Vaginitis is an inflammation of the vagina. About 1 in every 3 women will suffer from Vaginitis at some point in her life. Vaginitis affects women of all ages, but is most common during the reproductive years.
It is often caused by infections, which are sometimes linked to more serious diseases.
The most common vaginal infections are:
-- Bacterial Vaginosis
-- Trichomin
-- Vaginal Yeast Infection
Although most vaginal infections are caused by bacterial vaginosis, trichomoniasis, or yeast, there may be other causes as well. These causes include sexually transmitted diseases, allergic reactions, and irritations.
Allergic symptoms can be caused by spermicides, vaginal hygiene products, detergents, and fabric softeners. Inflammation of the cervix (opening to the womb) from these products often is associated with abnormal vaginal discharge, but healthcare providers can tell them apart from true vaginal infections by doing lab tests.
http://www.niaid.nih.gov/topics/vaginitis/Pages/default.aspx
Vaginitis is an inflammation of the vagina. About 1 in every 3 women will suffer from Vaginitis at some point in her life. Vaginitis affects women of all ages, but is most common during the reproductive years.
It is often caused by infections, which are sometimes linked to more serious diseases.
The most common vaginal infections are:
-- Bacterial Vaginosis
-- Trichomin
-- Vaginal Yeast Infection
Although most vaginal infections are caused by bacterial vaginosis, trichomoniasis, or yeast, there may be other causes as well. These causes include sexually transmitted diseases, allergic reactions, and irritations.
Allergic symptoms can be caused by spermicides, vaginal hygiene products, detergents, and fabric softeners. Inflammation of the cervix (opening to the womb) from these products often is associated with abnormal vaginal discharge, but healthcare providers can tell them apart from true vaginal infections by doing lab tests.
http://www.niaid.nih.gov/topics/vaginitis/Pages/default.aspx
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
Vaginitis- vaginal discharge all medical information martinshaji
Vaginitis is the most common gynaecologic diagnosis in the primary care setting..
In approximately 90% of affected women, this condition occurs secondary to bacterial vaginitis, vulvo vaginal candidiasis or trichomoniasis. this is a study describing all the aspects of vaginal discharge associated with vaginitis , types , infections , treatment , prevention etc
please comment
thank u
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
Vaginitis- vaginal discharge all medical information martinshaji
Vaginitis is the most common gynaecologic diagnosis in the primary care setting..
In approximately 90% of affected women, this condition occurs secondary to bacterial vaginitis, vulvo vaginal candidiasis or trichomoniasis. this is a study describing all the aspects of vaginal discharge associated with vaginitis , types , infections , treatment , prevention etc
please comment
thank u
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
Fertility, Pregnancy, Contraception, Lactation And Endocrine Therapy In Breas...Mamdouh Sabry
Discussing every detail concerning gynaecologist and obstetrician in breast cancer. As fertility, pregnancy outcome, contraception, lactation, adjuvant hormone therapy and prevention.
Discussing sexually transmissible diseases, body defense, resistance to infection, susceptibility of infection, prevention and possible management and conclusion.
Fertility And Pregnancy Outcome In Cancer PatientsMamdouh Sabry
Better life of Cancer patients during childhood and age reproductive period regarding fertility, fertility preservation and pregnancy outcome is the main concern.concentrating upon different safe diagnostic modalities, management and outcome.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Vaginitis
1. VAGINITIS UPDATE
Dr. Mamdouh Sabry
MD. Ain Shams, PhD. France
Consultant Ob. & Gyn.
EL Mataria Teaching Hospital, Nasser Institute
Cairo, Egypt
2. Vaginal Environment
• The vagina is a dynamic system that contains
approximately 109 bacterial colony-forming units.
And can do self reform in healthy females.
• Normal vaginal discharge is clear to white,
odorous or odorless and of high viscosity.
• Normal bacterial flora is dominated by lactobacilli
,strept., staf., E.coli, anaerobes,G. V. candida ,
mycoplasma and other potential pathogens .
• Acidic environment (pH 3.8-4.2) inhibits the
overgrowth of bacteria.
• Some lactobacilli also produce H2O2, it is a
potential microbicide.
3. Physiologic secretions
• Transudate from vaginal wall
-St. sq. epithelium.
-Polymorphs and leucocytes
-Bacterial flora.
• Genital tract secretions
-F. tube, endometrium and cervix.
-Vulva ( skene,s tubules, Bartholin gland
and seb. glands )
4. Defensive Mechanism
• Vulva :
- H shape closing.
- Fungicide gland secretions.
• Vagina:
- Cone shape - Closed introitus
-Vaginal flora - Acidity
- Epithelium St. sq. epithelium.
• Cervix :
- Bactericide sec. - Immunoglobulins A, G, M.
5. Factors Favoring Infection
- Age extremes .
- Pregnancy.
- Post-natal ( trauma, contamination )
- IUD, combined pills.
- Antibiotics.
- Immunosuppressive drugs or steroids.
