Candidial (Monilial) Vaginitis

CANDIDIAL (MONILIAL) VAGINITIS

Q. 1

True about vaginal candidiasis :

 A

Risk is not increased in pregnancy

 B

Associated with intense pruritus

 C

Typical “Cottage — cheese” discharge occurs

 D

b and c both

Q. 1

True about vaginal candidiasis :

 A

Risk is not increased in pregnancy

 B

Associated with intense pruritus

 C

Typical “Cottage — cheese” discharge occurs

 D

b and c both

Ans. D

Explanation:

b and c both


Q. 2 Regarding vaginal candidiasis which is false:
 A Cottage cheese like secretions are seen
 B Intense pruritus
 C Most common in non-pregnant women
 D Buds and hyphae seen in KOH preparation
Q. 2 Regarding vaginal candidiasis which is false:
 A Cottage cheese like secretions are seen
 B Intense pruritus
 C Most common in non-pregnant women
 D Buds and hyphae seen in KOH preparation
Ans. C

Explanation:

Candidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates. It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics anD. corticosteroids. It is also seen in patients with diabetes. It causes a profuse discharge and intense pruritus with soreness of vagina and dysuriA. Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identifieD. A 10% KOH smear shows the buds and hyphae of the Candida organism. Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with a cream of the same medication for External use.


Q. 3

Oral contraceptives cause all side effects, except:

 A

Monilial vaginitis

 B

Pituitary adenoma

 C

Ca uterus

 D

B and C

Q. 3

Oral contraceptives cause all side effects, except:

 A

Monilial vaginitis

 B

Pituitary adenoma

 C

Ca uterus

 D

B and C

Ans. D

Explanation:

Ans:D.)B and C.

Adverse Effects of Oral Contraceptive:

Minor:

• Intermenstrual spotting- first 3 months
• Nausea, vomiting, lack of appetite,
• Break through bleeding
• Breast tenderness , vaginal discharge
• Headache, migraine Chloasma
• Weight gain Acne, Oily skin

Major:

• Cardiovascular disease , Stroke, Venous Thromboembolism
• Vaginal moniliasis
• Ca. Endocervix: if used for> 5years, dysplasia more common
• Cancer – Breast Ca(controversial), Ca cervix, Liver Ca
• Diabetes & Gall stones
• Affects lactation

 

 


Q. 4

A patient presented with intense vulvar pruritus, a white curd like, cheesy vaginal discharge and vulvar erythema. Candidiasis was diagnosed. Which among the following is NOT a risk factor for vaginal candidiasis?

 A

Diabetes mellitus

 B

Hypertension

 C

Human Immunodeficiency Virus (HIV) infection

 D

Pregnancy

Q. 4

A patient presented with intense vulvar pruritus, a white curd like, cheesy vaginal discharge and vulvar erythema. Candidiasis was diagnosed. Which among the following is NOT a risk factor for vaginal candidiasis?

 A

Diabetes mellitus

 B

Hypertension

 C

Human Immunodeficiency Virus (HIV) infection

 D

Pregnancy

Ans. B

Explanation:

Risk factors of candida infection include:

  • Diabetes mellitus

  • Human immunodeficiency virus [HIV]

  • Obesity

  • Pregnancy

  • Medication (antibiotics, corticosteroids, oral contraceptives)

  • Chronic debilitation

Ref: Mazdisnian F. (2007). Chapter 37. Benign Disorders of the Vulva & Vagina. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.


Q. 5

Candidiasis is associated with all except-

 A

OCP user

 B

IUCD user

 C

Diabetes

 D

Pregnancy

Q. 5

Candidiasis is associated with all except-

 A

OCP user

 B

IUCD user

 C

Diabetes

 D

Pregnancy

Ans. B

Explanation:

Ans. is ‘b’ i.e., IUCD user


Q. 6

Commonest fungal infection of the female genitalia in diabetes is:

 A

Cryptococcal

 B

Madura mycosis

 C

Candidial

 D

Aspergellosis

Q. 6

Commonest fungal infection of the female genitalia in diabetes is:

