VAGINITIS and CERVICITIS

dr. Ni Made Dwi

Puspawati, SpKK
Bag/SMF IK Kulit & Kelamin
FK Unud/ RSUP Sanglah

CANDIDAL
VULVOVAGINITIS

INTRODUCTION
Candida albicans is a ubiquitous commensal of the
mouth, gastrointestinal and genital tract which can
produce opportunistic infection

Predisposing factors include :

-

Moist and opposing skin fold

Obesity or diabetes melitus
Immunosuppression
Pregnancy

Poor hygiene
Humid environment
Wetwork occupation
Use of broad spectrum
antibiotic

CLINICAL MANIFESTATION
Overgrowth C. albicans in vaginal tract can
cause severe pruritus, burning and discharge
The labia may be erythematous, moist and
macerated
The cercix hyperemic, swollen and eroded
showing small vesicles on its surface
The vaginal discharge is not usually profuse and
varies from watery, to thick and white or curd like
Candidal balanitis may be present in an
uncircumcised sexual partner

DIFFERENTIAL DIAGNOSIS
Psoriasis
Lichen planus
Lichen sclerosus

DIAGNOSIS

Diagnosis is established by :
-the clinical symptom and finding
-demonstration of the fungus by KOH microscopic
examination
-culture

TREATMENT
Oral fluconazole 150 mg given once, is easy and
effective.
Patients with predisposing factors, longer courses
of fluconazole 100 to 200 mg/day or itraconazole
200 mg/day for 5 to 10 days may be needed
Topical options include miconazole, nystatin,
clorimazole and terconazole
Candida glabrata vaginitis may be refractory to
azole drugs and can be difficult to eradicate
topical boric acid, amphotericin B and flucytosine

TRICHOMONAS
VULVOVAGINITIS
TRICHOMONIASIS

ETIOLOGY
Trichomonas vaginalis, a colorless
pyriform flagellate 5 to 15 m long
Trichomonas vaginalis is demonstrated
in smears from affected area

CLINICAL MANIFESTATION
Vaginal pruritus with burning and a
frothy leukorrhea
The vaginal mucosa appear bright
red from inflammation and may be
mottled with pseudomembranous
patches.

Clinical manifestation
The male urethra may also harbor
the organism; in the male it causes
urethritis and prostatitis
Occasionally, men may develop
balano-posthitis. Erosive lesions on
the gland and penis or abscesses of
the median raphae may occur.

Clinical manifestation
Neonates may acquired the infection
during passage through the birth
canal, but they require treatment only
if symptomatic or colonization lasts
more than 4 weeks
As tis is otherwise nearly exclusively
a STD, trichomonas vulvo-vaginitis in
a child should prompt suspicions of
sexual abuse

DIAGNOSIS
Ttesting by drect
immunofluorescence is sensitive and
specific

TREATMENT
Metronidazole 2 g in a single oral
dose treatment of choice
Alternatively 500 mg twice a day for
7 days may be given.
Patient should be warned not to drink
alcohol for 24 h after the last dose
because of the disulfiram type of
effects of this medication

 Male sex partners should also be

treated.
The use of metronidazole
contraindicated in pregnant women,
and clotrimazole, applied
intravaginally, at a dosage of 100 mg
a night for 2 weeks may be used in
instead