- D. M. uncontrolled.
6. Diabetic patients have higher risk of infection due
to many factors;
Hyperglycemia and acidemia that exacerbate
impairments in humoral immunity, polymorphs and
lymphocyte functions, ↓ random motion of
neutrophils, chemotaxis, phogocystosis and
microbial killing mechanisms.
Glucose levels in genital tissues enhance yeast
adhesion and growth.
Long standing D.M causes vasclopathy with poor
tissue perfusion.
Diabetic neuropathy results in delay response.
7. Vaginitis
• Most common gyn. condition seen in office,
Inflammation and irritation of the vagina and
vulva with abnormal discharge.
---Infections: ---No infections:
-Bacterial vaginosis -Atrophic
-Fungal, VVC. -Traumatic
-Parasitic, T.V. -Chemical
-Viral, HSV, HPV. -Adenosis, VIN.
Increase liability to inf.
8. 8
Vulvovaginal Candidiasis
• Fungal infection caused by candida albicans or non albicans
group, affects most females during lifetime. More common in
women at reproductive age.
• The second most common cause of vaginitis, 35 – 40% ???
• 75% of all women experienced at least one episode of VVC
during life time.
• 40 – 50% will suffer multiple attacks or episodes of VVC.
• Around 5-8% experienced chronic VVC.
• It is not a life threatening rather than a life disturbing disease,
affecting quality of life.
9. Microbiology
• Candida species are normal flora of the skin and
vagina
• VVC is caused by overgrowth of C. albicans and
other non-albicans species
• Yeast grows as oval budding yeast cells or as a
chain of cells (pseudohyphae)
• Symptomatic clinical infection occurs with
excessive growth of yeast
• Disruption of normal vaginal ecology or host
immunity can predispose to vaginal yeast
infections
10. Presentation and Symptoms
• Vulvar pruritus is most common symptom
• Thick, white, curdy vaginal discharge
("cottage cheese-like")
• Erythema, irritation, occasional
erythematous "satellite" lesion
• External dysuria and dyspareunia
• Cervix appears normal
11. Diagnosis
• History, symptoms and signs.
• Observing pseudohyphae and/or budding yeast
(candida) on KOH, Gram stain or saline wet prep (
Whiff test )
• pH > 4.5 (84-97% sensitive, 57-78% specific)
• Cultures not used for routine diagnosis, important in
non albicans resistant infection with Nickerson or
Sabourad media
• Pap smear have high (false +ve, -ve results )
• Latex agglutination test for candida sp. .
12. Classification of VVC
Uncomplicated VVC
– Sporadic or infrequent
vulvovaginal candidiasis
Or
– Mild-to-moderate
vulvovaginal candidiasis
Or
– Likely to be C. albicans
Or
– Non-immunocompromised
women
Complicated VVC
– Recurrent vulvovaginal
candidiasis (RVVC)
Or
– Severe vulvovaginal
candidiasis
Or
– Non-albicans candidiasis
Or
– Women with uncontrolled
diabetes, debilitation, or
immunosuppression or those
who are pregnant
14. •Both polyene and azoles are fungistatic
rather than fungicidal.
•Nystatin is less effective than azole
treatment. It needs to be given for 14 days.
•Azoles resulted mostly in higher rates of
clinical & mycologic cure (80-95%) than
nystatin (&0-90%) in non pregnant acute
VVC.
•Short course (single dose & regimens of 1-3
days) treats well uncomplicated VVC.
•Combined oral, local and male ttt is advised,
while during pregnancy, no oral ttt ???
15. Uncomplicated VVC
• Mild to moderate signs and symptoms
• Non-recurrent
• 75% of women have at least one
episode
• Responds to short course regimen
16. CDC-Recommended Treatment Regimens
• Intravaginal agents:
– Butoconazole 2% cream, 5 g intravaginally for 3 days†
– Butoconazole 2% sustained release cream, 5 g single intravaginally application
– Clotrimazole 1% cream 5 g intravaginally for 7-14 days†
– Clotrimazole 100 mg vaginal tablet for 7 days
– Clotrimazole 100 mg vaginal tablet, 2 tablets for 3 days
– Clotrimazole 500 mg vaginal tablet, 1 tablet in a single application
– Miconazole 2% cream 5 g intravaginally for 7 days†
– Miconazole 100 mg vaginal suppository, 1 suppository for 7 days†
– Miconazole 200 mg vaginal suppository, 1 suppository for 3 days†
– Nystatin 100,000-unit vaginal tablet, 1 tablet for 14 days
– Tioconazole 6.5% ointment 5 g intravaginally in a single application†
– Terconazole 0.4% cream 5 g intravaginally for 7 days
– Terconazole 0.8% cream 5 g intravaginally for 3 days
– Terconazole 80 mg vaginal suppository, 1 suppository for 3 days
• Oral agent:
– Fluconazole 150 mg oral tablet, 1 tablet in a single dose
17. Complicated VVC
• Recurrent (RVVC)
– Four or more episodes in one year
• Severe
– Edema
– Excoriation/fissure formation
• Non-albicans (Parapsilosis, lambica, glabrata, trop.)
