Term
| What is the second most common cause of vulvovagnial-related symptoms? |
|
Definition
|
|
Term
| ___% of women experience at least one episode of vulvovaginal candidiasis in their lifetime; ___% experience 2 or more episodes in their lifetime. |
|
Definition
|
|
Term
| What organisms can cause a yeast infection? |
|
Definition
Candida albicans (85%)
Candida glabrata (15%) |
|
|
Term
| What are the risk factors for recurrent yeast infections? |
|
Definition
high dose OCPs
diaphragm use with spermicide
diabetes mellitus
antibiotic use
pregnancy
immunosuppression
tight fitting clothing |
|
|
Term
| What are the signs and symptoms of a yeast infection? |
|
Definition
itching, burning, irritation, erythema
thick odorless curdy discharge with cottage cheese appearance |
|
|
Term
| What is the treatment for a yeast infection? |
|
Definition
Diflucan 150 mg single dose
topical antifungal agents |
|
|
Term
| What is an advantage of oral treatment over topical treatment for yeast infections? |
|
Definition
|
|
Term
| What is an advantage of topical treatment over oral treatment for yeast infections? |
|
Definition
| immediate symptomatic relief |
|
|
Term
| What causes trichomoniasis? |
|
Definition
| protozoan--Trichomonas vaginalis |
|
|
Term
| ___% of thrichomoniasis cases are asymptomatic. |
|
Definition
|
|
Term
| What are the signs and symptoms of trichomoniasis? |
|
Definition
yellow-green purulent frothy discharge with disagreeable odor
vulvar itching (50%) |
|
|
Term
| What causes the odor associated with trichomoniasis? |
|
Definition
| overgrowth of anaerobic microorganisims with resultant amine production |
|
|
Term
| What is the treatment for trichomoniasis? |
|
Definition
| Metronidazole (Flagyl) 2 gm single dose |
|
|
Term
| What is another name for bacterial vaginosis? |
|
Definition
| hemophilus vaginalis vaginitis |
|
|
Term
| What causes bacterial vaginosis? |
|
Definition
result of complex interactions between many species of bacteria
overgrowth of bacteria |
|
|
Term
| What species of bacteria are involved in bacterial vaginosis? |
|
Definition
Gardnerella vaginalis
genital mycoplasms
anaerobic bacteria of the vagina |
|
|
Term
| What are the criteria for diagnosis of bacteria vaginosis? |
|
Definition
-clue cells (at least 1 in 5 epi's with edges obscured by bacteria)
-vaginal pH <4.5
-amine (fishy) odor spontaneously after addition of 10% KOH to vaginal flora
-thin homogeneous discharge |
|
|
Term
| How many of the criteria must be present to diagnose bacterial vaginosis? |
|
Definition
|
|
Term
| What is the treatment for bacterial vaginosis? |
|
Definition
| Metronidazole (Flagyl) 500 mg PO BID x 7 days |
|
|
Term
| A Bartholin's gland infection is almost always an __________. |
|
Definition
|
|
Term
| What is the treatment for a Bartholin's cyst/abscess? |
|
Definition
I&D
Word catheter
antibiotics |
|
|
Term
| How long should a Word catheter be left in for a Bartholin's cyst/abscess? |
|
Definition
as long as possible
six weeks is best |
|
|
Term
| What is the only curative treatment for Bartholin's cysts/abscesses? |
|
Definition
|
|
Term
| What is marsupialization? |
|
Definition
| sewing the Barthonlin's gland open to prevent infections |
|
|
Term
| What organism causes pediculosis pubis? |
|
Definition
|
|
Term
| What percentage of partners are infected after a single exposure to pediculosis pubis? |
|
Definition
|
|
Term
| What symptom is associated with pedicularis pubis? |
|
Definition
|
|
Term
| What causes the constant itching associated with pedicularis pubis? |
|
Definition
| secondary to allergic sensitization (usually within 5 days) |
|
|
Term
| How long does the initial sensitization to pedicularis pubis take to develop? |
|
Definition
|
|
Term
| What is the incubation period for pedicularis pubis? |
|
Definition
|
|
Term
| What is the treatment for pedicular pubis? |
|
Definition
Permethrin (Nix Creme)
Lindone (Kwell) |
|
|
Term
| What organism causes scabies? |
|
Definition
| parasite--Sarcoptes scabies |
|
|
Term
| Which parasite has a predilection for hairy areas and which does not? |
|
Definition
pedicularis pubis--hairy areas
scabies--everywhere |
|
|
Term
| What symptom is associated with scabies? |
|
Definition
| severe but intermittent itching that is worse at night |
|
|
Term
| What is the treatment for scabies? |
|
Definition
| Permethrin (Nix Creme) 5% applied to all areas of the body from the neck down and washed off after 8-14 hours |
|
|
Term
| pink papules with a central umbilication |
|
