Non-Candidal Vaginitis: a Comprehensive Approach to Diagnosis & Management
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Vaginitis and Abnormal Vaginal Bleeding
UCSF Family Medicine Board Review 2013 Vaginitis and Abnormal • There are no relevant financial relationships with any commercial Vaginal Bleeding interests to disclose Michael Policar, MD, MPH Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine [email protected] Vulvovaginal Symptoms: CDC 2010: Trichomoniasis Differential Diagnosis Screening and Testing Category Condition • Screening indications – Infections Vaginal trichomoniasis (VT) HIV positive women: annually – Bacterial vaginosis (BV) Consider if “at risk”: new/multiple sex partners, history of STI, inconsistent condom use, sex work, IDU Vulvovaginal candidiasis (VVC) • Newer assays Skin Conditions Fungal vulvitis (candida, tinea) – Rapid antigen test: sensitivity, specificity vs. wet mount Contact dermatitis (irritant, allergic) – Aptima TMA T. vaginalis Analyte Specific Reagent (ASR) Vulvar dermatoses (LS, LP, LSC) • Other testing situations – Vulvar intraepithelial neoplasia (VIN) Suspect trich but NaCl slide neg culture or newer assays – Psychogenic Physiologic, psychogenic Pap with trich confirm if low risk • Consider retesting 3 months after treatment Trichomoniasis: Laboratory Tests CDC 2010: Vaginal Trichomoniasis Treatment Test Sensitivity Specificity Cost Comment Aptima TMA +4 (98%) +3 (98%) $$$ NAAT (like GC/Ct) • Recommended regimen Culture +3 (83%) +4 (100%) $$$ Not in most labs – Metronidazole 2 grams PO single dose Point of care – Tinidazole 2 grams PO single dose •Affirm VP III +3 +4 $$$ DNA probe • Alternative regimen (preferred for HIV infected -
Original Article
ORIGINAL ARTICLE ASSOCIATION OF BACTERIAL VAGINOSIS WITH PRETERM LABOUR Shilpa M.N1, A.P. Chandrashekar2, G.S. Vijay Kumar3, Rashmi P. Mahale4 HOW TO CITE THIS ARTICLE: Shilpa M.N, A.P Chandrashekar, G.S. Vijay Kumar, Rashmi P. Mahale. “Association of bacterial vaginosis with preterm labour”. Journal of Evolution of Medical and Dental Sciences 2013; Vol2, Issue 32, August 12; Page: 6104-6110. ABSTRACT: OBJECTIVES: To study the prevalence of bacterial vaginosis (BV) in preterm labour and to investigate its association as one of the causative factors of preterm labour. MATERIALS AND METHODS: Fifty women who presented with preterm labour (study group) and fifty women in labour at term (control group) admitted to a teaching hospital from November 2009 to May 2011 were examined for bacterial vaginosis using Nugent score. All the statistical methods were carried out through SPSS for windows (version 16.0), STUDY DESIGN: A comparative study. RESULTS: The prevalence of bacterial vaginosis among preterm labour group was 22% and its prevalence among full term group was 4%. There was statistically significant association of BV with preterm labor when compared to term labor (p=.007). Bacterial Vaginosis was strongly associated with very preterm delivery (<34 weeks) (p=.050). Bacterial vaginosis was significantly associated with lesser gestational age at delivery and low birth weight. CONCLUSION: Bacterial vaginosis is significantly associated with preterm labour and is one of the probable causative factors of preterm labour. KEYWORDS: Bacterial vaginosis, Nugent score, Preterm labor. INTRODUCTION: Preterm labour is defined as onset of labour prior to completion of 37 weeks gestation after period of viability.1,2 Though only 7-10% of all deliveries are preterm, prematurity alone accounts for more than 80% of perinatal morbidity and mortality in India.1,2,3,4 The etiology for preterm labour is multifactorial and in many of the cases is obscure. -
Japan Society of Gynecologic Oncology Guidelines 2015 for the Treatment of Vulvar Cancer and Vaginal Cancer
