Vaginal Infections MCQs

Associated with increased risk of acquiring HIV, C. trachomatis, and N. gonorrhoeae. Treatment of male partners with metronidazole does not prevent recurrence of bacterial vaginosis. Recurrence: Metronidazole gel twice weekly for >3 months Recommendation is against routine screening of pregnant women for bacterial vaginosis. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 136, Pg: 1083

Both estrogen alone or estrogen + progesterone can be used for treating menopausal symptoms. The choice depends on whether the uterus is present or not. "For women with a uterus, a progestin should be combined with an estrogen, to lower the risk of endometrial cancer." All women who have intact uterus should receive combined estrogen - progesterone therapy. Reference: Williams Gynae 1st/ed pp 495, 499-500

Syndromic management of sexually transmitted infections (WHO 1991) Principle: Treatment of STDs should be initiated at the patient's first visit to a clinic. At the same time the couple is counseled about the importance of condom use and prevention of STD transmission. Syndromic managements are based on epidemiological studies all over the world. Syndromic diagnosis and laboratory assisted diagnosis have been found similar in terms of accuracy. Method: Management is done by criteria for syndromic diagnosis of PID. These include detection of vaginal discharge abdominal pain, cervical motion tenderness, bilateral adnexal providers are trained up to follow a standardized protocol (flow chart) to treat such a patient. This is particularly suitable in a health care setting of developing countries. Reference: Dutta Gynae 6 th /ed p 176; Internet search-www. naconlinr.org/upload/publication/ste

Candida is M/C vaginitis in: – Pregnancy, diabetes – Immunocompromised – OCP users, steroid users, antibiotic users Symptoms: intense pruritus Curdy white vaginal discharge Signs: yeasty curdy white vaginal discharge Cervix normal Diagnosis: sabouraud's media Fungal hyphae in 10% KOH preparation pH Reference : J B Sharma, Textbook of Gynecology 1st edition p340

Bacterial vaginosis occurs due to alteration of vaginal flora; lactobacilli decrease whereas coccobacilli and Gardnerella increase. Amsel’s criteria includes: White milky, non viscous, adherent vaginal discharge Vaginal pH more than 4.5 Positive whiff test: amine odour with 10% KOH Presence of clue cells Increase in number of gardnerella vaginalis and reduced number of lactobacilli Treatment: tab. Metronidazole 2 g single dose or tinidazole or clindamycin 300 mg BD for 7 days Reference: J B Sharma, Textbook of Gynecology 1 st edition p333

Clue cells are diagnostic but about 40% patients may not have clue cells. Reference: Dutta Gynae 6th/ed p 152

Benign lesions of vagina: Congenital malformations Infections Ulcers Scarring Stenosis DES induced lesions Granulation tissue Cysts Reference: JB Sharma textbook of Gynecology e1 p 497

Vulvovaginitis occurs due to lack of estrogen. Most commonly seen in children. Causes Foreign body Worm infestation Tuberculosis Infections such as candida Symptoms are intense pruritus and offensive vaginal discharge. Estrogen cream and treatment of infections are done for its management. Reference: J B Sharma, Textbook of Gynecology 1 st edition p332