Bacterial Vaginosis Natural Treatment
Candidal vaginitis is characterized by a thick, curdy, white discharge and vulvar discomfort. Intense vulvar erythema, pruritus, or burning is often present. A microscopic slide prepared with 10 potassium hydroxide yielding characteristic branch chain hyphae and spores establishes the diagnosis (Fig. 25.13). The pH of the discharge is less than 4.5. Predisposing factors that should be considered include oral contraceptive, anti biotic, or corticosteroid use pregnancy and diabetes. Sexually transmitted diseases are not usually associated with isolated candidal vaginitis. Trichomonas vaginitis presents as a persistent, thin, copious discharge that is often frothy, green, or foul-smelling. The pH of these secretions is greater than 4.5. The amount of vaginal and cervical erythema and inflammation varies considerably thus the diagnosis depends on the presence of motile flagellates on normal saline wet-mount microscopy. Occasionally, multiple petechiae on the vaginal wall (strawberry...
Aerobic vaginitis is characterized by purulent vaginal discharge with a dominant abnormal aerobic flora. Patients experience a foul-smelling nonfishy discharge, and examination may reveal erythema, inflammation, and ulcers of the posterior fornix. Although culture is the gold standard, the diagnosis is usually one of exclusion, with pH greater than 6.0, white blood cells (WBCs) on microscopy, and absence Irritant and allergic vaginitis should be considered in the differential diagnosis of vaginal complaints. Common etiologies include spermicidal products, douching solutions, diaphragms, latex condoms, and topical medications. The treatment is discontinuation of intravaginal products (French et al., 2004). Cytolytic vaginitis is caused by an overgrowth of lactobacilli and cytolysis of squamous epithelial cells. Although it may be related to intravaginal products or other medication use, its etiology remains unclear. It can mimic VVC with a white, curdled-cheese discharge, and the pH...
Bacterial vaginosis is caused by a shift from the normal lacto-bacilli-dominated vaginal flora to a polymicrobial flora dominated by gram-positive anaerobes. Although BV is the most common cause of vaginal discharge and foul odor, more than half of women with BV are asymptomatic (CDC, 2006). BV is associated with postoperative infection, pelvic inflammatory disease (PID), premature delivery in women with certain risk factors (French et al., 2004), and an increased risk of human immunodeficiency virus type 1 (HIV-1) transmission (Oduyebo et al., 2009). Risk factors for acquisition of BV include tobacco use, intrauterine contraception (IUC) use, new male sexual partner, sex with another woman, and use of vaginal foreign bodies, perfumed soaps. or douching (Allsworth and Peipert, 2007). Table 25-3 Comparison of Findings for Vaginitis Table 25-3 Comparison of Findings for Vaginitis Bacterial vaginosis Atrophic vaginitis Aerobic vaginitis Irritant allergic vaginitis Box 25-4 Differential...
Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis after BV, with a lifetime prevalence in women of 70 to 75 (Spence, 2007). Candida albicans is the most common etiology (80 -90 ). Type 1 diabetes Figure 25-2 Candidal vaginitis (vulvovaginal candidiasis). Candidal organisms in a saline wet-mount preparation clearly demonstrate hyphae and conidia under high-power magnification. Figure 25-2 Candidal vaginitis (vulvovaginal candidiasis). Candidal organisms in a saline wet-mount preparation clearly demonstrate hyphae and conidia under high-power magnification.
You should be certain that you receive notification about the report on your Pap smear. If you receive a report of an abnormal finding on a Pap smear, or if your doctor observes anything abnormal in the internal examination, it means you need a biopsy to obtain further information. If you are diagnosed with ASCUS, we recommend having the Pap smear repeated. If there is any indication of inflammation, it's a good idea to treat the cervical or vaginal infection before the smear is repeated. In women who are menopausal and are not receiving hormone replacement therapy, before repeating the Pap smear we recommend treatment for several weeks with estrogen, using a vaginal insert or cream or sys
For candidal vaginitis, various regimens of topical antifungal agents are the mainstay of treatment (clotrimazole 1 cream, one applicatorful inserted high into the vaginal vault for 7 nights, clotrimazole, two 100-mg vaginal tablets for 3 nights, or one 500-mg vaginal tablet for single-dose treatment). Oral fluconazole (Diflucan, 150 mg as a single dose) is also effective. For Trichomonas vaginitis, a single, one-time dose of metronidazole (2 g) is generally curative but is For bacterial vaginosis, metronidazole (500 mg twice daily for 7 days) is recommended in the nonpregnant patient. Treatment for asymptomatic infection or for male sexual partners is not generally recommended. Candidal Vaginitis. Thick, curdy white discharge secondary to candidal vaginitis. (Photo contributor Kevin J. Knoop, MD, MS.) Trichomonas Vaginitis. Thin vaginal discharge suggestive of Trichomonas vaginitis. (Photo contributor H. Hunter Handsfield. Atlas of Sexually Transmitted Diseases. New York McGraw-Hill...