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Tsukuba Repository Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar cancer and vaginal cancer 著者 Saito Toshiaki, Tabata Tsutomu, Ikushima Hitoshi, Yanai Hiroyuki, Tashiro Hironori, Niikura Hitoshi, Minaguchi Takeo, Muramatsu Toshinari, Baba Tsukasa, Yamagami Wataru, Ariyoshi Kazuya, Ushijima Kimio, Mikami Mikio, Nagase Satoru, Kaneuchi Masanori, Yaegashi Nobuo, Udagawa Yasuhiro, Katabuchi Hidetaka journal or International Journal of Clinical Oncology publication title volume 23 number 2 page range 201-234 year 2018-04 権利 (C) The Author(s) 2017. This article is an open access publication This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons. org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. URL http://hdl.handle.net/2241/00151712 doi: 10.1007/s10147-017-1193-z Creative Commons : 表示 http://creativecommons.org/licenses/by/3.0/deed.ja Int J Clin Oncol (2018) 23:201–234 https://doi.org/10.1007/s10147-017-1193-z SPECIAL ARTICLE Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar cancer and vaginal cancer Toshiaki Saito1 · Tsutomu Tabata2 · Hitoshi Ikushima3 · Hiroyuki Yanai4 · Hironori Tashiro5 · Hitoshi Niikura6 · Takeo Minaguchi7 · Toshinari Muramatsu8 · Tsukasa Baba9 · Wataru Yamagami10 · Kazuya Ariyoshi1 · Kimio Ushijima11 · Mikio Mikami8 · Satoru Nagase12 · Masanori Kaneuchi13 · Nobuo Yaegashi6 · Yasuhiro Udagawa14 · Hidetaka Katabuchi5 Received: 29 August 2017 / Accepted: 5 September 2017 / Published online: 20 November 2017 © The Author(s) 2017. -
Evaluation of Different Diagnostic Methods of Bacterial Vaginosis
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 13, Issue 1, Ver. VIII (Feb. 2014), PP 15-23 www.iosrjournals.org Evaluation of different diagnostic methods of bacterial vaginosis Gamal F. M. Gad¹, Ahmed R. El-Adawy², Mohammed S. Mohammed3, Abobakr F. Ahmed1, Heba A. Mohamed¹ ¹ Microbiology department, Faculty of Pharmacy, Minia University 2 Gynecology and Obstetrics department, Faculty of Medicine, Minia University 3 Microbiology department, Faculty of Medicine, Minia University Abstract: Bacterial vaginosis (BV) is an ecological disorder of the vaginal microbiota that affects millions of women annually, and is associated with numerous adverse health outcomes including pre-term birth and the acquisition of sexually transmitted infections. This study aimed to determine the incidence rate of bacterial vaginosis among women and examine the effect of some risk factors and demographic features on BV incidence. Also aimed to compare between the different methods of BV diagnosis. The results revealed that from the 100 patients, 33% were diagnosed as bacterial vaginosis, 23% were having candidiasis, 8% aerobic vaginitis, 3% trichomoniasis and 33% were normal. The highest number of BV positive cases was in the age group of (26-35)Yrs, 94% of the 33 BV positive cases were using vaginal douches and 94% were married. BV positive cases using IUD were equal to BV positive cases using hormonal contraceptives including injection and tablets (12/33, 36.4%). BV was diagnosed in 33%, 38%, 36%, 30% and 34% of patients using Gram stain, culture, Amsel criteria, BV Blue test® and qPCR respectively. -
ICD-9-CM and ICD-10-CM Codes for Gynecology and Obstetrics
Diagnostic Services ICD-9-CM and ICD-10-CM Codes for Gynecology and Obstetrics ICD-9 ICD-10 ICD-9 ICD-10 Diagnoses Diagnoses Code Code Code Code Menstral Abnormalities 622.12 Moderate Dysplasia Of Cervix (CIN II) N87.2 625.3 Dysmenorrhea N94.6 Menopause 625.4 Premenstrual Syndrome N94.3 627.1 Postmenopausal Bleeding N95.0 626.0 Amenorrhea N91.2 627.2 Menopausal Symptoms N95.1 626.1 Oligomenorrhea N91.5 627.3 Senile Atrophic Vaginitis N95.2 626.2 Menorrhagia N92.0 627.4 Postsurgical Menopause N95.8 626.4 Irregular Menses N92.6 627.8 Perimenopausal Bleeding N95.8 626.6 Metrorrhagia N92.1 Abnormal Pap Smear Results 626.8 Dysfunctional Uterine Bleeding N93.8 795.00 Abnormal Pap Smear Result, Cervix R87.619 Disorders Of Genital Area 795.01 ASC-US, Cervix R87.610 614.9 Pelvic Inflammatory Disease (PID) N73.9 795.02 ASC-H, Cervix R87.611 616.1 Vaginitis, Unspecified N76.0 795.03 LGSIL, Cervix R87.612 616.2 Bartholin’s Cyst N75.0 795.04 HGSIL, Cervix R87.613 Cervical High-Risk HPV DNA 616.4 Vulvar Abscess N76.4 795.05 R87.810 Test Positive 616.5 Ulcer Of Vulva N76.6 Unsatisfactory Cervical 795.08 R87.615 616.89 Vaginal Ulcer N76.5 Cytology Sample 623.1 Leukoplakia Of Vagina N89.4 795.10 Abnormal Pap Smear Result, Vagina R87.628 Vaginal High-Risk HPV DNA 623.5 Vaginal Discharge N89.8 795.15 R87.811 Test Positive 623.8 Vaginal Bleeding N93.9 Disorders Of Uterus And Ovary 623.8 Vaginal Cyst N89.8 218.9 Uterine Fibroid/Leiomyoma D25.9 Noninflammatory Disorder 623.9 N89.9 Of Vagina 256.39 Ovarian Failure E28.39 624.8 Vulvar Lesion N90.89 256.9 Ovarian -
How to Evaluate Vaginal Bleeding and Discharge
