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Essentials - Gynecology > 8. Vulvar itch, vaginal discharge, and sexually transmitted disease > Flashcards

8. Vulvar itch, vaginal discharge, and sexually transmitted disease Flashcards

1
Q

Describe history: Vulvar itch, vaginal discharge, and STDs (14)

A
  • Vulvar Sx (burning or pruritus)
  • Vaginal discharge (consistency, color, odor)
  • Progression of Sx
  • Previous investigations, including cultures, swabs, etc.
  • Rx attempted, including antibiotics, antifungals, etc.
  • Hygienic practices
  • Dysuria (internal vs. external)
  • Abdo pain
  • Presence of IUD
  • Prev. infections
  • Menstrual Hx
  • Sexual activity, including number of partners, new partners, barrier protection use
  • Pregnancy Hx
  • PM H x, including H x of diabetes
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2
Q

Describe physical exam: Vulvar itch, vaginal discharge, and STDs (6)

A
  • Inspect external genitalia
    • Edema, excoriations, ulceration, condylomas, discharge on the perineum or introitus
  • Assessment of inguinal and/or femoral lymph nodes: lymphadenopathy
  • Speculum exam:
    • Vaginal discharge and lesions, evidence of characteristic lesions (e.g., strawberry cervix of trichomoniasis), presence of cervical discharge
  • Assess the presence of cervical and upper genital tract inflammation: Cervical motion tenderness, adnexal tenderness
  • Assess the presence of systemic Sx: Fevers, abdo tenderness
  • Perform perianal inspection, pharyngeal inspection
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3
Q

Describe investigations: Vulvar itch, vaginal discharge, and STDs (7)

A
  • Vaginal swabs
  • Vaginal discharge sample wet mount
  • Culture of the endocervix for gonorrhea or chlamydia infection
  • Pap test (biopsy if any suspicious areas)
  • UrineR&M, C&S
  • Vaginal pH (using phenaphthazine paper)—may be altered by lubricating gel, semen, douches, or intravaginal medication
  • CBC, specific blood tests (VDRL, treponemal tests, HSV PCR, HAV, HBV, HIV)
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4
Q

Describe: Normal vaginal Discharge (3)

A
  • Physiologic vaginal discharge (1–4 mL of fluid daily)
  • pH of normal flora is acidic (4.0–4.5)
  • Discharge may ↑at times (pregnancy, use of E contraceptives, mid-cycle).
    • ↑mid- cycle due to ↑ cervical mucus → can be malodorous and can be accompanied by irritative Sx
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5
Q

Describe: Vulvovaginitis (2)

A
  • Inflammation of the vulva and vagina due to both infectious and noninfectious causes
  • Sx of vaginitis are nonspecific → physical exam and lab findings are required to make a definitive Dx
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6
Q

Name types of infectious vaginitis (4)

A
  • Bacterial vaginosis (40% –50% of cases—most common cause of vaginitis in women of reproductive age)
  • Vaginal candidiasis (20%–25% of cases)
  • Trichomoniasis (15% –20% of cases)
  • Other (less common):
    • Atrophic vaginitis with 2° bacterial infection
    • Foreign body with 2° infection
    • Streptococcal vaginitis (group A)
    • Ulcerative vaginitis TSS
    • Idiopathic vulvovaginal ulceration related to HIV
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7
Q

Name types of noninfectious vaginitis (5)

A
  • Atrophic vaginitis
  • Chemical or other irritant
  • Allergic, hypersensitivity, and contact dermatitis
  • Neoplastic
  • Other:
    • Traumatic vaginitis
    • Postpuerperal atrophic vaginitis
    • Desquamativein ammatoryvaginitis
    • Erosive lichen planus
    • Lichen sclerosis
    • Lichen simplex chronicus
    • Collagen vascular disease, Crohn disease
    • Behçet syndrome
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8
Q

Name causative agents: Bacterial vaginosis (4)

A
  • G. vaginalis
  • Bacteroides
  • Peptostreptococcus
  • M. hominis
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9
Q

Why is it important to treat Bacterial vaginosis in pregnancy? (1)

A

↑ Risk of preterm birth

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10
Q

Name signs and sx: Bacterial vaginosis (2)

A
  • Predominant complaint of vaginal odor
  • ↑ Risk with uterine manipulation
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11
Q

Name Diagnostic Criteria: Bacterial vaginosis (4)

A

Amsel criteria (3 of 4):

  1. Thin homogeneous vaginal discharge
  2. Clue cells on N/S wet mount or Gram stain
  3. Positive Whiff test on KOH wet mount (presence of characteristically “ shy” [amine] odor)
  4. Vaginal pH > 4.5
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12
Q

