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Re: Unresolved cervicitisFrom: Ingrid Andenas Chamales, MD (chamales@brookings.net)Mon Jun 30 21:08:55 1997
At Mon, 30 Jun 1997, Susan Mcniel wrote: > >29 yo woman presents with "months" of fierce vulvar pruritis, occ. >dyspareunia. Has seen approx 3 providers including obgyn, FP PA, FP. Has >used multiple treatments of the "zoles" (both prescribed and self Rx), >doxy (both she and her husband have been treated), now on clindamycin >cream intravag. On Loestrin 1.5/30 X 7 years. Last PAP 3/97 - normal, >no abnormal PAP hx. 1 1/2 yrs ago had resistant cystitis, saw >urologist, had VCUG which was nl. but was placed on prophylactic antibx >(Macrodantin? she did not remember) which she stopped taking 2 mos ago. >On exam labia is inflamed and dry, vag walls dry,deep pink. Cx c ectopy & >covered c adherent thick white DC. No CMT. Ut: NSSC, NT. Nml adnexa. >Wet mt- neg X3, rare bacteria, copious WBC. Neg CT, GC. Couple of >thoughts: >1. Cytolytic vaginitis >2. High progestational OC is related to cervicitis, so change >to less progestational OC. >3. Mucopurulent DC prob due to ectopy and refer for cryo. (I am referring >but would like input from this group-what would you do?) >4. Other? >TIA >Susan McNiel, MN, ARNP Susan, On exam of the vulva, did you use acetic acid, and also use a magnifying glass to look for areas to biopsy? Also would suggest a q-tip exam to look for any vestibular tenderness. It's possible the cervix is a "red herring" since she has been treated with lots of chemicals. Sounds like this COULD be vulvar vestibulitis. I have 5 in my clinic practice. Good luck! Ingrid Brookings, SD
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