Diseases of vulva

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Diseases of vulva

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

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