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Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Vaginal Itching and Discharge CAPT Mike Hughey, MC, USNR.

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Presentation on theme: "Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Vaginal Itching and Discharge CAPT Mike Hughey, MC, USNR."— Presentation transcript:

1 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Vaginal Itching and Discharge CAPT Mike Hughey, MC, USNR

2 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 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.

3 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Yeast (AKA Monilia, Thrush, Candida) Itching is hallmark symptom Red, swollen, tender vulva Wet Mount confirms

4 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 Yeast Treatment Topical anti-fungal agents work well Monistat Gyne Lotrimin Mycelex G Oral agents also work well Diflucan 150 PO once

5 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Chronic Yeast Predisposing Factors: Heat Moisture Diet Diabetes Antibiotics Solution: PRN Anti-fungal Agents

6 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 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

7 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Contact Dermatitis Perfumes Deodorants Toilet Paper Soap RX: -Stop exposure -Burrow's Solution -Topical Steroids

8 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Crabs (Pubic Lice) Transmitted by: Sexual contact Infected bedding Sharing towels Close living quarters

9 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Crabs (Pubic Lice) Treatment Nix cream Kwell Shampoo

10 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 HPV (Condyloma) Clinical warts Flat warts Soak vulva in vinegar, Exam under 7x power, Red-free light filter Cryo, TCA, Laser, Cautery, Podo, etc.

11 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Vulvar Dystrophy - Hypertrophic Skin too thick Sx: Itching Dx: Biopsy Rx: Steroid Cream

12 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 Vulvar Dystrophy - Lichen Sclerosis Skin too thin Sx: Itching Dx: Biopsy Rx: Testosterone Cream or Clobetasol

13 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 VIN (Vulvar Intraepithelial Neoplasia) Itching Doesn’t respond to anti-fungal agents May have a white skin discoloration Need biopsy for diagnosis

14 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 VIN (Vulvar Intraepithelial Neoplasia)

15 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 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

16 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 Vaginal Discharge Does it Itch? Does it smell bad? What does it look like? Wet mount, cultures

17 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17 Bacterial Vaginosis Smells bad “Whiff Test” (KOH) AKA Gardnerella, BV, Hemophilus Vag. Anaerobic bacteria Rx: Flagyl Rx: Clindamycin Rx: Amox

18 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 18 Bacterial Vaginosis Rx: Flagyl Rx: Clindamycin Rx: Amox

19 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 19 Trichomonas Bubbly, frothy discharge Rx: Flagyl 250 TID x 7 days 500 BID x 5 days 2 gm PO stat

20 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 20 Wet Mount

21 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 21 Cultures If GC, Chlamydia, Strep suspected If pelvic pain present Treatment failures

22 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 22


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