• Immunocompromised host or D.M. uncontrolled
• Pregnancy
18. Complicated VVC Treatment
• Recurrent VVC (RVVC)
– 7-14 days of topical therapy, plus
– 150 mg oral dose of fluconazole repeated 3 days
later 2 times ( days 1,4, 7 )
– Maintenance regimens ( CDC STD treatment
guidelines) weekly or monthly
-Relapse
• Severe VVC
– 7-14 days of topical therapy, plus
– 150 mg oral dose of fluconazole repeated in 72
hours or itraconazol.
19. Partner Management
• VVC is not usually acquired through sexual
intercourse.
• Treatment of sex partners is not recommended
but may be considered in women who have
recurrent infection or symptomatic men.
• A minority of male sex partners may have
balanitis and may benefit from treatment with
topical antifungal agents to relieve symptoms.
20. Patient Counseling and Education
• Nature of the disease
– Normal vs. abnormal vaginal discharge,
signs and symptoms of candidiasis
• Transmission Issues
– Not always sexually transmitted
• Risk reduction
– Avoid unnecessary douching, unneeded
antibiotic use, finish course of treatment
21. BACTERIAL VAGINOSIS
• Commonest cause of vaginitis
• Asymptomatic in 50% of cases.
• Discharge may appear as thin, homogenous,
malodorous, greyish white or yellow.
• Vag. pain or vulval irritation is uncommon and
pruritis may occur.
• TTT early in pregnancy improves outcome.
• G. Vaginalis, anaerobic bacteria, mycopl. H.
22. Diagnosis
• Three of the following ( Amsel,s criteria ):
- Homogenous adherent white discharge.
- Vaginal Ph. More than 4,5.
- Amine ( fishy ) odour from discharge when
KOH is added (Whiff test) specificity 70%,
productive value 90%.
• -Clue cells in wet mount, ep. Cells covered
by coccobacilli, borders are indistinct and no
WBC or in saline drop test.
• Other tests may be done.
23. Treatment
• CDC; Metronidazol 500 mg twice a day for 7
days or Or vaginal gel 0.75% 5gm. Intrav.
once a day for 5 days Or Clindamycin cream
2% vaginal for 7 days.
• Metronidazol 2gm single dose oral or 300mg
oral clindamycin twice a day for 7 days or
clindamycin ovules 100 mg once per day
vaginal for 3 days.
• Theoretically metro. May be better as it does
not affect lactobacilli, but clindamycin is more
active against most involved bacteria.
24. Trichomonal Vaginitis
• Commonest non viral STD.
• Many pts. are asymptomatic ( 20-50 )
• The discharge is copious, frothy may be
white, yellow, grey or green.
• Pain, irritation with dysuria, pruritis and
postcoital bleeding.
• Male is affected. Has to be treated.
• Transmission sexual and asexual.
• Discharge Ph 5-7 alkaline.
25. Treatment
• Metronidazole the drug of choice as 2gm
single dose that might be repeated once or
500mg twice a day for 7 days.
• Secnidazol or ornidazol may be used and
equally effective.
• Male ttt is obligatory.
26. IMPORTANT P0INTS
• May pH ( by litmus paper ) help in
diagnosis of vaginal infection ?
• Yes……in some cases when diagnosis is
inconclusive…
28. • Mixed infection may be diagnosed or
evidenced ?
• If so on which bases ?
-Based on positive symptoms as discharge,
discomfort, pain, dysuria… and dyspareunia
- Condition specific test.
- Care during ttt. for drug interaction or
hepatotoxicity
29. • Asymptomatic fungal infection may be
treated or not ?
• Asymptomatic B. Vaginosis ?
• Special situations like vaginitis in children,
old age, pregnancy and immuno-affected
cases.
30. • Vaginal application of antimicrobials and
antiseptic agents with broad bactericide
and fungicide activity or cleansers may be
effective ?
• Effectiveness of human lactobacillus
strains as vaginal supp. ?
31. • Adjuvant ttt in mixed infection.
• Eradicate secretions prior to ttt starting.
• They decrease risk of resistance if not
sure of diagnosis.
• May be used as pre-ttt at ovulation time.
• Lactobacillus supp. may be helpful in
some situations…
32. • Teroconazol and other azoles better given
on single application or 3 days course and
why ?
• Teroconazol or other azoles in acute
attacks in diabetics and immune-affected
patients may be given more than 3 days
course ?
33. Conclusion
In simple words, prevention is better than cure
which means education control blood glucose
level in diabetics.
↑ Awareness → media, HCW., premarital
counseling; this will help also in UTI .
In STD; no safe sex is available outside
marriage; no barriers can prevent; enough
vaccines are not available.
We need revolution to get rid of uncontrolled
sexual freedom.