_ University of Washington阴道炎华盛顿大学课件.ppt

Vaginitis pathophysiology etiology diagnosis treatment Paul’s boat The dynamic vagina vaginal secretions, exfoliated cells, cervical mucosa lactobacillus acidophilus estrogen glycogen vaginal pH metabolic byproducts of flora and pathogens Causes of vaginitis antibiotics contraceptives sexual intercourse douching stress hormones allergies and chemical irritation Bacterial vaginosis proliferation of Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Peptostreptococcus species most common cause 1/3 to 2/3 asymptomatic 15 to 19% of all women 10 to 30% pregnant women BV misc. role of sexual transmission unclear risk for preterm labor and PROM increased frequency of abnl PAPs, PID, endometritis Sxs: profuse malodorous discharge Exam: thin grayish discharge, seldom vaginal or vulvar irritation Risks associated with BV Early sexual ‘debut’ new or multiple sex partners IUD (50% contract it over 2y) OCP Lesbians/receptive oral sex no RCT’s but association with douche, c-section and around time of menses Amsel’s criteria thin, homogenous discharge positive “whiff” test “clue cells” present on microscopy vaginal pH 4.5 BV treatment metronidazole 500 mg BID x 7 days clindamycin 2% cream qhs x 7 days metrogel 0.75% BID x 5 day (vs. QD) metronidazole 250 mg TID x 7 days metronidazole 2 g po single dose metrogel (no previous PTL) Vulvovaginal Candidiasis second most common in U.S. Candida albicans predominates increasing frequency of non-albicans species (C. glabrata) Risks: OCPs, diaphragm, IUD, early intercourse, 4X/month, receptive oral sex, diabetes, recent antibiotics. endogenous vaginal flora in 50% women Vaginal candidiasis not sexually transmitted nor related to number of sexual partners treatment of male partner of no benefit c/o pruritis, vaginal irritation, dysuria vulvovaginal itching not normal in healthy women (lichen sclerosis, vulvar cancer) exam: thick white discharge, no odor, normal pH vulvar and vaginal erythema diagnostics pH normal (