Name RX options: Bacterial vaginosis (3)

A
  • Metronidazole 500 mg PO b.i.d. × 7d
  • Metronidazole 5 g pv daily × 5d
  • Clindamycin 5g pv × 7d
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13
Q

Name causative agents: Vaginal candidiasis (3)

A
  • C. albicans
  • C. glabrata (less common)
  • Associated with antibiotics use, DM, immunosuppression
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14
Q

Name signs and sx: Vaginal candidiasis (3)

A
  • Vulvar/vaginal pruritus
  • Vulvar erythema, edema, fissures excoriations, external dysuria
  • Thick occulent white discharge
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15
Q

Name Diagnostic Criteria: Vaginal candidiasis (3)

A
  • Normal vaginal pH (4–4.5)
  • Hyphae and buds on saline wet mount (yeast)
  • Positive yeast culture from the vagina (many asymptomatic women have vaginal yeast colonization)
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16
Q

Name RX Options: Vaginal candidiasis (2)

A
  • Fluconazole 150 mg PO once
  • Clotrimazole 500 mg tablet p.v. ×1 or 5 g pv × 3d
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17
Q

Name causative agents: Vaginal trichomoniasis (2)

A
  • T. vaginalis
  • Facilitates HIV transmission, associated with PROM
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18
Q

Name signs and sx: Vaginal trichomoniasis (3)

A
  • Dyspareunia
  • Vaginal pruritus, vulvovaginal erythema “Strawberry” cervixon exam
  • Timing: ↑ common during/ immediately after menses
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19
Q

Name diagnostic criteria: Vaginal trichomoniasis (4)

A
  • Trichomonas (motile agellum) seen on N/S wet mount
  • High number of Polymorphonuclear leukocytes (PMNs) on saline microscopy
  • Positive culture for T. vaginalis
  • Vaginal pH 5–6.0
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20
Q

Name rx options: Vaginal trichomoniasis (3)

A
  • Metronidazole 2 g PO × 1
  • Metronidazole 500 mg PO b.i.d. × 7 d
  • *Must treat sexual partners simultaneously to prevent reinfection
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21
Q

Who to Test for Gonorrhea and Chlamydia (5)

A
  • Sexually active and < 25 yr
  • In all patients who have a fever and lower abdo pain
  • A symptomatic sexual partner
  • A new sexual partner or more than one sexual partner
  • Other STI diagnosed
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22
Q

Name causative agent: Gonorrhea (1)

A

N. Gonorrhea (diplococci)

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23
Q

Name signs and sx: Gonorrhea (12)

A
  • Cervicitis, PID
  • Mucopurulent discharge vagina
  • Rectal pain and discharge
  • Dysuria, dyspareunia
  • Perihepatitis (Fitz-Hugh-Curtis)
  • Lower abdo pain
  • Abnormal vaginal bleeding
  • Chorioamnionitis/endometritis
  • Bartholinities
  • Conjunctivitis
  • Pharyngeal infection
  • Disseminated infection (arthritis, dermatitis, endocarditis, meningitis)
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24
Q

Name dx criteria: Gonorrhea (4)

A
    1. Nucleic acid testing from endocervical specimens (sensitivity 96% )
    1. Gram stain of cervical swab sample
    1. Culture from endocervix, pharynx, rectum, conjunctiva
  • Usual incubation period is 2–7 d
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25
Q

Name rx options: Gonorrhea (6)

A
  • Recommended: Cefixime 800 mg PO × 1
  • or: Ceftriaxone 250 mg IM × 1 plus Azithromycin 1 g PO × 1
  • or Doxycycline 100 mg PO b.i.d. × 7d
  • Alternative
    • Azithromycin 2 g PO × 1
    • or Spectinomycin 2 g IM × 1
    • plus Co-treatment for chlamydia
  • Mandatory reporting
  • Rx/F/U of partners with contact within 60 d of Sx onset
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26
Q

Name causal agent: Chlamydia (2)

A
  • C. trachomatis
  • Serotypes D, E, F, G, H, I, J, K (obligate intracellular bacteria)
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27
Q

Name signs and sx: Chlamydia (8)

A
  • Majority of cases → asymptomatic
  • Vaginal discharge
  • Dysuria, dyspareunia
  • Lower abdo pain
  • Conjunctivitis
  • Proctitis
  • Reactive arthritis
  • Incubation period can be up to 6 wk
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28
Q

Name dx criteria: Chlamydia (2)

A
  1. Nucleic acid testing assay from endocervical, urethral, or urinary specimen
  2. Throat and/or rectal culture of C. trachomatisc
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29
Q