 A

Cryptococcal

 B

Madura mycosis

 C

Candidial

 D

Aspergellosis

Ans. C

Explanation:

C i.e. Candidial


Q. 7

Treatment of both partners is recomended in A/E :

 A

Candida infection

 B

Gardenella

 C

Herpes

 D

c and a

Q. 7

Treatment of both partners is recomended in A/E :

 A

Candida infection

 B

Gardenella

 C

Herpes

 D

c and a

Ans. D

Explanation:

C i.e. Herpes > A i.e. Candida infection

STD

Required T/t of Sexual partner

Herpes

–   None ie Avoid sex & use condomes

Candida

–   None; ie only topical t/t if Candidal dermatitis of penis is detected

Bacterial Vaginosis

(ex. gardnerella)

– T/t given only when STD present

–   T/t of parterner does not prevent recurrance of ds.

Trichomonas vaginalis

–   Sexual partner is always treatedQ as it reduces risk of recurrance reservoir.


Q. 8

Vulval candidiasis is associated with:         

March 2003

 A

Addison’s disease

 B

Cushing’s disease

 C

Diabetes mellitus

 D

Acromegaly

Q. 8

Vulval candidiasis is associated with:         

March 2003

 A

Addison’s disease

 B

Cushing’s disease

 C

Diabetes mellitus

 D

Acromegaly

Ans. C

Explanation:

Ans. C i.e. Diabetes mellitus


Q. 9

Genital infection in females presenting with thick curdy or flaky discharge may be:      

March 2004

 A

Candidiasis

 B

Trichomoniasis

 C

Syphilis

 D

Gonorrhoea

Q. 9

Genital infection in females presenting with thick curdy or flaky discharge may be:      

March 2004

 A

Candidiasis

 B

Trichomoniasis

 C

Syphilis

 D

Gonorrhoea

Ans. A

Explanation:

Ans. A i.e. Candidiasis


Q. 10

Pruritis of vulva may be a symptom of:      

March 2004

 A

Candidiasis

 B

Trichmoniasis vaginitis

 C

Early carcinoma of vulva

 D

All of the above

Q. 10

Pruritis of vulva may be a symptom of:      

March 2004

 A

Candidiasis

 B

Trichmoniasis vaginitis

 C

Early carcinoma of vulva

 D

All of the above

Ans. D

Explanation:

Ans. D.)All of the above.

Pruritus vulvae is itchiness of the vulva.

Causes:
Itch due to infections

  • Candida albicans infection (vulvovaginal thrush) is the most important microorganism to consider in a postpubertal woman with vulval itch.
  • Bacterial vaginosis causes a frothy, malodorous discharge, and uncommonly causes vulval itch, possibly as a result of contact dermatitis.
  • Genital viral warts are often itchy.
  • Pinworms can reside in the vagina or anus and cause itch when they exit at night.

Infections that rarely cause vulval itch include cytolytic vaginosis (associated with vaginal lactobacilli) and trichomoniasis.

Itch due to an inflammatory skin condition

Irritant contact dermatitis is the most common cause of an itchy vulva at all ages. It may be due to diverse causes, including:

  • Age-related prepubertal or postmenopausal lack of oestrogen
  • Underlying tendency to atopic dermatitis
  • Scratching for another reason
  • Friction from skin folds, clothing, activity, or sexual intercourse
  • Moisture due to occlusive underwear
  • Urine and/or faeces
  • Soap or harsh cleanser
  • Frequent washing
  • Inappropriate or unnecessary chemical applications, including over-the-counter or prescribed medications
  • Fissuring of the posterior fourchette
  • Normal, excessive or infected vaginal secretions

Severe vulval itch may be due to:

  • Lichen simplex
  • Lichen sclerosus
  • Lichen planus

Other common skin disorders that may cause vulval itch include:

  • Psoriasis
  • Seborrhoeic dermatitis
  • Allergic contact dermatitis*
  • Irritant or allergic contact urticaria
  • Dermographism
  • Folliculitis

*Potential vulval allergens include:

  • Methylisothiazolinone, a preservative in moist wipes
  • Various textile dyes in underwear
  • Fragrance in a douche or antiperspirant
  • Rubber accelerants in condom, menstrual cup or underwear
  • Latex rubber and semen are potential causes of contact urticaria.

