Female Gu Discharge

Front 1

Candida/ yeast infection etiology

Back 1

vag environment changes and candida adhere to walls; c.albicans (90%), c.gabralta, c.tropicalis

Front 2

Candida risks

Back 2

inc estrogen (pregnancy, hormone therapy), DM, immunocompromised host, warm/wet environment (inc glycogen production), abx, steroids, spermicides

Front 3

Candida symptoms

Back 3

discharge, dyspareunia, itchin, burning, erythema; severe infection is major redness, excoriations, fissures, edema

Front 4

Candida signs

Back 4

white, curdy discharge which adheres to vaginal walls, pH <=4.5
(-) whiff test
erythema
pseudohyphae/yeasts/buds/WBCs/lactobacilli on microscopy

Front 5

Candida diagnostics

Back 5

if wet mount negative, gram stain or culture for yeast; culture before tx help ID species; culture if recurrent

Front 6

Candida therapeutics

Back 6

fluconazole 150mg PO once or any azole in your vagina for 3-7days (don't drink for 3 days)

Front 7

Candida patient education

Back 7

PO meds work slower than vaginal creams, take all meds, avoid HFC products, ?probiotics, hygiene

Front 8

Candida follow up

Back 8

"recurrent" >4 infections in a year usually d/t incomplete medication regimen

Front 9

Candida treatment complicated

Back 9

recurrent infection: induction tx with vaginal azole HS 7-14 days or fluconazole 150mg PO days 1,3, 7 and maintence with fluconazole 150mg PO weekly or clotrimazole 500mg intravag weekly (3-6mo);

severe: same as induction PLUS low potency topical steroid;

for non albicans use nonfluconazole azole (Flucystosine cream14 days or Boric acid powder capsules in vagina for 14 days);

immunocompromised: treat underlying condition and vaginal azole 7-14 days

pregnancy: vaginal azole for 7 days

Front 10

Bacterial vaginosis etiology

Back 10

Overgrowth of commensal anaerobic flora (G. vaginalis-most common, Prevotella, Mobiluncus, M. hominis)

Front 11

Bacterial vaginosis risks

Back 11

"New Sexual Partner,
Women with female sex partners,
unprotected sex,
Decreased lacto
Of particular concern in pregnant women d/t preterm labor; Also may increased risk for other STDs/HIV"

Front 12

Bacterial vaginosis symptoms

Back 12

grey/white, thin, homogenous d/c, fishy/bad smell especially after intercourse

Front 13

Bacterial vaginosis signs

Back 13

"pH>=4.5
+ whiff test
+clue cells (>20%)
rare WBCs
increased bacteria
decreased lacto"

Front 14

Bacterial vaginosis diagnostics

Back 14

"Amsel criteria (3 of 4 for diagnosis):
-vaginal pH>4.5
-thin homogenous d/c coat vaginal walls
-accentuation of fishy odor w/ KOH
-20% clue cells
Can use Test Card (affirm III, fem exam card 2, Pip activity testcard);
Also screen for CT/GC, gonorrrhea, RPR, Hepatitis, HIV, screen and test before hysterectomy or abortion

Front 15

Bacterial vaginosis therapeutics

Back 15

"Typical Tx:
-Metronidazole po 7 days or Metronidazole vagina 5 days or Clindamycin cream vagina x 7 days; clindamycin ovules vagina 3 days; Tinidazole po 2 days
In Pregnancy (no gel):
-Metronidazole po 7 days or Clindamycin po 7 days
Recurrent:
Metronidazole gel intravaginally for 5 days and boric acid powder 21 days. If remission them maintenance biweekly for 6 months

Front 16

Bacterial vaginosis patient ed

Back 16

"-Condom therapy prevents alkalization and possibly recurrence
-No alcohol for 24 hours after metronidazole
-No douching
-Clean sex toys
-No need to treat partner
-No vaginal sex during tx"

Front 17

Bacterial vaginosis follow up

Back 17

RTC if symptoms to not resolve with tx