How to Evaluate Vaginal Bleeding and Discharge Is the bleeding normal or abnormal? When does vaginal discharge reflect something as innocuous as irritation caused by a new soap? And when does it signal something more serious? The authors’ discussion of eight actual patient presentations will help you through the next differential diagnosis for a woman with vulvovaginal complaints. By Vincent Ball, MD, MAJ, USA, Diane Devita, MD, FACEP, LTC, USA, and Warren Johnson, MD, CPT, USA bnormal vaginal bleeding or discharge is typically due to either inadequate levels of estrogen one of the most common reasons women or a persistent corpus luteum. Structural causes of come to the emergency department.1,2 bleeding include leiomyomas, endometrial polyps, or Because the possible underlying causes malignancy. Infectious etiologies include pelvic in- Aare diverse, the patient’s age, key historical factors, flammatory disease (PID). Additionally, a variety of and a directed physical examination are instrumental bleeding dyscrasias involving platelet or clotting fac- in deciding on diagnosis and treatment. This article tors can complicate the normal menstrual period. Iat- will review some common case presentations of rogenic causes of vaginal bleeding include hormone nonpregnant female patients with abnormal vaginal replacement therapy, steroid hormone contraception, bleeding, inflammation, or discharge. and contraceptive intrauterine devices.3-5 Anovulatory bleeding is common in perimenar- ABNORMAL VAGINAL BLEEDING chal girls as a result of an immature hypothalamic- To ensure appropriate patient management, “Is she pituitary axis and in perimenopausal women due to pregnant?” should be the first question addressed, declining levels of estrogen. During reproductive since some vulvovaginal signs and symptoms will years, dysfunctional uterine differ in significance and urgency depending on the bleeding (DUB) is the most >>FAST TRACK<< answer. -
Diagnosing Bacterial Vaginosis with a Novel, Clinically-Actionable Molecular Diagnostic Tool
ISSN: 2581-7566 Volume 1: 2 J Appl Microb Res 2018 Journal of Applied Microbiological Research Diagnosing Bacterial Vaginosis with a Novel, Clinically-Actionable Molecular Diagnostic Tool Joseph P Jarvis1 Doug Rains2 1Coriell Life Sciences, Pennsylvania, USA Steven J Kradel1 2Quantigen Genomics, Indiana, USA James Elliott2 3ThermoFisher Scientific, USA Evan E Diamond3 4Primex Clinical Laboratories, California, USA Erik Avaniss-Aghajani4 5Maternity & Infertility Institute, California, USA Farid Yasharpour5 Jeffrey A Shaman1* Abstract Article Information Bacterial vaginosis is a common condition among women of Article Type: Research reproductive age and is associated with potentially serious side-effects, Article Number: JAMBR109 including an increased risk of preterm birth. Recent advancements in Received Date: 15 June, 2018 microbiome sequencing technologies have produced novel insights Accepted Date: 11 July, 2018 into the complicated mechanisms underlying bacterial vaginosis and Published Date: 18 July, 2018 have given rise to new methods of diagnosis. Here we report on the validation of a quantitative, molecular diagnostic algorithm based on *Corresponding author: Dr. Jeffrey A Shaman, Coriell the relative abundances of ten potentially pathogenic bacteria and four Life Sciences, Philadelphia, Pennsylvania, USA. Tel: + 609 357 0578; Email: jshaman(at)coriell.com as symptomatic (n=149) or asymptomatic (n=23). We observe a clear #These Authors are Joint First Authors on this Work. commensal Lactobacillus species in research subjects (n=172) classified and reinforcing pattern among patients diagnosed by the algorithm that Citation: Jarvis JP, Rains D, Kradel SJ, Elliott J, Diamond is consistent with the current understanding of biological dynamics EE, Avaniss-Aghajani E, Yasharpour F, Shaman JA (2018) and dysregulation of the vaginal microbiome during infection. -
Comparison of the Management of Vaginal Complaints in General Practice to a Protocol
