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Vaginal lesions

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21 diapositives · 846 Views · Feb 15, 2014

Vaginal lesions. Prof Greta Dreyer University of Pretoria. Outline. Infections Vaginal Intra-epithelial Lesions Vaginal cancer Primary Secondary. Infections. Viral HPV HSV 2 Bacterial Vaginosis Vaginitis / cervicitis Fungal Candida albicans, glabrata, etc Immunocompromise .

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  1. Vaginal lesions Prof Greta Dreyer University of Pretoria

  2. Outline • Infections • Vaginal Intra-epithelial Lesions • Vaginal cancer • Primary • Secondary

  3. Infections • Viral • HPV • HSV 2 • Bacterial • Vaginosis • Vaginitis / cervicitis • Fungal • Candida albicans, glabrata, etc • Immunocompromise

  4. Viral infections • HPV • Condyllomata accuminata = warts • Benign neoplasm • Associated with ”LOW RISK” HPV types 6 and 11 • Preventable with vaccination that targets these viral types • Treated with: • Chemicals = podophyllin NOT in vagina, absorbed = toxin • Local destruction = cauterisation, laser • Cytotoxins = chemoRx, 5FU = BURNS the vagina due to cytotoxic effect, EFFECTIVE • Immunostimulants = ALDARA,= imiquimod = EFFECTIVE vulva, vagina

  5. Viral infections • HSV TYPE 2 • Cold sore, fever ulcer • Typically vulvar lesion, cervical lesion • Nerve distribution, Zoster type, can be chronic, severe • Treat systemically NOT locally (placebo) • AB, urination, keep clean (NaCl H2O)

  6. Bacterial infections • Vaginosis • CHANGE in vaginal flora for the worse! • Often associated with sexual intercourse • pH alkaline (>4,5), watery discharge, fishy • Gardnerella vaginalis and friends colonise • Not major inflammatory reaction • Treatment • Kill offensives – metronidazole, clindamycin • Change environment – lower the pH • Enhance “good” bacteria = Lactobacillus

  7. Bacterial infections • Vaginitis • Also change in vaginal flora • watery discharge, itch, burning • Often Streptococcus culture • Can have inflammatory reaction • Pre- and post-menopausal condition • Treatment: • Kill offensives – Penicillin • Change environment – increase the estrogen, enhance “good” bacteria = Lactobacillus

  8. Bacterial infections • Vaginitis / Cervicitis • STI’s – NOT a problem if vagina only • Chlamydia and Gonococcus = friends • Identical clinical picture • PAIN, RED, discharge • Upper abdomen, peri-hepatitis, peritonitis • Difficult to confirm, culture, identify • Treated empirically • Ciprofloxacin stat • Doxycyclin for 21 days

  9. Fungal infections • Vaginitis / Vulvitis • NOT an STI • Can be transmitted, aggrevated • Opportunistic infection • Commensal in GIT • After AB, hospitalisation, ICU, UTI

  10. Fungal infections • Also associations with: • Low estrogenic states • OC use • Eczema, dermatitis • High glucose states • Chronic trauma

  11. Fungal infections • Treatment: • Local antifungals • Creams, vaginal tablets, suppositories, SR tabs • Systemic antifungals • Stat, repeat (1x pw, 1x pm), courses • Equally effective, preference dictates • Better choice for recurrent, hypersensitivity states • NOT for pregnant, LIPID soluble

  12. Immuno-compromise • HIV, transplant, severe malnourishment • MIXED infections • Severe Candida, also C. glabrata • SEVERE HPV related disease • KS, other HSV, Zoster • Lymphoma, carcinoma • (Spontaneous) non-malignant fistulation

  13. Immuno-compromise • Improve immunity if possible • Improve nutrition • Improve hygiene • Saltwater sit and douche • Chronic AB (TMP-SMZ), AF (Flu-conazole) • Repeated AV (Acyclovir) • Diagnosis including serology, cytology, histology

  14. VA ginal I ntra-epithelial N eoplasia – VAIN now SIL • With or without current cervical lesions • Prior cervical lesions • HPV “HIGH RISK” viral types • 16, 18, 31, 33, 35, 45 • Diagnosis: • Cytology • HPV typing • Colposcopy = vagina-scope • Iodine = Schiller’s TEST (not LIST) = Iodine NEG • Acetic acid = AWE

  15. VAIN or Vaginal SIL:Treatment • Exclude invasion = histology = biopsy • Increase immunity, smoking cessation • Imiquimod • 5FU local application • Excision • Vault excision • In theatre, mark area carefully • MONOCLONAL disease, usually confluent • Can be multi-focal • Destruction • Laser • Caterisation • With or without current cervical lesions

  16. PRIMARY Vaginal cancer • Squamous OR • Adenocarcinoma • Staging = FIGO cervical cancer • Treatment usually (chemo) radiation • HPV related • SCARCE!!

  17. PRIMARY Vaginal cancer • Sarcoma OR • Melanoma • Treatment usually surgery • Systemic recurrence • NOT HPV related • VERY SCARCE!!

  18. SECONDARY Vaginal cancer • Direct spread • CERVIX • VULVA • ENDOMETRIUM • OVARIAN • RECTUM • BLADDER / URETHRA • Metastatic disease • COLON • OVARY • STOMACH • BREAST • THYROID • LYMPHOMA

  19. SECONDARY Vaginal cancer • BIOPSY • FIND SOURCE • STAGE and TREAT appropriately

  20. Summary • Infections • Vaginal Intra-epithelial Lesions • Vaginal cancer • Primary • Secondary

  21. Thank You