Name rx options: Chlamydia (5)

A
  • Recommended: Doxycycline 100 mg PO b.i.d. × 7 d
  • or Azithromycin 1 g PO × 1b
  • Alternative :
    • Erythromycin 500 mg PO q.i.d. × 7 d
    • or Erythromycin 250 mg PO q.i.d. × 14 d
  • Mandatory reporting
  • Rx/F/U of partners with contact within 60 d of Sx onset
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30
Q

Name repeat screening of Gonorrhea indications (8)

A
  • All cases 6 mo post-Rx
  • Test of cure with culture 3 to 7 d after initiation of treatment when:
    • Gonococcal pharyngeal infection
    • Patient treated with non recommended regimen, including known antimicrobial resistance
    • Suspected treatment failure
    • Uncertain compliance
    • Reexposure to untreated partner
    • PID or disseminated infection
    • Pregnancy
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31
Q

Name STI RFs (11)

A
  • Previous STI
  • Sexually active < 25 yr of age
  • Sexual contact with person(s) with a known STI
  • A new sexual partner or > 2 sexual partners in the past year/serially monogamous patients
  • IV drug use
  • No contraception or sole use of a nonbarrier method
  • Sex workers and their clients
  • Street involvement, homelessness
  • Victims of sexual assault/abuse
  • Anonymous sexual partnering
  • “Survival sex” (i.e., exchanging sex for money, drugs, etc.)
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32
Q

Name C. trachomatis Repeat testing indications (7)

A
  • All cases 6 mo post-Rx
  • Test of cure in 3 to 4 wk recommended when:
    • Uncertain compliance
    • Patient treated with nonrecommended regiment
    • Pregnancy
  • Test of cure at 3 to 4 wk is not recommended when:
    • Standard treatment regimen has been completed
    • Signs and Sx have resolved
    • No reexposure to an untreated partner
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33
Q

Must consider ____ in any child diagnosed with gonorrhea and/or chlamydia after the immediate neonatal period.

A

Must consider sexual abuse in any child diagnosed with gonorrhea and/or chlamydia after the immediate neonatal period.

Suspected or known sexual abuse of children must be reported to child protection agencies.

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34
Q

What is the great imitator as it is associated with a variety of signs and Sx (1)

A

Syphilis

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35
Q

Describe signs and sx: Primary Syphilis (5)

A
  • chancre (genital ulcer), regional
  • LAD
  • Ulcer is classically painless
  • Resolves in 2–8 wk
  • Incubation period: 3-90d
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36
Q

Name dx criteria: Primary Syphilis (1)

A

Dark field microscopy of serous fluid from genital lesions for observation of spirochetes

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37
Q

Name rx options: Primary Syphilis (2)

A

1°, 2°, early latent:

  • Benzathine Penicillin G 2.4 million units IM × 1
  • Doxycycline 100 mg PO b.i.d. × 28 d (if allergic to PCN)
38
Q

Describe signs and sx: Secondary Syphilis (12)

A
  • widespread symmetric maculopapular rash (palms and soles)
  • fever
  • malaise
  • LAD
  • mucous lesions
  • condyloma lata
  • alopecia
  • meningitis
  • headaches
  • uveitis
  • retinitis
  • Incubation period: 2 wk to 6 mo
39
Q

Name dx criteria: Secondary Syphilis (1)

A

Initial screening with non-treponemal antibody tests (VDRL and RPR)

40
Q

Name rx options: Secondary Syphilis (2)

A
  • Benzathine Penicillin G 2.4 million units IM×1b
  • Doxycycline 100 mg PO b.i.d. × 28 d (if allergic to PCN)
41
Q

Describe: Latent Syphilis (1)

A
  • asx
  • incubation period: 10-30 yr
42
Q

Describe: Tertiary syphilis (6)

A
  • aortic aneurysm
  • aortic regurgitation
  • coronary artery ostial stenosis
  • Early < 1 yr
  • Late > 1 yr
  • Incubation period: 10-30 yr
43
Q

Name dx criteria: Tertiary Syphilis and Latent (1)

A

If nontreponemal tests positive, perform confirmatory testing

44
Q

Name Rx options: Late latent,CVS syphilis, and other syphilis not involving CNS (2)

A
  • Benzathine Penicillin G 2.4 million units IM weekly × 3 dosesb
  • Doxycycline 100 mg PO b.i.d.× 28 d (if allergic to PCN)
45
Q

Describe: Neurosyphilis (3)

A
  • form of 3°
  • Argyll-Robertson pupil
  • Incubation period: 2-20 yr
46
Q

Name dx criteria: Neurosyphilis (1)

A

The treponemal tests remain positive for life, even after successful Rx.

