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2 Vaginal Environment The vagina is a dynamic ecosystem that contains approximately 10 9 bacterial colony- forming units. 36 Risk Reduction The clinician should: Assess patient’s potential for behavior change Discuss individualized risk-reduction plans with the patient Discuss prevention strategies such as abstinence, monogamy, use of condoms, and limiting the number of sex partners Latex condoms, when used consistently and correctly, can reduce the risk of transmission of T. Genital infections are one of the most common reasons for women of all age groups to present to a medical practioner. Normal Vaginal Ecosystem Characteristics : A dynamic equilibrium exist between the intact stratified epithilium, normal colonizing microorganisms, and local secretory ( hormonal) and cellular immune factors.
Physiological discharge it occurs in response to hormonal levels during the menstrual cycle.
Pathological discharge Vaginal discharge is the most common gynaecologic condition encountered by physicians in the office.
BV linked to: premature rupture of membranes, premature delivery and low birth-weight delivery(Women with such history should have a vaginal swab performed in the 1 st trimester and if BV detected, it should be actively treated in the early 2 nd trimester of pregnancy.
4.5 (more alkaline) *Fishy odor with KOH(10%) *Clue cells on wet prep( >20% per HPF of "clue cells", clue cells are epithelial cells which are covered with bacteria).
Clue cell on wet prep Clue cells are epithelial cells covered with bacteria giving the cell a “ furlike ” appearance or stippled appearance. The vaginal discharge of patients with BV has a characteristic fishy odor due to increased activity of anaerobic species. TRICHOMONIASIS Etiologic agent *Trichomonas vaginalis – a single cell flagellated protozoan. DIAGNOSIS * Copious, yellow-green or gray frothy discharge, adherent to vaginal walls, with foul odor. Management : CDC, 1998 Both partners should be treated and both should be screened for other STDS.

VULVOVAGINAL CANDIDIASIS vulvovaginal candidiasis," "candidal vaginitis," "monilial infection," or "vaginal yeast infection”.
Recurrent vaginal candidiasis * Some women have four or more attacks per year or a positive microscopy of moderate to heavy growth of C.albicans.
In such cases the principle of treatment would be an induction regimen to treat acute infection followed by a maintenance regimen to treat futher recurrences.
Prevention ? Treatments should not be taken unless the woman had been diagnosed ? Douching should be avoided because it may disturb the balance of organisms in the vagina and may spread them higher into the reproductive system. 15 ?? ??? 1392 – ????? ????? vaginitis Vaginitis is the general term for disorders of the vagina caused by infection, inflammation, or changes in the. Pathophysiology : Disturbance of the normal vaginal pH and estrogen levels can alter the vaginal flora, leading to overgrowth of pathogens. Metronidazole is safe in pregnancy), acquisition of HIV, development of PID, and post-operative infections after gynecological procedures. Recommended regimen Metronidazole 400 mg PO bid for 7 days, Metronidazole 2 gm orally in a single dose(cure rate up to 95%).
Painful sexual intercourse(dyspareunia) or there may be pain on passing urine(dysuria)., A thick, curdy, white (like cottage cheese) vaginal discharge.
Conditions such as contact dermatitis,allergic reactions and non-specific vaginal infections can present in a similar manner. Commonly fluconazole 150 mg is given in three doses orally every 72 h followed by a maintenance dose of 150 mg weekly for 6 months. Factors that alter vaginal environment include feminine hygiene products, contraceptives, vaginal medications, antibiotics, STDs, sexual intercourse, and stress. Most male partners of women with VVC do not experience any symptoms of the infection.However, a transient rash and burning sensation of the penis have been reported after intercourse if condoms were not used.

Oral imidazoles cannot be used in pregnancy but a topical imidazole can be used for 2 weeks for induction followed by a weekly dose of clomtrizole 500 mg for possibly 6-8 weeks.
The discharge mainly consist of mucous, desquamated epithelia cells, bacteria (lactobacillius) and fluid. Bacterial vaginosis tend to occur more frequently in women who have using an intrauterine device (IUD), non-white race, prior pregnancy, first sexual activity at an early age, having multiple sexual partners, and having a history of sexually transmitted diseases.
Very high numbers of bacteria such as Gardnerella vaginalis, Mycoplasma hominis, Bacteroides species, and Mobiluncus species. Trichomoniasis is primarily an infection of the urogenital tract; the urethra is the most common site of infection in men, and the vagina is the most common site of infection in women.
Clinically, vulvar erythema and edema with satellite lesions (discrete pustulopapular lesions). Intense or prolonged scratching may cause the skin of the vulva to become cracked and raw, making it more susceptible to infection. These bacteria can be found at numbers 100 to 1000 times greater than found in the healthy vagina. Control, and management of stress also are important factors in control of recurrent vaginal infections.
Use condoms to avoid sexually transmitted disease As Trichomonas infection is sexually transmitted, ? Decreasing the frequency of sexual intercourse seems to have more of a scientific basis than other standard advice frequently given to decrease vulvovaginal candidiasis has been found among nonpregnant women. Bacterial vaginosis is not considered a sexually transmitted disease although it can be acquired by sexual intercourse..

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