • Skin too thick
    • Sx: Itching
    • Dx: Biopsy
    • Rx: Steroid Cream
    www.freelivedoctor.com
  • 16. Vulvar Dystrophy - Lichen Sclerosis
    • Skin too thin
    • Sx: Itching
    • Dx: Biopsy
    • Rx: Testosterone Cream or Clobetasol
    www.freelivedoctor.com
  • 17. Paget's Disease
    • Slow-growing malignancy
    • Exzematoid lesion -dry, crusty skin -moist, weepy -contact bleeding
    • Looks like yeast, but isn’t cured with anti-fungal Rx
    • Confirm by Bx, treat with local excision
    www.freelivedoctor.com
  • 18. Vulvar Hematoma
    • Straddle injury
    • Foley/Ice/Rest
    • Completely resolves in 2-3 weeks
    • Try not to drain them
      • Unnecessary
      • Bleeding point elusive
      • Risk infection
      • Spontaneous drainage in half
    www.freelivedoctor.com
  • 19. Primary Syphilis Appearance
    • Painless solitary ulcer
    • LNs enlarged, firm, non-tender
    • Positive RPR, VDRL
    • Positive Darkfield
    www.freelivedoctor.com
  • 20. Primary Syphilis Treatment
    • Benzathine PCN G, 1.2 M in each buttock (2.4 M total)
    • TTCN, 500 mg PO QID x 14 days
    • Doxycycline 100 PO BID x 14 days
    www.freelivedoctor.com
  • 21. Condyloma Lata Diagnosis
    • Secondary syphilis
    • Raised, painless flat lesions
    • Resemble condyloma, but smooth surface
    • Positive VDRL
    • Positive darfield of surface scrapings
    www.freelivedoctor.com
  • 22. Condyloma Lata Treatment
    • Same as Primary Syphilis
    www.freelivedoctor.com
  • 23. Chancroid Appearance
    • Tender, red papule filled with pus
    • Grayish, necrotic base
    • Jagged, irregular margins
    • No induration (contrast syphilis)
    • Tender inguinal LNs in 50%
    www.freelivedoctor.com
  • 24. Chancroid Diagnosis
    • Hemophilus ducreyi
    • Hard to culture
    • Gram-neg coccobacillus in clusters around Polymorphonucleocytes
    • "School of Fish Appearance"
    • History, physical, exclude other ulcerative diseases
    www.freelivedoctor.com
  • 25. Chancroid Treatment
    • Azithromycin 1 g PO
    • Ceftriaxone 250 mg IM
    • Ciprofloxacin 500 mg PO BID for 3 days
    • Erythromycin base 500 mg PO QID for 7 days.
    www.freelivedoctor.com
  • 26. Lymphogranuloma Venereum (LGV)
    • Ulceration of the vulva, rectum or groin
    • Pain with walking, sitting, or BMs
    • Hard tender masses (bubos) arise in the inguinal area
    • Untreated, extensive scarring in the rectum and vagina
    www.freelivedoctor.com
  • 27. LGV Diagnosis
    • Chlamydia trachomatis serotype culture from a bubo
    • Acute/convelescent serum complement fixation test
    • History of exposure
    • Visual appearance
    • Prevalence in the population.
    www.freelivedoctor.com
  • 28. LGV Treatment
    • Doxycycline 100 mg orally twice a day for 21 days, or
    • Erythromycin base 500 mg orally four times a day for 21 days.
    • Zithromax? (Probably with multiple doses over several weeks)
    www.freelivedoctor.com
  • 29. Granuloma Inguinale Appearance
    • Chronic ulcerative disease
    • Clean, granulomatous, sharply-defined
    • Multiple, confluent ulcers
    • Beefy red base which bleeds easily
    • Pseudobuboes in the groin
    • Confirm with biopsy (Donovan Bodies)
    www.freelivedoctor.com
  • 30. Granuloma Inguinale Treatment
    • Minimal scarring when treated early
    • Extensive scarring when treated late
    • 3 Weeks of:
      • Bactrim DS BID
      • Doxycycline 100 mg BID
      • Ciprofloxacin 750 mg BID
      • Erythromycin base 500 mg QID
    www.freelivedoctor.com

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