The most common side effect, occurring in one-third to one-half of all men who take MUSE, is pain. This pain may be present in the penis, urethra, testis, or perineum. The intensity of the pain varies according to the dose taken. Thus, as the dose increases, the intensity of the pain may likewise increase. Hypotension and syncopal episodes (temporary loss of consciousness caused by decreased blood flow to the brain) have been reported in 1.2 to 4 of men who took MUSE, with their frequency depending on the dose used. Other side effects include urethral bleeding (in 4 to 5 of men who took MUSE), dizziness (in 1 ), and urinary tract infection (in 0.2 ). Prolonged erections and penile fibrosis (scarring) rarely occur. Ten percent of female partners experience vaginal irritation or vaginitis.
VVC, also known as moniliasis, is a common form of vaginitis, accounting for 20 to 25 of vaginitis cases. Although VVC is uncommon prior to menarche, nearly 50 of women will experience one or more episodes by the age of 25 years.1 A survey of women in the United States found that 6.5 of women over the age of 18 years reported experiencing at least one episode of vaginitis during the previous 2 months. Q Candida albicans is the primary pathogen responsible for VVC, accounting for more than 90 of cases.5 A small percentage of cases are caused by nonalbicans species including C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis. In patients with recurrent vaginitis, the causative Candida is twice as likely to be nonalbicans.6 The incidence of nonalbicans VVC is increasing, possibly due to overuse of nonprescription vaginal antifungal products, short-course antifungal treatments, and long-term suppressive therapy with antifungals.
Dysuria, frequency, and urgency are the classic clinical triad. The condition most commonly mimicking UTI is vaginitis. Other conditions have been described (see Dysuria). Patients may also experience back or flank pain and supra-pubic abdominal pain. Dipstick urinalysis may show leukocyte esterase or nitrite or may be heme positive. Microscopic analysis should assess for pyuria, hematuria, and bacteriuria. The gold standard for diagnosis is urine culture.
The most critical factor is the route of delivery. After vaginal delivery, the incidence of post-partum endometritis varies between 0.9 and 3.9 , but can increase to 12-51 after Cesarean section. Factors such as duration of labor, bacterial vaginosis and vaginal interventions are secondary predictors of post-Cesarean endometritis. Early rupture of the membranes, mid-forceps delivery, poor maternal health and soft tissue trauma act as 'relative risk factors' for uterine sepsis, although they are not present in most patients with such infections1. Indigent parturients are at higher risk of developing postpartum endometritis.
Vaginismus is an involuntary, usually painful, spastic contraction of the pelvic musculature surrounding the outer third of the vagina. It is classified as complete (e.g., precluding intercourse, tampon insertion, or other vaginal penetration), partial (resulting in dyspareunia or difficulty with other forms of vaginal penetration, including speculum examination), or situational (e.g., occurring when intercourse is anticipated). Vaginismus is often idiopathic. Many cases, however, may follow pelvic trauma, such as painful intercourse, sexual assault, rough gynecologic examination, complicated episiotomy, vaginal infections, pelvic inflammatory disease, or pelvic surgery. Childhood or adolescent sexual abuse may also lead to vaginismus during adulthood. Regardless of the cause of vaginismus (traumatic, psychological, or idiopathic), once a pattern of pain and anticipation of pain has been established, it will likely recur unless treatment is provided.
The American Urological Association revised their policy to say that circumcision should be presented for health benefits (Tobian et al., 2010). The American Academy of Pediatrics, American Medical Association, and American College of Obstetrics and Gynecology all consider the procedure elective with minimal benefits (Lannon et al., 1999). The WHO-United Nations program on HIV AIDS concluded that male circumcision is efficacious in reducing sexual transmission of HIV from women to men. In Africa, circumcision decreased HIV acquisition by 53 to 60 . Herpesvirus type 2 is decreased by 28 to 34 and HPV prevalence by 32 to 35 in circumcised men. Among female partners of circumcised men in these African studies, the incidence of bacterial vaginosis was reduced by 40 and Trichomonas vaginalis by 48 genital ulcers decreased as well (Tobian et al., 2010).
