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Vaginitis (Áú¿°)

The Root of Ambulatory Care (¿Ü·¡ Áø·á Áöħ¼­) Àüü ¸ñ·Ï º¸±â
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The Root of Ambulatory Care

The Root of Ambulatory Care

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KEYWORDS: ..Bacterial vaginosis/Candida vulvovaginitis/Trichomonas vaginitis°¡ Àüü Áú¿° ÀÇ 90%¸¦ Â÷ÁöÇÏ°í ³ª¸ÓÁö´Â atrophic vaginitis, À̹°Áú µîÀÇ ¿øÀο¡ ÀÇÇϸç 10~20%´Â È¥ÇÕ°¨¿°À¸·Î ¹ß»ýÇÑ´Ù. 1. Vaginal discharge 2. Vaginal and/or vulvar itching, irritation, or swelling 3. Genital odor Bacterial vaginosis : Moderate white discharge, possible fishy odor (often accentuated after vaginal exposure to semen) Candida vulvovaginitis : Itching and/or discomfort, discharge (may be absent), swelling of the vulva may be present Trichomonas vaginitis : Moderate to copious thin discharge, occasionally foamy, possible fishy odor, discolored discharge suggests this diagnosis ..´ëºÎºÐÀÇ È¯ÀÚµéÀº »ó±âÇÑ ÀüÇüÀûÀÎ Áõ»óÀ» º¸ÀÌÁö ¾Ê¾Æ, Á¤È®ÇÑ Áø´ÜÀ» À§ ÇØ¼± Áõ»ó¿¡¸¸ ÀÇÁ¸Çؼ± ¾ÈµÈ´Ù. Vaginitis Key symptoms 539 The Root of ambulatory care ..Bacterial vaginitisÀÇ ¿øÀαÕÀ¸·Î Gardnerella vaginalis°¡ ´ëÇ¥ÀûÀ̸ç, ±× ¿Ü¿¡ mobiliuncus, mycoplasma hominis, peptostreptococcusµîÀÌ ÀÖ´Ù. °¨¿°µÈ ¿©¼º ÀÇ 50% °¡·®¿¡¼­ ¾Æ¹«·± Áõ»óÀÌ ¾ø´Ù. (ÀϹÝÀûÀ¸·Î ¼º»ýȰÀÌ ¹®¶õÇÑ ¿©¼º¿¡¼­ È£¹ßÇϳª ¼ºÀû ÀüÆÄ´Â ¸íÈ®ÇÏÁö ¾Ê ´Ù. ±×¿Ü IUD, ÀæÀº µÞ¹°, ÀӽеîÀÌ À§Çè¿äÀÎÀÌ´Ù.) i. Thin, homogeneous discharge ii. Positive¡° whiff¡±test iii.¡° Clue cells¡±present on microscopy : Highly significant criterion iv. Vaginal pH > 4.5 Three of four criteria must be met : establishes accurate diagnosis of bacterial vaginosis in 90 percent of affected women. Bacterial Vaginosis Trichomoniasis Candidiasis Symptoms Malodorous, purulent Malodorus, purulent Pruritis, dyspareunia, discharge discharge : dyspareunia soreness Color of Gray/thin Discharge adherent Greenish or yellow/green, Thick, white, clumpy discharge in nondependent portions frothy/thin Erythema and edema of labia Examination of vagina Erythema of labia -¡°strawberry¡±cervix in 10% > 20% of squamous cells are Motile trichomonads Budding yeast forms and clue cells : absence of (60% of cases) may be pseudohyphae with KOH lactobacilli : positive nonmotile if hypertonic saline in 60~70% Wet prep ¡°whiff¡±test with KOH used ¢º Clue cells of G. vaginalis ¢º Trichomonads in a ¢º Candida in a saline wet vaginitis on a