Benign vulval disease

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 09/03/2015

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Chapter 24 Benign vulval disease

Neroli Ngenda

Infections

Fungal

Candida albicans

• predisposed groups: newborns, females between puberty and menopause, postmenopausal women on hormone replacement therapy (HRT), women with diabetes mellitus
• symptoms: vulval pruritus, cheesy discharge, dyspareunia
• premenstrual and postcoital exacerbation can occur
• diagnosis: on vaginal swab
• treatment: vaginal imidazoles (e.g. clotrimazole) and, if required, single-dose oral therapy fluconazole; vaginal boric acid may be used
• apply imidazoles and boric acid intravaginally only, not to the vulva
• longer term oral therapy may be required for recurrent candidiasis (e.g. ketoconazole, fluconazole)

Non-albicans yeast infection

• Candida glabrata, C. krusei, C. parapsilosis, C. guillermondii
• relatively resistant to imidazoles
• boric acid is used for treatment

Tinea cruris

• It produces a well-demarcated erythematous lesion extending from the labia to the inner aspect of the thigh.
• Diagnosis is via microscopy of scrapings.
• Topical treatment with imidazoles may help; however, oral antifungal treatment is required for cure (e.g. griseofulvin).

Pityriasis versicolor (tinea versicolor)

• caused by Malassezia furfur
• may be asymptomatic or cause vulval pruritus
• treatment: topical or oral azoles

Viral

• herpes simplex virus 1 and 2
• human papillomavirus
• molluscum contagiosum

Bacterial

• pyogenic vulval infection (impetigo, folliculitis, abscess, carbuncle, cellulitis), Bartholin’s gland infection, chancroid, donovanosis, syphilis, lymphogranuloma venereum

Parasitic

• pediculosis pubis (pubic lice), scabies, worms, trichomoniasis, schistosomiasis, filariasis, hydatid disease

Non-infectious dermatoses

Contact/allergic dermatitis

• may be triggered by local irritants (e.g. perfumes, soaps, fabric softeners, detergents, feminine sprays, urine, pads and panty liners, toilet paper); drugs; topical creams; latex in condoms
• causes vulval pruritus
• examination may reveal vulval erythema and/or swelling; fissuring in the interlabial sulci may occur
• lichenification can occur from scratching
• important to exclude the presence of candidiasis
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