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This disease (infection of the mucous membrane, especially of the mouth) in infants was referred to in the Hippocratic corpus (400 B.C.) and later by Galen and other classical writers under the heading aphthae. Over the centuries, references to thrush in the young, as a feature of terminal illness and as a vaginal infection in women, continued, with the clinical descriptions being given increasing precision (see Higgs 1972). Candidiasis, like ringworm, was demonstrated to be mycotic by three independent workers in the 1840s B. Langenbeck in Berlin, F. T. Berg in Stockholm, and Gruby in Paris. Berg, who had studied under Gruby, subsequently published on thrush in infants and in 1844, J. H. Bennett described in Edinburgh what was probably C. albicans from the human lung.
Vaginitis is an inflammation of the vagina and vulva that is marked by pain, itching, and vaginal discharge. Normal vaginal discharge consists of mucous secretions from the cervix and vagina, as well as exfoliated vaginal cells. A normal vaginal discharge is thin and transparent and has little odor. When the normal bacterial flora in the vagina is disturbed, one or more organisms can multiply out of their normal proportions. This change in the normal flora may also make the vagina more susceptible to other invading organisms. The rapid growth of organisms produces an excess of waste products that irritate tissues, cause a burning sensation and itching, and produce a discharge with an unpleasant odor. The discharges caused by different organisms have different appearances.
Women with mixed UI (UUI plus SUI) or UUI plus atrophic vaginitis and or urethritis may also benefit from the addition of a locally administered (per vagina PV ) estrogen to anticholinergic therapy. Preliminary data suggest that desmopressin (DDAVP) may reduce daytime UUI symptoms (i.e., for up to approximately 8 hours after morning dosing) when used on both regular and as needed bases. 3 An intriguing pilot placebo-controlled trial ofduloxetine in UUI in individuals with bladder O Vaginally administered estrogen plays only a modest role in managing SUI (urethral underactivity), unless it is accompanied by local signs of estrogen deficiency (e.g., atrophic urethritis or vaginitis).
To avoid inappropriate use of nonprescription products, the practitioner should only recommend them to women who have previously been diagnosed with VVC. Estimates of how accurately women self-diagnose VVC are difficult to assess. One study found that only one-third of women accurately diagnosed an episode of vaginitis.11 Women with a previous clinically based diagnosis of VVC are no more accurate at self-diagnosing than women without prior clinical diagnosis.11
BA is discharged home on warfarin therapy. She was referred to a local area antith-rombosis center for monitoring of her oral anticoagulation therapy and has been maintained on warfarin 6 mg daily for the last 3 months. The patient presents today for a routine visit for anticoagulation monitoring and her INR is 8.3. She reports that 6 days ago she was started on metronidazole 500 mg by mouth twice daily, which was prescribed by her primary care physician for a vaginal infection. In addition, the primary care physician told the patient that her thyroid gland was enlarged and ordered some lab tests to determine if she has a thyroid problem. The patient has not heard what the results are. She also reports that her intake of vitamin K-rich foods (spinach, broccoli, and cabbage) has increased significantly over the last month because she is trying to lose weight. BA has no other complaints today and denies any signs or symptoms of bleeding.
In addition to the increasing number of adolescents engaging in unsafe sexual practices is a high incidence of men who have sex with men (MSM) and women who have sex with women (WSW). Many MSM do not disclose their HIV status. This don't ask, don't tell practice has been linked to an upsurge in newly diagnosed HIV infections and STIs among previously noninfected people.5 Although limited data are available with regard to STIs in WSW, risk of transmission probably varies by the specific STI and sexual techniques. Sharing penetrative items or employing practices involving digital vaginal or digital anal contact most likely represent common modes of transmission. This possibility is supported by reports of metronidazole-resistant trich-omoniasis and genotype-specific HIV transmitted sexually between women who reported such behaviors and an increased prevalence of bacterial vaginosis (BV) among monogamous WSW.6
Trichomonas vaginalis causes vaginitis in women, who may have a stereotypic frothy, green, and foul-smelling discharge. Many women are asymptomatic with trichomoniasis. In addition to causing asymptomatic infection in men, T. vaginalis may cause urethritis. This organism may be suspected in men when patients have repeated treatment failures and
Vaginitis The role of estrogen in the treatment of incontinence in the elderly patient remains uncertain. Topical estrogen is often prescribed for older women with urge incontinence related to atrophic vaginitis or severe vaginal atrophy. Conversely, combination estrogen progestin oral hormone therapy has been associated with increased frequency of incontinence (Cody et al., 2009 Grady et al., 2001 Rossouw et al., 2002).
