vulvar and vaginal disease and lower tract STI Flashcards
HPV strains + diseases
6+11 = genital warts
16, 18, 45, 31 = neoplasia
genital warts dx + tx
- visual dx, can biopsy
- imiquimod 5% 3 days/wk x 16 wks
- podofilox 5% for 3 days/wk in a row x 4 weeks
in office:
- podophyllin - not if preg
- trichloroacetic acid
- cryotherapy
- surgical removal (excise, laser)
HSV testing + treatment
- test: HSV PCR or viral culture (not sensitive when heals)
first time:
- acyclovir, famciclovir, or valacyclovir for 5-10 days
recurrent:
- same for 5 days per episode
6+ recurrences per year or very bothersome:
- acyclovir or famciclovir or valacyclovir daily
- prevents outbreaks + shedding
to prevent transmission to partner
- valacyclovir daily
syphilis testing
- darkfield examination of lesion fluid, +ve = spirochetes
- VDRL: antigens, non specific, titre corresponds to disease activity, usually becomes nonreactive after tx
- specific anti-treponemal antibody tests: confirmatory, reactive for life, can do 1st and then VDRL for active/vs old
syphillis treatment
primary, secondary, latent < 1 year
- benzathine penicillin G 2.4 million U IM in 1 dose
(or doxycycline x14 days if allergy)
latent >1 year or tertiary
- same but weekly for 3 weeks
neurosyphilis:
- aqueous crystalline pen G by IV q4h for 10-14 days
pregnant
- if allergic to penicillin, desensitize + then treat
lichen sclerosus presentation, dx, treatment,
- intense itching + burning
- white figure-8, purpura, hemorrhage, ulceration
- dx = visual, can bx
- tx: clobetasole, long term
lichen simplex chronicus
- itching, burning, chronic irritation
- leathery skin, esp lab majora
- dx = visual, can bx
- 2-3wks high or med potency steroid cream
- antihistamines
- break scratch cycle
lichen planus
- plaques on skin, erosion of vestibule + vagina
- loss of structure and erosion of vaginal wall
- oral lesions: lacy, white
- dx is visual, can biopsy
- tx: steroid creams or foams internally, cyclosporine
bartholin’s gland disease
- cyst in posterior vestibule, can become infected
- centre at labia minora
- dx - visual
- tx: incise and drain, insert word catheter or surgical marsupialization
vulvodynia
- pain without lesion/cause
- dx of exclusion
- tx: support, local moisturizers/creams, cold compress, xylocaine
- amitriptyline or neurontin
- biofeedback, pelvic floor physio
non infectious causes of vag discharge
- physiologic
- hypersensitivity
- dermatologic condition
- hormone related (OCP, HRT, preg)
- genital atrophy
- foreign body
- trauma
- lack of lubrication in intercourse
history for vag discharge
- colour, amount, texture
- smell
- pruritis, burning, pain
- dysuria
- dysparunia
- skin changes
- associations: menstruation, sex
- product use
- sexual hx, symptoms in partners
- hx of sti, treatments
- current meds
- medhx etc
physical exam + lab tests for vag discharge
- external genitalia (lesions, colour, excoriations)
- vagina + cervix: dicharge, edema, lesions, color
- collect swabs
- bimanual exam: CMT, uterine size, etc, adnexal mass
secretions tests:
- pH
- wet mount /w saline + KOH
- KOH whiff test
- gram stain
- culture (Trichomonas and yeast, species of yeast, for BV use wet mount)
- cervical swabs for C + G
BV signs + lab tests
- discharge + odour
- thin, grey/white, adherent discharge
- +ve whiff
- pH >4.5
- wet mount: clue cells /w coccoids, decreased lactobacilli, no WBCs
- gram stain: change in flora
yeast signs + labs
- pruritis, burn, discharge
- white, curdy
- -ve whiff
- pH <4.5 (normal)
- on KOH slide: budding, hyphae
- culture can grow yeast
- gram stain: hyphae
