Vaginal prurities

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Vaginal prurities

  1. 1. Vaginal Itching and Discharge www.freelivedoctor.com
  2. 2. Vaginal or Vulvar Itching <ul><li>95% of women with vulvar itching have yeast. </li></ul><ul><li>Giving an anti-fungal agent (Monistat, Lotrimin, etc.) will cure most of this itching. </li></ul><ul><li>Treatment failures need further evaluation. </li></ul>www.freelivedoctor.com
  3. 3. Yeast (AKA Monilia, Thrush, Candida) <ul><li>Itching is hallmark symptom </li></ul><ul><li>Red, swollen, tender vulva </li></ul><ul><li>Wet Mount confirms </li></ul>www.freelivedoctor.com
  4. 4. Yeast Treatment <ul><li>Topical anti-fungal agents work well </li></ul><ul><li>Monistat </li></ul><ul><li>Gyne Lotrimin </li></ul><ul><li>Mycelex G </li></ul><ul><li>Oral agents also work well </li></ul><ul><li>Diflucan 150 PO once </li></ul>www.freelivedoctor.com
  5. 5. Chronic Yeast <ul><li>Predisposing Factors: </li></ul><ul><li>Heat </li></ul><ul><li>Moisture </li></ul><ul><li>Diet </li></ul><ul><li>Diabetes </li></ul><ul><li>Antibiotics </li></ul>Solution: PRN Anti-fungal Agents www.freelivedoctor.com
  6. 6. 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
  7. 7. Contact Dermatitis <ul><li>Perfumes </li></ul><ul><li>Deodorants </li></ul><ul><li>Toilet Paper </li></ul><ul><li>Soap </li></ul><ul><li>RX: -Stop exposure </li></ul><ul><li>-Burrow's Solution </li></ul><ul><li>-Topical Steroids </li></ul>www.freelivedoctor.com
  8. 8. Crabs (Pubic Lice) <ul><li>Transmitted by: </li></ul><ul><li>Sexual contact </li></ul><ul><li>Infected bedding </li></ul><ul><li>Sharing towels </li></ul><ul><li>Close living quarters </li></ul>www.freelivedoctor.com
  9. 9. Crabs (Pubic Lice) Treatment <ul><li>Nix cream </li></ul><ul><li>Kwell Shampoo </li></ul>www.freelivedoctor.com
  10. 10. 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>Cryo, TCA, Laser, Cautery, Podo, etc. </li></ul>www.freelivedoctor.com
  11. 11. 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
  12. 12. 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
  13. 13. VIN (Vulvar Intraepithelial Neoplasia) <ul><li>Itching </li></ul><ul><li>Doesn’t respond to anti-fungal agents </li></ul><ul><li>May have a white skin discoloration </li></ul><ul><li>Need biopsy for diagnosis </li></ul>www.freelivedoctor.com
  14. 14. VIN (Vulvar Intraepithelial Neoplasia) www.freelivedoctor.com
  15. 15. 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
  16. 16. Vaginal Discharge <ul><li>Does it Itch? </li></ul><ul><li>Does it smell bad? </li></ul><ul><li>What does it look like? </li></ul><ul><li>Wet mount, cultures </li></ul>www.freelivedoctor.com
  17. 17. Bacterial Vaginosis <ul><li>Smells bad </li></ul><ul><li>“ Whiff Test” (KOH) </li></ul><ul><li>AKA Gardnerella, BV, Hemophilus Vag. </li></ul><ul><li>Anaerobic bacteria </li></ul><ul><li>Rx: Flagyl </li></ul><ul><li>Rx: Clindamycin </li></ul><ul><li>Rx: Amox </li></ul>www.freelivedoctor.com
  18. 18. Bacterial Vaginosis <ul><li>Rx: Flagyl </li></ul><ul><li>Rx: Clindamycin </li></ul><ul><li>Rx: Amox </li></ul>www.freelivedoctor.com
  19. 19. Trichomonas <ul><li>Bubbly, frothy discharge </li></ul><ul><li>Rx: Flagyl </li></ul>250 TID x 7 days 500 BID x 5 days 2 gm PO stat www.freelivedoctor.com
  20. 20. Wet Mount www.freelivedoctor.com
  21. 21. Cultures <ul><li>If GC, Chlamydia, Strep suspected </li></ul><ul><li>If pelvic pain present </li></ul><ul><li>Treatment failures </li></ul>www.freelivedoctor.com

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