Definition
|
|
Term
| What is the treatment for molluscum contagiosum? |
|
Definition
| mechanical disruption of the surface and extrusion of the white material containing "molluscum bodies" |
|
|
Term
| What STD affects 75% of sexually active adults at some point in their lifetime? |
|
Definition
|
|
Term
| HPV currently affects _________ adults in the U.S. |
|
Definition
|
|
Term
| What causes condyloma acuminatum? |
|
Definition
|
|
Term
| Condyloma acuminatum presents as a clinically recognizable macroscopic lesions in ___% of infected women. |
|
Definition
|
|
Term
| Condyloma acuminatum presents as an asymptomatic unrecognized subclinical infection in ___% of infected patients. |
|
Definition
|
|
Term
| What is the treatment for condyloma acuminatum? |
|
Definition
| trichloroacetic acid 80-90% |
|
|
Term
| What is the ease of HPV transmission? |
|
Definition
probability of transmission per act of intercourse is approximately 40%
condoms will provide some protection (approx 70%) |
|
|
Term
| Approximately ___% of women infected with HPV develop persistent HPV infections. |
|
Definition
|
|
Term
| ___% of HPV infections are clinically transient and resolve spontaneously and successfully. |
|
Definition
|
|
Term
| What HPV strains are associated with high risk for cancer of the cervix? |
|
Definition
|
|
Term
| What do high risk viral genotypes of HPV cause? |
|
Definition
| cancer of the cervix, vulva, vagina, penis, anus |
|
|
Term
| What do low risk viral genotypes of HPV cause? |
|
Definition
genital warts
pre-invasive cancer of the vulva, vagina, cervix, anus, and penis |
|
|
Term
| What strains of HPV are associated with genital warts? |
|
Definition
|
|
Term
| Who should get the HPV vaccine? |
|
Definition
-11-12 year old girls (as young as 9)
-13-26 year old females who have no received or completed the series
-ideally should be administered before onset of sexual activity |
|
|
Term
| What is the dosing schedule for the HPV vaccine? |
|
Definition
|
|
Term
| Why should girls under the age of 9 not get the Gardasil vaccine? |
|
Definition
| immunogenicity and efficacy are not known for girls younger than 9 |
|
|
Term
| What adverse reactions are associated with the Gardasil vaccine? |
|
Definition
low grade fever
mild nausea
mild dizziness
redness at injection site |
|
|
Term
| What type of HSV can cause genital herpes? |
|
Definition
|
|
Term
| Where is the herpes virus carried to after the initial infection? |
|
Definition
| sensory and autonomic ganglia of adjacent nerves where it becomes latent |
|
|
Term
| Recurrent attacks of genital herpes are usually due to ____________ rather than ____________. |
|
Definition
| reactivation; reinfection |
|
|
Term
| ________ is common with HSV-2 infections. |
|
Definition
|
|
Term
| What patients is genital HSV infection more severe and protracted in? |
|
Definition
|
|
Term
| What are the signs and symptoms of genital herpes infection? |
|
Definition
erythema
edema
multiple vesicles (may coalesce)
significant pain
often have bilateral LAD |
|
|
Term
| What is the incubation period for herpes? |
|
Definition
|
|
Term
| A viral culture for herpes virus will become positive within _________ of inoculation. |
|
Definition
|
|
Term
| What is the false negative rate for viral cultures for herpes virus? |
|
Definition
|
|
Term
| What organism causes syphilis? |
|
Definition
| spirochete--Treponema pallidum |
|
|
Term
| Syphilis infection involves ________ _________. |
|
Definition
|
|
Term
| Describe the primary syphilis lesion. |
|
Definition
| painless button-like chancre with a central shallow ulceration |
|
|
Term
| When do multiple primary syphilic chancres typically occur? |
|
Definition
| when pt. is immunocompromised |
|
|
Term
| When do serologic tests become positive in a patient with syphilis? |
|
Definition
4-6 weeks after exposure
1-2 weeks after development of the chancre |
|
|
Term
| What causes secondary syphilis? |
|
Definition
hematogenous dissemination of the spirochetes
systemic disease |
|
|
Term
| What percentage of untreated cases does secondary syphilis develop in? |
|
Definition
|
|
Term
| When does secondary syphilis typically develop? |
|
Definition
| between 6 weeks and 6 months (avg 9 weeks) |
|
|
Term
| How long will a secondary syphilis attack last if untreated? |
|
Definition
|
|
Term
| What are the systemic symptoms associated with secondary syphilis? |
|
Definition
-red macules and papules over the palms and soles
-vulvar lesions include mucous patches and condyloma lata associated with painless LAD |
