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1、VaginitispathophysiologyetiologydiagnosistreatmentPaul’sboatThedynamicvaginavaginalsecretions,exfoliatedcells,cervicalmucosalactobacillusacidophilusestrogenglycogenvaginalpHmetabolicbyproductsoffloraandpathogensCausesofvaginitisantibioticscontraceptivessexualintercoursedouchingstresshormonesallerg
2、iesandchemicalirritationBacterialvaginosisproliferationofGardnerellavaginalis,Mobiluncusspecies,Mycoplasmahominis,Peptostreptococcusspeciesmostcommoncause1/3to2/3asymptomatic15to19%ofallwomen10to30%pregnantwomenBVmisc.roleofsexualtransmissionunclearriskforpretermlaborandPROMincreasedfrequencyofabn
3、lPAPs,PID,endometritisSxs:profusemalodorousdischargeExam:thingrayishdischarge,seldomvaginalorvulvarirritationRisksassociatedwithBVEarlysexual‘debut’newormultiplesexpartnersIUD(50%contractitover2y)OCPLesbians/receptiveoralsexnoRCT’sbutassociationwithdouche,c-sectionandaroundtimeofmensesAmsel’scrite
4、riathin,homogenousdischargepositive“whiff”test“cluecells”presentonmicroscopyvaginalpH>4.5BVtreatmentmetronidazole500mgBIDx7daysclindamycin2%creamqhsx7daysmetrogel0.75%BIDx5day(vs.QD)metronidazole250mgTIDx7daysmetronidazole2gposingledosemetrogel(nopreviousPTL)VulvovaginalCandidiasissecondmostcommon
5、inU.S.Candidaalbicanspredominatesincreasingfrequencyofnon-albicansspecies(C.glabrata)Risks:OCPs,diaphragm,IUD,earlyintercourse,>4X/month,receptiveoralsex,diabetes,recentantibiotics.endogenousvaginalflorain50%womenVaginalcandidiasisnotsexuallytransmittednorrelatedtonumberofsexualpartnerstreatmentof
6、malepartnerofnobenefitc/opruritis,vaginalirritation,dysuriavulvovaginalitchingnotnormalinhealthywomen(lichensclerosis,vulvarcancer)exam:thickwhitedischarge,noodor,normalpHvulvarandvaginalerythemadiagnosticspHnormal(<4.5)pseudohyphae,buddingyeastcellsnegative“whiff”testGSandcultureinselectcasesnonc
7、.albicansmultiplebuddingyeastabsenceofpseudohyphaevulvovaginalcandidiasisRxtopicalantifungals(clotrimazole,miconazole,terconazole)fluconazole(Diflucan)150mgsingledoseBoricacid600mginsize0gelatincapsules,IV,dailyx