Comparison of the management of vaginal complaints in general practice to a protocol Introduction of the cervix, which are often caused by sexually transmitted pathogens, are less In the 'Standards' program of the Dutch easy to diagnose . Both a 'broad' approach College of General Practitioners, Stand and a strategy based on microbiological L. WIGERSMA ards (sets of guidelines) for quality medi diagnosis appear to besuitable for general cal care are developed.I 2 The Standards practice. The patient 's choice may often be Wigersma L. Comparison of the manage project was preceded by a research pro decisive . Variations in every phase of the ment of vaginal complaints in general prac gram for assessment of the feasibility and process ofcare can be accounted for. tice to a protocol. Huisarts Wet 1993; utility in daily practice of protocols for In this article, the diagnostic and thera 36(Suppl): 25·30. common conditions (the Protocols Pro peutic approach of vaginal disease in ject).' Decisive elements in the process of general practices in Amsterdam, the Abstract A protocol was developed for the problem solving (prior probability, prog Netherlands, is described and compared to approach of vaginal complaints, common con nosis, the efficacy of diagnostic tests and the corresponding elements of the proto ditions in general practice (GP). The manage ment of vaginal complaints in general practices treatments, and the influence of contextual col. The comparison specifically deals in Amsterdam, the Netherlands, was studied. factors such as the relationship between with the use and efficacy of office labora The diagnostic and therapeutic approach is de doctor and patient) are included in proto tory tests, microbiological tests, presump scribed and compared to the protocol. -
Prevalence of Bacterial Vaginosis Among Patients with Vulvovaginitis in a Tertiary Hospital in Port Harcourt, Rivers State, Nigeria
Asian Journal of Medicine and Health 7(4): 1-7, 2017; Article no.AJMAH.36736 ISSN: 2456-8414 Prevalence of Bacterial Vaginosis among Patients with Vulvovaginitis in a Tertiary Hospital in Port Harcourt, Rivers State, Nigeria 1 1* 1 1 1 K. T. Wariso , J. A. Igunma , I. L. Oboro , F. A. Olonipili and N. Robinson 1Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Nigeria. Authors’ contributions This work was carried out in collaboration between the authors. Author KTW designed the study and wrote the protocol. Author FAO wrote the first draft of the manuscript. Authors JAI and NR managed the literature search and performed statistical analysis. Author ILO managed the analysis of the study. All authors read and approved the final manuscript. Article Information DOI: 10.9734/AJMAH/2017/36736 Editor(s): (1) Jaffu Othniel Chilongola, Department of Biochemistry & Molecular Biology, Kilimanjaro Christian Medical University College, Tumaini University, Tanzania. Reviewers: (1) Olorunjuwon Omolaja Bello, College of Natural and Applied Sciences, Wesley University Ondo, Nigeria. (2) Ronald Bartzatt, University of Nebraska, USA. Complete Peer review History: http://www.sciencedomain.org/review-history/21561 Received 12th September 2017 Accepted 12th October 2017 Original Research Article Published 25th October 2017 ABSTRACT Background: Bacterial vaginosis (BV) is one of the three common causes of vulvovaginitis in women of child bearing age, usually resulting from alteration the normal vaginal microbiota and PH. Common clinical presentation includes abnormal vaginal discharge, pruritus, dysuria and dyspareunia. Aims: To determine the prevalence of bacterial vaginosis among symptomatic women of child bearing age that attended various outpatient clinics in the university of Port Harcourt teaching Hospital. -
Vaginal Atrophy (VVA)
Information Sheet Vulvovaginal symptoms after menopause Key points • Vulvovaginal symptoms are numerous and varied and result from declining oestrogen levels. • Investigate any post- menopausal bleeding or malodorous discharge. • Management includes lifestyle changes as well as prescription and non- prescription medications. • As women age they will experience changes to their vagina and urinary system largely due to decreasing levels of the hormone oestrogen. • The changes, which may cause dryness, irritation, itching and pain with intercourse1-3 are known as the genito-urinary syndrome of menopause (GSM) and can affect up to 50% of postmenopausal women4. GSM was previously known as atrophic vaginitis or vulvovaginal atrophy (VVA). • Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with ageing4. • Changes in vaginal and urethral health occur with natural and surgical menopause, as well as after treatments for certain medical conditions (Please refer to AMS Information Sheet