Itch due to neoplasia

Benign and malignant neoplastic disorders of the vulva are often asymptomatic in their early stages, but they can cause itch. The most common cancerous lesions are:

  • Squamous intraepithelial lesions (SIL, also known as vulval intraepithelial neoplasia or VIN)
  • Extramammary Paget disease
  • Invasive vulval cancer (squamous cell carcinoma)

Itch due to neuropathy


Q. 11

Which of the following condition is most likely to be associated with vaginal pH of 4 :   

September 2009

 A

Atrophic vaginitis

 B

Trichomanas vaginatis

 C

Candidal vaginitis

 D

Gardenella vaginitis

Q. 11

Which of the following condition is most likely to be associated with vaginal pH of 4 :   

September 2009

 A

Atrophic vaginitis

 B

Trichomanas vaginatis

 C

Candidal vaginitis

 D

Gardenella vaginitis

Ans. C

Explanation:

Ans. C: Candidal Vaginitis

Candida albicans is a gram positive yeast like microorganism and grows well in acidic medium.

Vaginal pH remains normal (4.0-4.5) in candida infection whereas pH in excess of 4.5 should suggest possibility of Other bacterial vaginosis (BV), trichomoniasis or mixed infections.


Q. 12

A female presented with thick white discharge and pruritus. aetiological agent is:

September 2009, March 2013

 A

Gardnerella

 B

Trichomonas vaginalis

 C

Candida

 D

Gonococci

Q. 12

A female presented with thick white discharge and pruritus. aetiological agent is:

September 2009, March 2013

 A

Gardnerella

 B

Trichomonas vaginalis

 C

Candida

 D

Gonococci

Ans. C

Explanation:

Ans. C: Candida

The most common etiologies in adults resulting in symptoms of vaginitis include Candida albicans, Trichomonas vaginalis, and bacterial vaginosis.

  • Candidiasis is a fungal infection common in women of childbearing age that results in pruritus, with a thick, white vaginal discharge. Patients often have a history of recurrent yeast infections or recent antibiotic treatment. Symptoms of candidiasis often begin just before menses. Precipitating factors include immunosuppression, diabetes mellitus, pregnancy, and hormone replacement therapy. Candidiasis is usually not contracted from a sexual partner. Seventy-five percent of all women have one episode of candidiasis in their lifetime. Recurrent episodes may indicate underlying immunodeficiency or diabetes.
  • Trichomoniasis is associated with risk factors for other sexually transmitted diseases (STDs); elicit a history of multiple sexual partners. The discharge is usually copious, slightly green and frothy, resulting in local pain and irritation. Pruritus might be present. Symptoms often peak just after menses. Trichomonas vaginalis is the most common nonviral STD in the world. Infection during pregnancy has been associated with preterm deliveries and low birth weight infants.
  • Bacterial/ gardnerella vaginosis is asymptomatic in up to 50% of women. If a discharge is present, it is typically a homogeneous grayish white or yellowish white. Bacterial vaginosis is common in pregnant women and is associated with preterm birth. Treating pregnant women that have a history of preterm birth with symptomatic bacterial vaginosis early in pregnancy has been shown to decrease the incidence of preterm birth.

Q. 13

Identify the infection in Vagina as shown in the photograph below ? 

 A

Candidiasis.

 B

HIV.

 C

Bacterial vaginosis.

 D

Syphilis.

Q. 13

Identify the infection in Vagina as shown in the photograph below ? 

 A

Candidiasis.

 B

HIV.

 C

Bacterial vaginosis.

 D

Syphilis.

Ans. A

Explanation:

The infection in vagina as shown in the photograph above represents candidiasis as it shows the presence of white, thick, curd like discharge.

Candidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates. It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics and corticosteroids. It is also seen in patients with diabetes. It causes a profuse discharge and intense pruritus with soreness of vagina and dysuriA. Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identifieD. A 10% KOH smear shows the buds and hyphae of the Candida organism. Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with a cream of the same medication for external use.



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