Flashcards in Sexual Health Deck (141)
What is the normal vaginal pH.
How is this beneficial?
inhibits growth of other bacteria
What maintains the normal vaginal pH
lactobacilli produce hydrogen peroxide - maintains acidic pH
What is the pathophysiology of bacterial vaginosis
disturbance of normal vaginal flora
decrease in lactobacilli
increase in Gardnerella vaginalis, anaerobes and mycoplasma
increase in vaginal pH >4.5
What are the risk factors for BV?
new or multiple sexual partners
receptive oral sex
What are the symptoms of BV
white/grey homogenous thin vaginal discharge
What is the differential diagnosis for BV
What investogations are done for BV
high vaginal smear of discharge, gram stained
What are Amsel's criteria
help to diagnose BV - need >=3
homogenous white/grey thin discharge
bacilli on microscopy of smear - clue cells
positive KOH whiff test
What are clue cells
vaginal epithelium studded with gram variable coccobacilli - indicate presence BV
What are the Ison/Hay criteria?
Way of classifying BV depending on gram stained smear of vaginal discharge
Grade 1 - mainly lactobacilli = normal
grade 2 - some lactobacilli, others present = intermediate
grade 3 - few lactobacilli, others predominate = BV
What is the management of BV
metronidazole 400mg BD 5 days
avoid scented shower gels, douching
What are the risks of BV in pregnancy
What microorganism is involved in Vaginal candidiasis
Candida albicans - 90%
Describe the pathophysiology of vaginal candidiasis
opportunistic - immunocompromised leads to infection
hypersensitivity - changes in oestrogen etc leads to hypersensitivity reaction
What are the risk factors for candida
recent course of broad spectrum Abx
What are the symptoms of candida
vaginal discharge -white, curd like, non-offensive
What can be seen in examination in candida
white curd like vaginal discharge
erythema and swelling of vulva
Differential diagnosis of candidiasis
What investigations are needed to diagnose candidiasis
if uncomplicated - none! do on history + examination
if complicated eg. DM, pregnancy, recurrent
- do vaginal smear and microscopy (see spores adn mycelia)
What is the management of candidiasis
topical clotrimazole for vagina
What is the management of recurrent candidiasis
3 x 150mg oral fluconazole over 10 days
500mg clotrimazole once a week for 6 months
What is the management of candidiasis in pregnancy
pessary of clotrimazole - avoid damaging cervix with applicator for vaginal cream
check for otehr STIs which could be dangerous in pregnancy
How quickly should candidiasis clear up with treatment
What should be done if the infection does not clear?
within 7-10 days
consider alternative diagnosis
modify predisposing factors eg. diabetic control
When is emergency contraception used?
after sexual intercourse if:
failed method of contraception
What are the options for emergency contraception
Which method of emergency contraception is most effective?
How does levonorgestrel work?
prevents ovulation for 5-7days
no effect on implantation
How does ullipristal acetate work?
progesterone receptor modulator
delay ovulation for 5-7days
prevents development of follicles/rupture of follicles at time of LH surge but not after
How does the copper IUD work as emergency contraception?
toxic to sperm
makes implantation impossible due to inflammation of endometrium