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Vaginal Itching and Discharge

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1 Vaginal Itching and Discharge
CAPT Mike Hughey, MC, USNR

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 Yeast (AKA Monilia, Thrush, Candida)
Itching is hallmark symptom Red, swollen, tender vulva Wet Mount confirms

4 Yeast Treatment Topical anti-fungal agents work well Monistat
Gyne Lotrimin Mycelex G Oral agents also work well Diflucan 150 PO once

5 Chronic Yeast Predisposing Factors: Heat Moisture Diet Diabetes
Antibiotics Solution: PRN Anti-fungal Agents

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 Contact Dermatitis Perfumes Deodorants Toilet Paper Soap
RX: -Stop exposure -Burrow's Solution -Topical Steroids

8 Crabs (Pubic Lice) Transmitted by: Sexual contact Infected bedding
Sharing towels Close living quarters

9 Crabs (Pubic Lice) Treatment
Nix cream Kwell Shampoo

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 Vulvar Dystrophy - Hypertrophic
Skin too thick Sx: Itching Dx: Biopsy Rx: Steroid Cream

12 Vulvar Dystrophy - Lichen Sclerosis
Skin too thin Sx: Itching Dx: Biopsy Rx: Testosterone Cream or Clobetasol

13 VIN (Vulvar Intraepithelial Neoplasia)
Itching Doesn’t respond to anti-fungal agents May have a white skin discoloration Need biopsy for diagnosis

14 VIN (Vulvar Intraepithelial Neoplasia)

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 Vaginal Discharge Does it Itch? Does it smell bad?
What does it look like? Wet mount, cultures

17 Bacterial Vaginosis Smells bad “Whiff Test” (KOH)
AKA Gardnerella, BV, Hemophilus Vag. Anaerobic bacteria Rx: Flagyl Rx: Clindamycin Rx: Amox

18 Bacterial Vaginosis Rx: Flagyl Rx: Clindamycin Rx: Amox

19 Trichomonas Bubbly, frothy discharge Rx: Flagyl 250 TID x 7 days
500 BID x 5 days 2 gm PO stat

20 Wet Mount

21 Cultures If GC, Chlamydia, Strep suspected If pelvic pain present
Treatment failures

22


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