|
|
Term
| What do condyloma lata look like? |
|
Definition
| large raised, flattened, grayish-white areas |
|
|
Term
| What stage of syphilis follows secondary syphilis? |
|
Definition
|
|
Term
| What is the duration of latent syphilis? |
|
Definition
|
|
Term
| What happens during the latent stage of syphilis? |
|
Definition
| positive serology without symptoms or signs of disease |
|
|
Term
| What systems are affected by tertiary syphilis? |
|
Definition
CNS
cardiovascular
musculoskeletal |
|
|
Term
| What percentage of untreated patients with syphilis progress to tertiary syphilis? |
|
Definition
|
|
Term
| What causes lichen sclerosus? |
|
Definition
|
|
Term
| What symptoms are associated with lichen sclerosus? |
|
Definition
intense pruritus
dyspareunia |
|
|
Term
| What is used for the acute treatment of lichen sclerosus? |
|
Definition
| Clobetasol propionate 0.05% once daily |
|
|
Term
| What is used for the chronic treatment of lichen sclerosus? |
|
Definition
| Testosterone propionate 2% |
|
|
Term
| What is the major symptom of squamous cell hyperplasia of the vulva? |
|
Definition
|
|
Term
| What does inspection of the vulva reveal in a patient with squamous cell hyperplasia? |
|
Definition
elevated localized lesions with white and red plaques
may have weeping or crust formations |
|
|
Term
| What is the treatment for squamous cell hyperplasia of the vulva? |
|
Definition
Clobetasol propionate 0.05% twice daily until symptoms resolve
then steroid ointment that is not as potent |
|
|
Term
| What is the mean age of occurrence for vulvar intraepithelial neoplasia? |
|
Definition
|
|
Term
| What do patients with VIN 3 require? |
|
Definition
| close examination of the vagina, cervix, perianal skin, and anal canal (these sites may harbor similar changes) |
|
|
Term
| What may help to identify VIN? |
|
Definition
staining of the vulva with 1% solution of toluidine blue
abnormally stained areas need to be biopsied |
|
|
Term
| Although VIN is being diagnosed more commonly in younger women, the risk of progressing to invasive cancer is higher for those who are _________ and ______________. |
|
Definition
| older and immunosuppressed |
|
|
Term
| What type of lesions cause a greater risk of invasion with VIN? |
|
Definition
| raised lesions with irregular surface patterns |
|
|
Term
| What is used to make the diagnosis of VIN? |
|
Definition
careful inspection
acetic acid (2%) application
toluidine blue 1% application
vulva biopsies (used liberally) |
|
|
Term
|
Definition
-surgical excision with disease-free border of at least 5 mm
-skinning vulvectomy with split thickness skin graft (extensive multifocal lesions)
-laser therapy (esp. for multifocal disease) |
|
|
Term
| How much destruction of non-hair bearing epithelium is required with laser therapy for multifocal VIN? |
|
Definition
|
|
Term
| How much destruction of non-hair bearing epithelium is required for multifocal VIN if skin appendages are involved? |
|
Definition
|
|
Term
| What signs and symptoms are associated with invasive cancer of the vulva? |
|
Definition
pruritus
mass
pain
bleeding
ulceration
discharge
groin mass |
|
|
Term
| Where do most invasive cancers of the vulva arise? |
|
Definition
|
|
Term
| What route of metastases is the primary route for invasive cancer of the vulva? |
|
Definition
|
|
Term
| What type of spread is rare with invasive cancer of the vulva? |
|
Definition
|
|
Term
| What is the treatment for unilateral lesions in invasive cancer of the vulva? |
|
Definition
| wide radical resection of primary lesion plus ipsilateral superficial inguinal node dissection |
|
|
Term
| What should be done if the superficial inguinal node is positive in a patient with unilateral invasive cancer of the vulva? |
|
Definition
| remove deep inguinal node and contralateral superficial and deep inguinal nodes |
|
|
Term
| If all nodes are positive in a patient with unilateral invasive cancer of the vulva, what should you do? |
|
Definition
| post-operative radiotherapy to affected areas |
|
|
Term
| What is the treatment for bilateral lesions in a patient with invasive cancer of the vulva? |
|
Definition
| radical vulvectomy plus bilateral superficial inguinal node dissections through separate incisions |
|
|
Term
| What is the treatment for midline lesions in a patient with invasive cancer of the vulva? |
|
Definition
| wide radical resection plus bilateral superficial lymph node dissection through separate incisions |
|
|
