Diseases of vulva Bartholin Gland Normally not seen

Diseases of vulva

Bartholin Gland • Normally not seen nor felt • If enlarged, can be a painless cyst or painful abscess

Bartholin's Abscess • Must be drained • Simple I&D • Marsupialization • Word Catheter

Don’t Confuse it with These: Inclusion Cyst of the Vulva Right Vaginal Wall Cyst

Herpes Vulvitis • Prodrome of itching or tingling • Multiple, small, painful blisters • Shallow ulcers filled with gray material • Crusts over in 7 -10 days • Recurrences in 50%

Herpes Vulvitis Treatment • Spontaneous resolution in 10 days • Zovirax 200 mg PO Q 4 hours while awake #50 • May need to place Foley cather • Recurrences are not as severe

Molluscom Contagiosum • Multiple, 1 -2 mm raised, painless lesions • Dome-shaped with central dimple • Contain cheesy-white material • Sexually transmitted

Molluscom Contagiosum Treatment Video • Cryosurgery (just the lesion) • Bichloracetic acid (just the lesion) • Dermal curette (Ag. NO 3 to base) • Electrocute the lesion (local anes. )

HPV (Condyloma) • Clinical warts • Flat warts • Soak vulva in vinegar, Exam under 7 x power, Red-free light filter • No specific treatment

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

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

Primary Syphilis Appearance • Painless solitary ulcer • LNs enlarged, firm, nontender • Positive RPR, VDRL • Positive Darkfield

Primary Syphilis Treatment • Benzathine PCN G, 1. 2 M in each buttock (2. 4 M total) • TTCN, 500 mg PO QID x 14 days • Doxycycline 100 PO BID x 14 days

Condyloma Lata Diagnosis • Secondary syphilis • Raised, painless flat lesions • Resemble condyloma, but smooth surface • Positive VDRL • Positive darfield of surface scrapings

Chancroid Appearance • Tender, red papule filled with pus • Grayish, necrotic base • Jagged, irregular margins • No induration (contrast syphilis) • Tender inguinal LNs in 50%

Chancroid Diagnosis • Hemophilus ducreyi • Hard to culture • Gram-neg coccobacillus in clusters around Polymorphonucleocytes • "School of Fish Appearance" • History, physical, exclude other ulcerative diseases

Chancroid Treatment • Azithromycin 1 g PO • Ceftriaxone 250 mg IM • Ciprofloxacin 500 mg PO BID for 3 days • Erythromycin base 500 mg PO QID for 7 days.

Lymphogranuloma Venereum (LGV) • Ulceration of the vulva, rectum or groin • Pain with walking, sitting, or BMs • Hard tender masses (bubos) arise in the inguinal area • Untreated, extensive scarring in the rectum and vagina

LGV Diagnosis • Chlamydia trachomatis serotype culture from a bubo • Acute/convelescent serum complement fixation test • History of exposure • Visual appearance • Prevalence in the population.

LGV Treatment · Doxycycline 100 mg orally twice a day for 21 days, or · Erythromycin base 500 mg orally four times a day for 21 days. · Zithromax? (Probably with multiple doses over several weeks)

Granuloma Inguinale Appearance • Chronic ulcerative disease • Clean, granulomatous, sharply-defined • Multiple, confluent ulcers • Beefy red base which bleeds easily • Pseudobuboes in the groin • Confirm with biopsy (Donovan Bodies)

Granuloma Inguinale Treatment • Minimal scarring when treated early • Extensive scarring when treated late • 3 Weeks of: – Bactrim DS BID – Doxycycline 100 mg BID – Ciprofloxacin 750 mg BID – Erythromycin base 500 mg QID