saline wet saline wet mount mount mount pH > 4.5 5~7 < 4.5 Amsel¡¯s criteria DNA probe tests : Culture : Sabaurand's media, Nugent¡¯s criteria sensitivity of 90% and Nickerson's media at room Additional tests Spigel¡¯s criteria specificity of 99.8% temperature for 24hours Culture : Tricholt or (Candida can be normal flora) Diamond's media < Characteristics of infectious vaginitis> Key treatments Vaginitis ..ÀÚ±Ã¾Ï ¼¼Æ÷Áø °Ë»ç¿¡¼­ Æ®¸®Äڸ𳪽º ¿øÃæÀÌ ¹ß°ßµÇ´Â °æ¿ìµµ ÀÖÀ¸³ª À§¾ç ¼º·üÀÌ 30~40%·Î ³ôÀ¸¹Ç·Î Áø´ÜÀÌ È®½ÇÇØÁú ¶§±îÁö Ä¡·á´Â º¸·ùÇØ¾ß ÇÑ´Ù. ..Candida´Â Áú³»¿¡ Á¤»óÀûÀ¸·Î Á¸ÀçÇÏ´Â ±ÕÁÖ °¡¿îµ¥ ÇϳªÀÌÁö¸¸, °úÁõ½ÄÇÏ °Ô µÇ¸é º´¿ø±ÕÀ¸·Î º¯È­ÇÏ°Ô µÈ´Ù. (ÀÓ½Å, ´ç´¢º´, ºñ¸¸, °æ±¸ÇÇÀÓÁ¦, Àü½ÅÀû ½ºÅ×·ÎÀ̵å, ¸é¿ª¾ïÁ¦Á¦, ¿©¼º È£¸£¸ó ¶Ç´Â Ç×»ýÁ¦ µî ÀÌ ¼±Çà¿äÀÎÀÌ µÉ ¼ö ÀÖÀ¸³ª ´ëºÎºÐ ÀÌ·± ¼±Çà¿äÀÎ ¾øÀÌ ¹ß»ýÇÑ´Ù.) 1. Bacterial vaginosis (Áõ»óÀÌ Àְųª ÀÓ»êºÎ¿¡ ÇÑÇÏ¿© Ä¡·áÇÑ´Ù.) ..Flasinyl.. 250mg 1T, 2T bid¡¿7days (ÀӽŽà 1T tid¡¿7days) ..Cleocin.. 150mg 1C, 2C bid¡¿7days 2. Trichomonas vaginitis ..Flasinyl.. 250mg 1T, 8T(2g) qd¡¿1day / 2T bid¡¿7days 3. Candida vulvovaginitis ..Canesten.. vag. Tab. 100mg 1T, 2T/day¡¿3days ..Diflucan.. 50mg 1C, 3C qd ¿øÀÎÀ» Àß ¸ð¸¦¶§ ..Canesten.. vag. Tab. 100mg 1T, 2T/day¡¿3days ..Flasinyl.. 250mg 1T, 2T bid¡¿7day ..Canesten.. vag tab - Clotrimazole ..Diflucan.. - Fluconazole ..Flasinyl.. - Metronidazole ..Cleocin.. - Clindamycin ..Trichomonas Áú¿°ÀÎ °æ¿ì¿£ ¹è¿ìÀÚµµ ¹Ýµå½Ã ÇÔ²² Ä¡·á¹Þ¾Æ¾ß ÇÏÁö¸¸, bacterial Áú¿°ÀÎ °æ¿ì¿£ ¹è¿ìÀÚ Ä¡·á¿¡ ´ëÇØ ³í¶õÀÌ ÀÖÀ¸¸ç Àç¹ßÇÏ´Â °æ¿ì¿¡¸¸ °í·ÁÇÑ´Ù. Candida Áú¿°ÀÎ °æ¿ì¿£ ¹è¿ìÀÚ¸¦ Ä¡·áÇÒ Çʿ䰡 ¾ø´Ù. ..Metronidazole »ç¿ë ÈÄ 48½Ã°£ µ¿¾ÈÀº ¼úÀ» ±ÝÇØ¾ßÇÑ´Ù. 541 The Root of ambulatory care ..Imidazole°ú clindamycinÀ» ÇÔÀ¯ÇÑ Å©¸²Á¦Á¦´Â latex condomÀ» ¾àÇÏ°Ô ÇÒ ¼ö ÀÖ´Ù. ..Oral fluconazole agent°ú oral Hypoglycemic agent¸¦ µ¿½Ã º¹¿ë½Ã hypoglycemia¸¦ À¯¹ßÇÒ ¼ö ÀÖ´Ù. Âü°í ¹®Çå Mari E. Egan, M.D., Martin S. Lipsky, M.D. : Diagnosis of Vaginitis. A journal of the American Family Physicains 2000 ; 62 : 1095-1104 Barbara D. Reed : Vaginitis, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 567-570 °íÈñÁ¤ : Áú¿°, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí.¼­¿ï, °èÃø¹®È­»ç, 2002, P 1335-1341 David A. Baker, M.D. : Vulvovaginitis, in Conn's Current Therapy 2004, Robert E. Rakel(ed), Edward T. Bope(ed). Philadelphia, Saunders, 2004, P 1117-1120 ¿Àâ¼®(ed) : À½¹®Áú¿°, in Complete Guide To Practical Based Prescription Medicine. ¼­¿ï, Çѿ츮, 2005, P 308-309