Vaginal Itching and Discharge
CAPT Mike Hughey, MC, USNR
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 1
Vaginal or Vulvar Itching
• 95% of women with vulvar itching
have yeast.
• Giving an anti-fungal agent (Monistat,
Lotrimin, etc.) will cure most of this
itching.
• Treatment failures need further
evaluation.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 2
Yeast (AKA Monilia, Thrush, Candida)
•
Itching is hallmark symptom
•
Red, swollen, tender vulva
•
Wet Mount confirms
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 3
Yeast Treatment
•
•
•
•
•
•
Topical anti-fungal
agents work well
Monistat
Gyne Lotrimin
Mycelex G
Oral agents also work
well
Diflucan 150 PO once
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 4
Chronic Yeast
Predisposing Factors:
•
•
•
•
•
Heat
Moisture
Diet
Diabetes
Antibiotics
Solution: PRN Anti-fungal Agents
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 5
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
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 6
Contact Dermatitis
•
Perfumes
•
Deodorants
•
Toilet Paper
•
Soap
•
RX:
-Stop exposure
-Burrow's Solution
-Topical Steroids
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 7
Crabs (Pubic Lice)
Transmitted by:
•
•
•
•
Sexual contact
Infected bedding
Sharing towels
Close living quarters
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 8
Crabs (Pubic Lice) Treatment
Nix cream
Kwell Shampoo
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 9
HPV (Condyloma)
•
Clinical warts
•
Flat warts
•
Soak vulva in vinegar,
Exam under 7x power,
Red-free light filter
•
Cryo, TCA, Laser,
Cautery, Podo, etc.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 10
Vulvar Dystrophy - Hypertrophic
•
Skin too thick
•
Sx: Itching
•
Dx: Biopsy
•
Rx: Steroid Cream
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 11
Vulvar Dystrophy - Lichen Sclerosis
• Skin too thin
• Sx: Itching
• Dx: Biopsy
• Rx: Testosterone
Cream or
Clobetasol
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 12
VIN (Vulvar Intraepithelial Neoplasia)
•
•
•
•
Itching
Doesn’t respond to
anti-fungal agents
May have a white
skin discoloration
Need biopsy for
diagnosis
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 13
VIN (Vulvar Intraepithelial Neoplasia)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 14
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
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 15
Vaginal Discharge
• Does it Itch?
• Does it smell bad?
• What does it look
like?
• Wet mount, cultures
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 16
Bacterial Vaginosis
• Smells bad
• “Whiff Test” (KOH)
• AKA Gardnerella, BV,
Hemophilus Vag.
• Anaerobic bacteria
• Rx: Flagyl
• Rx: Clindamycin
• Rx: Amox
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 17
Bacterial Vaginosis
• Rx: Flagyl
• Rx: Clindamycin
• Rx: Amox
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 18
Trichomonas
• Bubbly, frothy discharge
• Rx: Flagyl
250 TID x 7 days
500 BID x 5 days
2 gm PO stat
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 19
Wet Mount
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 20
Cultures
• If GC, Chlamydia,
Strep suspected
• If pelvic pain present
• Treatment failures
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 21
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 22