47
Q

Name rx options: Neurosyphilis (1)

A

Penicillin G 3–4 million units IV q4h × 10–14 db

48
Q

Describe: Gumma syphilis (4)

A
  • form of 3°
  • tissue destruction in any organ
  • The specific manifestations depend on the site involved.
  • Incubation period: 1-46 yr
49
Q

Name dx criteria: Gumma syphilis (1)

A

CSF samples should be taken in those with neurologic or ophthalmic Sx.

50
Q

Name rx options: Gumma syphilis (1)

A

Sexual contacts (last 30 d): Benzathine Penicillin G 2.4 million units weekly × 3 doses

51
Q

Name mode of transmission: Syphilis (3)

A
  • direct sexual contact with infected lesions
  • contact with infected blood
  • vertical transmission (congenital syphilis)
52
Q

Name syphilis forms that are considered infectious (3)

A

1°, 2°, and early latent phases are considered infectious (60% risk of transmission per partner)

53
Q

Name Syphilis Follow-up Considerations (4)

A
  • Test for other STIs, including HIV, HPV, hepatitis B, chlamydia, and gonorrhea
  • Genital ulcers should be tested for HSV, chancroid, and/or lymphogranuloma venereum
  • Immunization against HPV and hepatitis A and B if not already immunized
  • Syphilis is reportable to public health (1°,2°,and early latent); sexual and perinatal contacts must be tested
54
Q

Name signs and sx: Herpes HSV types 1 and 2 (11)

A
  • Painful ulcerating genital lesions (80%)
  • Atypical presentation (20% ) including genital pain, urethritis, cervicitis
  • 1°outreak:
    • Painful ulcerative genital lesions
    • Systemic Sx (fever, myalgias)
    • lymphadenopathy
    • Aseptic meningitis (16% –26% )
    • Extragenital lesions (10% –28% )
  • 2°outreak:
    • Residual latent sensory ganglion infection leads to late recurrence(s) in tissues innervated by sacral sensory nerves.
    • Prodromal Sx: itching, burning, tingling, or discomfort
    • Triggers: stress, illness, or certain medications
    • Clinical Presentation: systemic sx (16%), ↓severity/durationof sx, meningitis (1% ), extragenital lesions (8%)
55
Q

Name dx criteria: Herpes HSV types 1 and 2 (5)

A
  • Cultures from HSV lesions (70% sensitive—ulcers, 94% —vesicles)
  • HSV PCR : 100% specific
  • Antibody response: early → IgM, followed by IgG
  • 3–6 wk to seroconversion after 1° outbreak
  • NAAT assay—vesicle fluid or ulcer swab (~100% sensitivity and specificity)
56
Q

Name Measures to ↓ transmission of HSV (3)

A
  • Counseling (i.e., HSV is not curable, potential for recurrent episodes, sexual transmission, asymptomatic shedding)
  • Condom use
  • Antiviral Rx to ↓ asymptomatic shedding and recurrent lesions NOTE: greatest RF for neonatal herpes → primary maternal genital HSV-1 or -2
57
Q

For HSV, must inform which sexual partners? (1)

A

sexual partners from the preceding 60 d before Sx (due to risk of asymptomatic shedding)

58
Q

Describe Rx of first episode of HSV (4)

A
  • Urinary retention may be an indication for hospitalization
  • Acyclovir 400 mg PO × t.i.d. ×7–10d
  • Famciclovir 250 mg PO t.i.d. ×5–7d
  • If severe: IV acyclovir 5 mg/ kg over 60 min q8h until improvement
59
Q

Describe Rx of recurrent episode of HSV (episodic therapy) (3)

A
  • Acyclovir 400 mg PO t.i.d. ×5d
  • Valacyclovir 500 mg b.i.d. ×3d
  • Famciclovir 125 mg PO b.i.d. ×5d
60
Q

Name HSV Suppressive Rx for nonpregnant patients (6–9 yr) (3)

A
  • Acyclovir 400 mg PO b.i.d. × 6–12 mo
  • Famciclovir 250 mg b.i.d. × 6–12 mo
  • Valacyclovir 500 mg daily × 6–12 mo
61
Q

Name HSV suppressive Rx for pregnant patients (1)

A

Acyclovir 400 mg PO t.i.d., start- ing at 36 wk gestational age

62
Q

Name causative agent: Chancroid (1)

A

H. ducreyi
Known cofactor in HIV transmission

63
Q

Name signs and sx: Chancroid (3)

A
  • Painful genital ulcers with granulomatous bases
  • May progress to inguinal ulcers, painful inguinal LAD

