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Vaginosis, Vaginitis, Wet Preps: What I Want You To Know Stephen Poff, M.D.

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Vaginosis, Vaginitis, Wet Preps: What I Want You To Know Stephen Poff, M.D.

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    1. Vaginosis, Vaginitis, & Wet Preps: What I Want You To Know! Stephen Poff, M.D.

    3. Know Normal! Epithelial Cells 2. Lactobacilli - 5 to 15 3. WBCs - Few = NL - Never > Epis - Many = Inflammation (Parabasilar Cell) >

    4. Vaginitis - Know 2+ Trichomonas - Many WBCs 2. Candidiasis/Yeast Candida albicans: 1) Blastospores CANDIDIASIS 2) Budding Yeast 3) Pseudohyphae Candida glabrata: 1) Blastospores (Torulopsis g.) 2) Budding yeast YEAST - Grow is clusters = CUMULI > - Many WBCs

    5. Vaginosis - Know 3 Bacterial Vaginosis - NONE/FEW Lactobacilli (5 to 15 ) - Few WBCs!!!!!!! Cytolytic Vaginosis - Lactobacillus Overgrowth Syndrome - Can look like NORMAL - MANY Lactobacilli (5 to 15 ) - Few WBCs!!!!!!! Lactobacillosis - Leptothrix - Can look like YEAST - LONG Lactobacilli (40 to 75 ) - Few WBCs!!!!!!!

    6. Vaginosis - Know 3 1. Bacterial Vaginosis - FEW or NO LACTOBACILLI - MANY Coccobacillary Orgs. = GARBAGE - CLUE CELLS = CELL EDGE - FEW WBCs!!!!!!! - MOBILUNCUS = MOTILE

    7. Vaginosis - Know 3 2. Cytolytic Vaginosis = Lactobacillus Overgrowth Syndrome - MANY LACTOBACILLI - 5 to 15 - Few WBCs!!!!!!! - Symptoms: - middle of cycle - menses - ++Vaginal itching - ++Vulvar dysuria - ++Dyspareunia - Treatment: - No tampons 6mths - vaginal pH - 1 Tsp Na-Bicarb/1Pint H2O/ Douche 1 2 X/wk - 2-4 Tbsp Na-Bicarb/2 in bath/ Sitz Baths 2 3 X/wk

    8. Vaginosis - Know 3 3. Lactobacillosis = Leptothrix - LONG LACTOBACILLI - 40 to 75 - Few WBCs!!!!!!! - Symptoms: - 1wk before menses - +Vaginal itching - +Vulvar dysuria - Curd-like discharge - Treatment: - Augmentin or Doxycycline

    9. 3 Cases Case 1 A 29-year-old woman comes in with a chief complaint of a white vaginal discharge off and on for the last 2 months. She notices that the discharge smells really fishy after intercourse. She reports that she has tried Monistat 3 vaginal suppositories with no relief. I don't feel clean unless I douche on a regular basis.

    10. 3 Cases Case 1

    11. 3 Cases Case 2 A 33 year old woman complains of monthly vaginal infections. She reports that she has vaginal itching, no noticeable discharge, and the outside of my vagina burns particularly with urination. She states the symptoms disappear during her menses and then get worse again in the middle of her cycle. I can't have intercourse during this time because it is too painful... I have tried to use over-the-counter [OTC] lubricants and nothing eases the pain.

    12. 3 Cases Case 2

    13. 3 Cases Case 3 A 44 year old woman reports symptoms of vaginal itching, burning, and irritation with a thick, white, curdy vaginal discharge. She reports the symptoms appear about a week and a half before her menses. She has tried many OTC products initially and finally called her OB/GYN who did not see her but did call in prescriptions for Flagyl and Diflucan. However, the symptoms continued even after this treatment.

    14. 3 Cases Case 3

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