The term comprehensive medical care spans the entire spectrum of medicine. The effectiveness with which a physician delivers primary care depends on the degree of involvement attained during training and practice. The family physician must be trained comprehensively to acquire all the medical skills necessary to care for most problems. The greater the number of skills omitted from the family physician's training and practice, the more frequent is the need to refer minor problems to another physician. A truly comprehensive primary care physician adequately manages acute infections, biopsies skin and other lesions, repairs lacerations, treats musculoskeletal sprains and minor fractures, removes foreign bodies, treats vaginitis, provides obstetric care and care for the newborn infant, gives supportive psychotherapy, and supervises diagnostic procedures. The needs of a family physician's patient range from a routine physical examination, when the patient feels well and wants to identify...
The dosas could be disturbed by sexual practices that included too much abstinence or too much intercourse. Syphilis was introduced to India by the Portuguese, and thus there is no mention of syphilitic chancres in the older Ayurvedic texts. But at least soft chancre seems to be discussed under diseases of males and various forms of vaginitis under the female heading. In addition, ailments of women such as amenorrhea and possibly eclampsia can be discerned.
Urinary burning or pain most often represents UTI or vaginitis. It is common in middle-aged and or sexually active women. In men, it is more likely to occur as they grow older (Bremnor and Sadovsky, 2002). Both voiding history and sexual history are essential. Questions regarding vaginal symptoms are important in women. Also, use of medications and personal hygiene products should be reviewed. Urethritis infectious, irritant, chemical, spondyloarthropathy Urinary tract infection cystitis, pyelonephritis, prostatitis Vaginitis allergic, atrophic, bacterial vaginosis, candidiasis, chemical
Dyspareunia refers to pain experienced immediately before, during, or after intercourse. Diagnosis of dyspareunia is made by history and physical examination. Useful questions include the onset, duration, and circumstances in which this problem occurred, the location of the pain (e.g., superficial, deep, unilateral, bilateral), and whether it is specific to a particular partner or practice. Physical exam may reveal peri-neal trauma or vaginal infection, vaginal mucosal atrophy, or other anatomic factors (e.g., vaginal septa, partial vaginismus). Emotional factors may contribute, such as ambivalence or distaste regarding the sexual relationship, as well as the sequelae of childhood abuse. Inadequate lubrication, relationship difficulties, poor sexual technique or a rough or abusive partner can cause dyspareunia. Treatment of physiologic dyspareunia caused by atrophic vaginitis may require vaginal estrogen. Vaginal infections must be diagnosed and treated. For poor lubrication,...
Intimate partner violence leads to significant morbidity and mortality and contributes to high health care costs. Victims of IPV experience similar problems as patients with general crisis or trauma (Box 45-1). Abused U.S. women show increased rates of poor general health, digestive problems, abdominal pain, urinary and vaginal infections, pelvic pain, sexual dysfunction, headache, and chronic pain (Campbell, 2002). In particular, these women suffer from gynecologic, central nervous system (CNS), and stress-related problems at an increased rate of 50 to 70 (Wathen and MacMil-lan, 2003). The largest difference between sexually abused and non-sexually abused women is in gynecologic complaints. In addition to direct harm caused by trauma, perinatal complications include low birth weight, antepartum
It is important to evaluate a patient to determine if she is an appropriate candidate for an implantable contraceptive. Implantable contraceptives are recommended for women with at least one child, in a monogamous relationship, who have no history of pelvic inflammatory disease (PID) and no history or risk of ectopic pregnancy. There are also multiple contraindications to IUD use. Evaluation of the patient is essential because IUDs cannot be used in the following situations (a) pregnancy or suspected pregnancy, (b) anatomically abnormal or distorted uterine cavity, (c) acute PID or history of PID, unless there has been a subsequent intrauterine pregnancy, (d) postpartum endometritis or infected abortion in the past 3 months, (e) known or suspected uterine or cervical neoplasia or unresolved abnormal pap smear, (f) genital bleeding of unknown etiology, (g) untreated acute cervicitis or vaginitis, (h) acute liver disease or liver tumor, (i) woman or her partner has multiple sexual...
Bacterial Vaginosis Facts
This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.