Vaginitis for PA
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Vaginitis for the Physician Assistant Licensing Exam
Definition and Classification
- Definition
- Vaginitis is an inflammation of the vaginal mucosa that commonly leads to symptoms such as discharge, pruritus, odor, and discomfort.
- Primary causes include:
- Bacterial Vaginosis (BV): Overgrowth of anaerobic bacteria in the vaginal flora.
- Vulvovaginal Candidiasis (VVC): Fungal infection, usually from Candida albicans.
- Trichomoniasis: Sexually transmitted infection caused by Trichomonas vaginalis.
Pathophysiology
- Bacterial Vaginosis (BV):
- Loss of lactobacilli and increased vaginal pH allow overgrowth of anaerobic bacteria like Gardnerella vaginalis, Mycoplasma, and Prevotella.
- Linked to sexual activity but not classified as an STI.
- Vulvovaginal Candidiasis (VVC):
- Overgrowth of Candida species in response to changes in vaginal flora.
- Risk factors include antibiotic use, diabetes, pregnancy, and estrogen therapy.
- Trichomoniasis:
- Caused by Trichomonas vaginalis, a sexually transmitted flagellated protozoan.
- High reinfection rates if partners are untreated.
Clinical Manifestations
- Bacterial Vaginosis (BV):
- Thin, gray-white discharge with a fishy odor, especially after intercourse.
- Minimal itching or irritation.
- Vulvovaginal Candidiasis (VVC):
- Thick, white “cottage cheese” discharge without odor.
- Associated with intense pruritus, erythema, and vulvar swelling.
- Trichomoniasis:
- Frothy, yellow-green discharge with a foul odor.
- Vaginal pruritus and a “strawberry cervix” (cervical petechiae) may be present.
Diagnosis
- Wet Mount Microscopy:
- BV: Clue cells and positive “whiff” test.
- VVC: Budding yeast and pseudohyphae on KOH prep.
- Trichomoniasis: Motile trichomonads.
- pH Testing:
- BV and trichomoniasis: pH >4.5.
- VVC: pH ≤4.5.
Treatment
- Bacterial Vaginosis (BV):
- Metronidazole 500 mg orally twice daily for 7 days, or clindamycin cream.
- Vulvovaginal Candidiasis (VVC):
- Topical azoles or oral fluconazole for uncomplicated cases; extended treatment for recurrent cases.
- Trichomoniasis:
- Metronidazole 2 g orally in a single dose; partner treatment required.
Key Points
- Vaginitis is typically caused by BV, VVC, or trichomoniasis.
- Symptoms:
- BV: Thin, gray discharge with fishy odor; pH >4.5.
- VVC: Thick, white discharge with pruritus; pH ≤4.5.
- Trichomoniasis: Frothy, green discharge; pH >4.5.
- Diagnosis:
- Based on microscopy, pH testing, and nucleic acid amplification tests (NAATs).
- Treatment:
- BV: Metronidazole or clindamycin.
- VVC: Azole therapy.
- Trichomoniasis: Metronidazole with partner treatment to avoid reinfection.