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Vulvar Lesions

Vulvar Lesions. CAPT Mike Hughey, MC, USNR. Bartholin Gland. Normally not seen nor felt If enlarged, can be a painless cyst or painful abscess. Bartholin Duct Cyst. Video. Bartholin's Abscess. Must be drained Simple I&D Marsupialization Word Catheter. Don’t Confuse it with These:.

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Vulvar Lesions

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  1. Vulvar Lesions CAPT Mike Hughey, MC, USNR

  2. Bartholin Gland • Normally not seen nor felt • If enlarged, can be a painless cyst or painful abscess

  3. Bartholin Duct Cyst Video

  4. Bartholin's Abscess • Must be drained • Simple I&D • Marsupialization • Word Catheter

  5. Don’t Confuse it with These: Inclusion Cyst of the Vulva Right Vaginal Wall Cyst

  6. Skene's Gland • Each side of urethra • Normally neither seen nor felt • May become swollen and tender, particularly with GC or chlamydia • Culture • I&D if pointing

  7. Skenitis • Will need I&D • Culture for GC, Chlamydia

  8. Herpes Vulvitis • Prodrome of itching or tingling • Multiple, small, painful blisters • Shallow ulcers filled with gray material • Crusts over in 7-10 days • Recurrences in 50%

  9. Herpes Vulvitis Treatment • Spontaneous resolution in 10 days • Zovirax 200 mg PO Q 4 hours while awake #50 • May need to place Foley cather • Recurrences are not as severe

  10. Molluscom Contagiosum • Multiple, 1-2 mm raised, painless lesions • Dome-shaped with central dimple • Contain cheesy-white material • Sexually transmitted

  11. Molluscom Contagiosum Treatment • Cryosurgery (just the lesion) • Bichloracetic acid (just the lesion) • Dermal curette (AgNO3 to base) • Electrocute the lesion (local anes.) Video

  12. HPV (Condyloma) • Clinical warts • Flat warts • Soak vulva in vinegar,Exam under 7x power,Red-free light filter • No specific treatment

  13. Tinea Cruris (Jock Itch) • Raised, reddened intertrigenous lesion • Dx: visual, but may obtain KOH scrapings • Rx: (BID x 2-3 weeks) -Monistat -Lotrimin -Diflucan -Nizoral

  14. Runner’s Rash • Chafing from running, walking or other exercise • Lubricate with vaseline • Avoid cotton underwear • Local treatment

  15. Vulvar Dystrophy - Hypertrophic • Skin too thick • Sx: Itching • Dx: Biopsy • Rx: Steroid Cream

  16. Vulvar Dystrophy - Lichen Sclerosis • Skin too thin • Sx: Itching • Dx: Biopsy • Rx: Testosterone Cream or Clobetasol

  17. Paget's Disease • Slow-growing malignancy • Exzematoid lesion -dry, crusty skin -moist, weepy -contact bleeding • Looks like yeast, but isn’t cured with anti-fungal Rx • Confirm by Bx, treat with local excision

  18. Vulvar Hematoma • Straddle injury • Foley/Ice/Rest • Completely resolves in 2-3 weeks • Try not to drain them • Unnecessary • Bleeding point elusive • Risk infection • Spontaneous drainage in half

  19. Primary Syphilis Appearance • Painless solitary ulcer • LNs enlarged, firm, non-tender • Positive RPR, VDRL • Positive Darkfield

  20. Primary Syphilis Treatment • Benzathine PCN G, 1.2 M in each buttock(2.4 M total) • TTCN, 500 mg PO QID x 14 days • Doxycycline 100 PO BID x 14 days

  21. Condyloma Lata Diagnosis • Secondary syphilis • Raised, painless flat lesions • Resemble condyloma, but smooth surface • Positive VDRL • Positive darfield of surface scrapings

  22. Condyloma Lata Treatment • Same as Primary Syphilis

  23. Chancroid Appearance • Tender, red papule filled with pus • Grayish, necrotic base • Jagged, irregular margins • No induration (contrast syphilis) • Tender inguinal LNs in 50%

  24. Chancroid Diagnosis • Hemophilus ducreyi • Hard to culture • Gram-neg coccobacillus in clusters around Polymorphonucleocytes • "School of Fish Appearance" • History, physical, exclude other ulcerative diseases

  25. Chancroid Treatment • Azithromycin 1 g PO • Ceftriaxone 250 mg IM • Ciprofloxacin 500 mg PO BID for 3 days • Erythromycin base 500 mg PO QID for 7 days.

  26. Lymphogranuloma Venereum (LGV) • Ulceration of the vulva, rectum or groin • Pain with walking, sitting, or BMs • Hard tender masses (bubos) arise in the inguinal area • Untreated, extensive scarring in therectum and vagina

  27. LGV Diagnosis • Chlamydia trachomatis serotype culture from a bubo • Acute/convelescent serum complement fixation test • History of exposure • Visual appearance • Prevalence in the population.

  28. LGV Treatment • Doxycycline 100 mg orally twice a day for 21 days, or • Erythromycin base 500 mg orally four times a day for 21 days. • Zithromax? (Probably with multiple doses over several weeks)

  29. Granuloma Inguinale Appearance • Chronic ulcerative disease • Clean, granulomatous, sharply-defined • Multiple, confluent ulcers • Beefy red base which bleeds easily • Pseudobuboes in the groin • Confirm with biopsy (Donovan Bodies)

  30. Granuloma Inguinale Treatment • Minimal scarring when treated early • Extensive scarring when treated late • 3 Weeks of: • Bactrim DS BID • Doxycycline 100 mg BID • Ciprofloxacin 750 mg BID • Erythromycin base 500 mg QID

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