Uploaded byAhmed Nasef
Vulvovaginitis
Vulvovaginitis is an inflammation of the vulva and vagina, common in women of all ages and caused by various factors such as bacteria, fungi, and viruses. Key types of vulvovaginitis include bacterial vaginosis, candidiasis, and trichomoniasis, each with specific presentations and treatment methods. Diagnosis typically involves criteria based on symptoms and lab tests, while management focuses on maintaining cleanliness, using appropriate medications, and treating partners.
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Vulvovaginitis
- 1. Vulvovaginitis By D. Ahmed MohamedNasef Assistant lecturer in obstetrics & gynecology department Benha University
- 2. What is Vulvovaginitis? Inflammationof vulva and vagina It’s a common condition in all ages across female life span It has many causes
- 3. Causes of Vulvovaginitis Primarycauses bacterial bacterial vaginosis, syphilis, TB Fungal candidiasis Parasitic Trichomonas vaginalis Chlamydia LGV Viruses HSV, CMV, HPV Secondary causes Cervical& vaginal discharge Urinary conditions incontinence, fistula, glucosuria, pyuria Rectal conditions rectovaginal fistula, complete perineal tear Chemical douches, sprays, perfumes Physical scratching, irradiation Traumatic FB, prolapse, Pessary Senile atrophic Vulvovaginitis
- 4. Presentation of Vulvovaginitis Pain Pruritisvulvae Dysuria Dyspareunia Discharge And every cause has its specific criteria
- 5. 3 classic entitiesof vaginitis include Bacterial vaginosis Trichomonas infection Candidiasis
- 6. Bacterial vaginosis Means replacementof normal vaginal flora (lactobacilli) which maintain acidity of vagina by other bacteria as G Vaginalis, mycoplasma hominis, ureaplasma urealyticum It accounts for about 60% of all causes of Vulvovaginitis
- 7. What predispose tobacterial vaginosis? Any condition which change PH of vagina from acidic to alkaline Frequent sexual intercourse Frequent use of alkaline vaginal douches
- 8. Presentation Asymptomatic (50%) Mild Vulvovaginitiswith no pain, pruritis, dyspareunia nor discharge Vaginal discharge (profuse, thin, greyish, malodorous) characteristic fishy odor due to formation of amines by anaerobic bacteria from amino acids
- 9. How to diagnose? AMSELcriteria Characteristic vaginal discharge Vaginal PH >4.5 Clue cell Whiff test (adding 10% KOH to discharge gives fishy odor) Only 3 of these 4 are needed to diagnose BV
- 10. What is clue cell? Granularappearance of vaginal epithelial cells Due to adherence of bacteria to their surface on gram stain
- 11. Complications In non pregnantwomen PID UTI Salpingitis Endometritis Wound infections In pregnant women Chorioamnionitis PROM PTL
- 12. Treatment of BV Generalprinciples Keep vulva dry and clean If using douches should be neutral (better to avoid) Use cotton, loose, dry underwear BV occurring in pregnant women should be treated Medical Metronidazole local or oral Or clindamycin oral or local Antipruritic antihistaminic, corticosteroids
- 13. Candidiasis Also called moniliasis or moniliathrush Caused by candida organism
- 14. Predisposing factors Increased vaginalacidity Moisture Increased vaginal epithelial glycogen (COCs, pregnancy) Decreased resistance (DM, steroids) Prolonged use of antibiotics Contamination from STDs, hands, towels, instruments
- 15. Presentation Premenstrual Severe Vulvovaginitis (pain, pruritis, dyspareunia& discharge) Discharge is odorless,whitish, thick, curdy- cheese, scanty
- 16. Investigations PH acidic Smear grampositive, hyphae, spores Culture on sabarouds agar
- 17. Management Prophylaxis Eliminate pdfs Avoid vaginaldouches Treat husband Keep vulva dry and clean Use cotton, loose, dry underwear Medical Local clotrimazole, miconazole Oral (in virgins, in resistant to local treatment) Ketoconazole, fluconazole
- 19.
- 20. Predisposing factors Increased vaginalalkalinity Frequent use of alkaline douches Frequent sexual intercourse Decreased resistance (DM, steroids) Prolonged use of antibiotics Contamination from STDs, hands, towels, instruments
- 21. Presentation Postmenstrual Severe Vulvovaginitis Discharge (malodorous, greenish, frothy, profuse) Onexamination Red edematous punctate hemorrhage (strawberry vagina)
- 23. Investigations PH alkaline Gram negative Motileflagellated organisms
- 24. Management Prophylaxis Eliminate pdfs Avoid vaginaldouches Treat husband Keep vulva dry and clean Use cotton, loose, dry underwear Medical Local Metronidazole Oral (in virgins, in resistant to local treatment) Metronidazole Tinidazole
- 26. Genital herpes Genital herpesis a sexually transmitted infection (STI) May be transmitted orogenital Two types of the herpes simplex virus (HSV) cause genital herpes: HSV 1 & 2
- 27. Presentation Asymptomatic Pain or itching Smallred bumps or tiny white blisters or vesicles Ulcers (These may form when blisters rupture and ooze or bleed. Ulcers may make it painful for the patient to urinate Secondary bacterial infections
- 28. Complications of HSV Othersexually transmitted infections Newborn infection Bladder problems Meningitis Rectal inflammation (proctitis)
- 29. Diagnosis Viral culture Polymerase chainreaction (PCR) test
- 30. Treatment Antiviral medications usedfor genital herpes include: Acyclovir Valacyclovir
- 31. How to takevaginal swab?