Vaginitis. By. Prof. Dr. Professor of Obest. & Gynecology Tanta University. Amal E. Mahfouz. Vaginitis. WHAT IS VAGINITIS? I t is a term applied to any kind of vaginal inflammation that cause abnormal discharge and pruritis .
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Professor of Obest. & Gynecology
Amal E. Mahfouz
WHAT IS VAGINITIS?
It is a term applied to any kind of vaginal inflammation that cause abnormal discharge and pruritis .
It is one of the most common reasons for a women to seek Gynecological care.
The 5th World Conference on Vaginitis1 - 3 May 2008Ritz CarltonIstanbul,Turkey
1- ALLERGIC VAGINITIS:caused by spermicidal creams, bath oils or soaps.
2- INFECTIOUS VAGINITIS:
B-Candidiasis(candida albicans) 20-30 %.
C- Bacterial vaginosis(Gardnerella vaginitis) 40-50%.
D- Miscellaneous organisms (herpes simplex, HPV, gonorrhea &$).
3- ATROPHIC VAGINITIS:
4-Parasitic vaginitis:caused by Entropius Vermicularis
5-Foreign Body Vaginitis:retained tampons or condoms cause malodorous vaginal discharges.
Superficial skin infection (from scratching)
Complications of the causative condition as gonorrhea and candida infection
Unicellular flagellated protozoan (Trichomonas vaginalis) that causes up to10-30% of vaginitis.
* Vagina, skene ducts & lower urinary tract.
MODES OF INFECTION.
2-Vulvo-vaginal contamination by bath, towels or wet bathing suits.
1-Discharge, copious, greenish-yellow, frothy and foul-smelling (fishy odor).
2-Pruritis,Edema, Erythema, especially in acute stage.
3-Urinarysymptoms may be present due to urethro-cystitis.
Profuse purulent frothy vaginal discharge
Thin, water, cervical discharge of trichomonas infection
Prof.Dr. Amal E. Mahfouz
Frothy" Discharge seen around the cervix
1- Vaginal pH > 5.0
2- Skiff Test positive
- Fishy odor of discharge when KOH added.
3- Wet preparation(from vaginal vault, not endocervix).
- Motile pear shaped Trichomonads with flagella (70%).
4- Gram Stain
- White Blood Cells over 10 per high powered field.
5- Culture of Trichomonas vaginalis
- Grown on Kupfierberg medium.
1-Single dose of oral metronidazol (2gm).
2- Metronidazol 500mg bid for 7 days.
3- Intravaginal metronidazol supp. 500mg (bid) for 7 days.
4- Secnidazol (2 gm) oral single dose.
Treatment of both partners is mandatory.
The antibiotic Paromomycin cream is an effective, alternative treatment option for women with hard-to-treat vaginal trichomoniasis
Candida albicans,is a common organism found in the vagina of healthy women.
Certain types of clothing may predispose for Candida. Females should be cautioned to avoid wearing tight-fitting clothes and synthetic underwear.
Frequent coitus and the use of intrauterine devices may also be contributing factors.
Situations That Mimic Vaginal Candidal Infection
Contact dematitis Soaps, deodorants, detergents, spermicides, vaginal lubricants, perfumed cleansing wipes
Irritant vulvitisExcessive use of minipads
Vulvo-vaginitisAdverse reaction to vaginal antifungal
Change in vaginal mucusThat occurs at ovulation
Coitus-related vaginitisAllergy to partner’s sperm
Fluconazole is a potentantifungalknown to act against most candida species (particularly candida albican)has demonstrated effective action against both oral andvaginal candidiasiseven in cases resistant to nystatin orclotrimazole.
One of it's side effects is liver toxicity although that appears to be more common in patients with concomitant health issues and seems to be reversible on stopping the drug.
Fluconazole taken once a week for six months was found to reduce the frequency of recurrent vaginal Candida infections by more than 90%.
Antifungal vaginal medications
GYNAZOLE vaginal cream, contains butoconazole nitrate 2%, an imidazole derivative withantifungalactivity.
The term vaginosis indicates lack of an inflammatory reaction (absence of white blood cells in the discharge.
The causative organisms is Hemophilus vaginalis (Gardnerella vaginalis).
Incubation period:5-10 days after inoculation.
Three points help confirm bacteria as the source of vaginitis:
The discharge is thin, homogeneous, white, and resembles skim milk adhering to vaginal walls.
(2) The pH is above 4.5 (normal vaginal pH is 3.8-4.4).
(3) When a sample of the discharge is mixed with 10% KOH, it will produce a typical "fish-like" odor (this is indicative of an increase in anaerobic activity, which yields amines such as cadaverine and putrescine)
Irritative symptoms:pruritis and burning, less than with trichomonas infection.
Gram Stain - Bacterial Vaginosis
3.8 – 4.2
Thin, white (milky), gray
Yellow, green, frothy
White, curdy, cottage cheese
White, thin, floccuent
Amine odor "whiff" test
Clue cellsadherent cocci, no WBC's
Budding yeast, hyphae, pseudohyphae
Differential Diagnosis of Vaginal Infections
II Urinary Symptoms:
Prof.Dr. Amal E. Mahfouz