Vaginal health after breast cancer: A guide for patients). Why is oestrogen important for vaginal health? • The vaginal area needs adequate levels of oestrogen to maintain tissue integrity. • The vaginal epithelium contains oestrogen receptors which, when stimulated by the hormone, keep the walls thick and elastic. • When the amount of oestrogen in the body decreases this is commonly associated with dryness of the vulva and vagina. • A normal pre-menopausal vagina is naturally acidic, but with menopause it may become more alkaline, increasing susceptibility to urinary tract infections. A number of factors, including low oestrogen levels, have been implicated in the development of UTIs4-7 and vaginitis8-9 in postmenopausal women. -
Update on Vaginal Infections
PROGRESOS DE Obstetricia y Revista Oficial de la Sociedad Española Ginecología de Ginecología y Obstetricia Revista Oficial de la Sociedad Española de Ginecología y Obstetricia Prog Obstet Ginecol 2019;62(1):72-78 Revisión de Conjunto Update on vaginal infections: Aerobic vaginitis and other vaginal abnormalities Actualización en infecciones vaginales: vaginitis aeróbica y otras alteraciones vaginales Gloria Martín Saco, Juan M. García-Lechuz Moya Servicio de Microbiología. HGU Miguel Servet. Zaragoza Abstract It is estimated that abnormal vaginal discharge cannot be attributed to a clear infectious etiology in 15% to 50% of cases. Some women develop chronic vulvovaginal problems that are difficult to diagnose and treat, even by specialists. These disorders (aerobic vaginitis, desquamative inflammatory vaginitis, atrophic vaginitis, and cytolytic vaginosis) pose real challenges for clinical diagnosis and treatment. Researchers have established Key words: a diagnostic score based on phase-contrast microscopy. We review reported evidence on these entities and Vaginitis. present our diagnostic experience based on the correlation with Gram stain. We recommend treatment with Aerobic vaginitis. an antibiotic that has a very low minimum inhibitory concentration against lactobacilli and is effective against Parabasal cells. enterobacteria and Gram-positive cocci, which are responsible for these entities (aerobic vaginitis and desqua- Diagnosis. mative inflammatory vaginitis). Resumen Se estima que entre el 15 y el 50% de las mujeres que tienen trastornos del flujo vaginal, éstos no pueden atri- buirse a una etiología infecciosa clara. Algunas de ellas desarrollarán problemas vulvovaginales crónicos difíciles de diagnosticar y tratar, incluso por especialistas. Son trastornos que plantean desafíos reales en el diagnóstico Palabras clave: clínico y en su tratamiento como la vaginitis aeróbica, la vaginitis inflamatoria descamativa, la vaginitis atrófica y la vaginitis citolítica. -
The Older Woman with Vulvar Itching and Burning Disclosures Old Adage
Disclosures The Older Woman with Vulvar Mark Spitzer, MD Itching and Burning Merck: Advisory Board, Speakers Bureau Mark Spitzer, MD QiagenQiagen:: Speakers Bureau Medical Director SABK: Stock ownership Center for Colposcopy Elsevier: Book Editor Lake Success, NY Old Adage Does this story sound familiar? A 62 year old woman complaining of vulvovaginal itching and without a discharge self treatstreats with OTC miconazole.miconazole. If the only tool in your tool Two weeks later the itching has improved slightly but now chest is a hammer, pretty she is burning. She sees her doctor who records in the chart that she is soon everyyggthing begins to complaining of itching/burning and tells her that she has a look like a nail. yeast infection and gives her teraconazole cream. The cream is cooling while she is using it but the burning persists If the only diagnoses you are aware of She calls her doctor but speaks only to the receptionist. She that cause vulvar symptoms are Candida, tells the receptionist that her yeast infection is not better yet. The doctor (who is busy), never gets on the phone but Trichomonas, BV and atrophy those are instructs the receptionist to call in another prescription for teraconazole but also for thrthreeee doses of oral fluconazole the only diagnoses you will make. and to tell the patient that it is a tough infection. A month later the patient is still not feeling well. She is using cold compresses on her vulva to help her sleep at night. She makes an appointment. The doctor tests for BV.