Picture Time
Evidence Rating
Treatment options
Partners and Complications
Random facts
100
What is Bacterial Vaginosis
note the vaginal epithelial cells with borders obscured by adherent coccobacilli visible on saline wet mount preparation
100
Symtoms alone cannot differentiate between the causes of vaginitis. Office-based or laboratory testing should be used with the history and physical examination findings to make the diagnosis.
What is C
C= consensus, disease-oriented evidence, usual practice, expert opinion or case series
100
Initial oral regimen for Bacterial vaginosis
What is Metronidazole 500 mg PO BID x 7 days
other options: metronidazole 0.75% gel, one full applicator (5g) intravaginally QD x 5 days
or
Clindamycin 2% cream, one full applicator (5g) intravaginally at bedtime for 7 days
100
Routine treatment of sex partner is not recommended for this vaginitis
What is bacterial vaginosis
100
True or False: The CDC recommends nucleic acid amplification testing for diagnosis of trichomoniasis in symptomatic or high-risk women?
What is TRUE!
The tests have higher sensitivity that saline microscopy (95%-100% vs. 51% to 65%) and can be performed on endocervical, vaginal, or urine specimens, or on liquid-based Pap test samples.
200
What is Vulvoganinal candiasis
Note the budding yeast with pseudo hyphae
200
In non-pregnant women, oral and vaginal treatment options for uncomplicated vulvovaginal candidiasis have similar clinical cure rates.
What is B
B= inconsistent or limited quality patient oriented evidence
200
Treatment for pregnant women with Trichomoniasis?
What is Metronidazole 2 g PO x 1 dose
regardless of pregnancy stage
200
If severe or recurrent vulvovaginal candidiasis does not respond to initial treatment, this test may help guide therapy
What is a culture
which would help identify nonalbicans species which are less responsive to fluconazole, more responsive to topical imadazoles (i.e., econazole, clotrimazole, miconazole, and ketoconazole)
200
Because Trichonomiasis is sexually transmitted andhas a righ rate or recurrence, the CDC recommends testing for reinfection HOW MANY MONTHS after treatment?
What is 3 months.
300
What is Trichomonas vaginalis
When vaginal wet mount preparation is promptly examined, motile trichomonads with flagella slightly larger than a leukocyte may be visible
300
Nucleic acid amplification testing is recommended for the diagnosis of trichomoniasis in symptomatic or high-risk women
What is C
C= consensus, disease-oriented evidence, usual practice, expert opinion or case series
300
Treatment ROUTE and LENGTH for pregnant women with vulvovaginal candidiasis
What is topical azole applied INTRAVAGINALLY for 7 days
such as RX Terconazole 0.4% cream 5 g intravaginally QD x 7days or
OTC Miconazole 2% cream, 5g inravaginally QD x 7 days
300
Concurrent treatment of sex partner is recommended for this vaginitis
What is Trichomoniasis
300
Name 2 non-infectious causes of vaginitis that are less common and account for 5-10% of vaginitis cases
What is atrophic vaginitis, irritant vaginitis,inflammatory vaginitis
Treatment options:
Atrophic vaginitis: low-dose vaginal estrogen preparations in creams, tablets, or rings. Or vaginal lubricants and moisturizers.
400
What are normal vaginal epithelial cells
400
Do not obtain culture for the diagnosis of bacterial vaginosis because it represents a polymicrobial infection
What is C
C= consensus, disease-oriented evidence, usual practice, expert opinion or case series
400
Initial oral regimen for vulvovaginal candidiasis
What is fluconazole 150 mg PO x 1 dose
other options: many different topical azole therapies as OTC or prescription
400
Routine treatment of sex partners is not recommended for this vaginitis unless the partner is symptomatic??
What is vulvovaginal candidiasis
400
TRUE OR FALSE: Test of cure for bacterial vaginosis is recommended
What is FALSE!
Recurrence of bacterial vaginosis is common. Women should be advised to return for treatment if symptoms recur. Routine testing in asymptomatic women and test of cure are not recommended because these bacteria can be part of normal flora.
500
What is Candida albicans
Note the budding yeast
500
Treatment of bacterial vaginosis during pregnancy improves symptoms but does not reduce the risk of preterm birth
What is A
A= consistent, good-quality patient-oriented evidence
500
Treatment regimen for bacterial vaginosis in pregnant women
Metronidazole 500 mg PO BID x 7 days
500
True or false: When treating trichomoniasis, partners should refrain from intercourse until treatment has started?
What is FALSE!
Advise refraining from intercourse until partners are TREATED and SYMPTOM FREE!
500
DAILY DOUBLE!!!
Name 3 of the 4 Amsel Diagnostic Criteria that must be met to diagnose Bacterial Vaginosis
What is: 1)Thin, homogenous discharge
2) Positive whiff test (amine odor by mixing 10% KOH with discharge sample)
3) Clue cells present on microscopy
4) Vaginal pH > 4.5