Note: 50% of those exposed develop the disease (incubation period 5–14 d)

64
Q

Name dx criteria: Chancroid (3)

A
  • Culture of H. ducreyi
  • Gram stain of GN coccobacilli with “school of sh” pattern
  • Must also R/O T. Pallidum or HSV
65
Q

Name RX options: Chancroid (5)

A
  • Ciprofloxacin 500 mg PO × 1
  • Erythromycin 500 mg PO t.i.d. ×7d
  • Azithromycin 1 g PO × 1
  • Ceftriaxone 250 mg IM × 1
  • Must empirically treat all individuals with sexual exposure in the last 2 wk from onset
66
Q
A
67
Q

True or False

HPV is not reportable in Canada

A

True

68
Q

Once genital warts are healed, what is recommended? (1)

A

routine F/U for cervical CA is recommended

69
Q

Consider what in children presenting with genital warts? (1)

A

sexual abuse

70
Q

Is C/S recommended in HPV? (1)

A

C/S is not indicated unless warts obstruct the birth canal

71
Q

Name signs and sx: HPV (5)

A
  • Hpv in infection is requently asymptomatic.
  • HPV lesion:
    • external genital warts (condyloma acuminata)—multifocal cauli ower-like exophytic fronds → ± pruritus or local discharge
    • On cervix, vagina, vulva, or perianal
    • D in size and number of warts with pregnancy
  • Intraepithelial lesions on Pap smear → cervical involvement (LSIL, HSIL, invasive carcinoma)
  • HIV : collaborative care with other specialists is required in patients with HIV due to ↑ risk of cervical CA.
  • 90% of patients with external genital warts experience clearance within 2 yr with medical intervention.
72
Q

Name DX criteria: HPV (6)

A
  1. pap test
  2. HPV typing not indicated for routine. Dx/management of visible genital warts. HPV typing is indicated > 30 with ASCUS
  3. Coloscopy if high grade squamous intraepithelial lesion (HSIL), atypical glandular cells or invasive carcinoma on Pap test or positive high-risk HPV subtype and negative cytology or persistent ASCUS or LSIL × 2 yr
  4. Anoscopy: in patients with anal warts due to the risk of anal CA
  5. Urethroscopy in patients with extensive urethral warts
  6. Suspect neoplasia if:
    • Pigmented lesion
    • Bleeding
    • Persistent ulceration
    • Persistent pruritus
    • Recalcitrant lesions
    • Biopsy if lesion suspicious
73
Q

What RX guarantees eradication of HPV? (1)

A

No RX

74
Q

Name Patient applied RX for HPV (2)

A
  • Imiquimod × 3/wk for up to 16 wk. Cream must be washed off after 6–8 h.
  • Podophyllotoxin 0.5%, 0.5 mL q 12h × 3/wk for 6 wk
75
Q

Name Provider-based RX for HPV (4)

A
  • Cryotherapy (liquid nitrogen, CO2)
  • Podophyllin resin 10% –25% for 1–4 h, repeated at weekly intervals
  • Bi- or trichloroacetic acid (50% –80% solution) weekly for 4–6 wk
  • CO2 laser ablation, excision
76
Q

Name RX for extensive or resistant lesions of HPV (2)

A
  • Excision with electrosurgery
  • CO2 laser removal
77
Q

Describe: Pelvic Inflammatory Disease (5)

A
  • Ascending infection of the upper genital tract from the vagina and/or cervix.
  • Sx range from asymptomatic to severe Sx.
  • Up to two-thirds of cases go unrecognized.
  • 10% to 15% of women of reproductive age will have at least one episode of PID.
  • PID is the most common infectious cause of lower abdo pain in women.
78
Q

Name signs and sx: Pelvic Inflammatory Disease (11)

A
  • Fever > 38.3°C
  • Mucopurulent discharge
  • Dyspareunia
  • RUQ pain
  • Dysuria
  • Adnexal mass
  • Vaginal bleeding
  • Nausea/vomiting
  • ↑ESR, CRP
  • WBC > 10,000/mm3
  • Lab confirmation of cervical Dx of chlamydia and/or gonorrhea
79
Q

Name Risk factors for PID (3)

A
  • STI RFs
  • IUDs
  • Frequent vaginal douching
80
Q

Most common causative agent in PID (12)

A
  • C.trachomatis
  • N.gonorrhea
  • Other:
    • E.coli
    • Peptostreptococcus
    • G. vaginalis
    • Prevotella
    • Bacteroides
    • Streptococcus
    • H. influenzae
    • T.vaginalis
    • M. genitalium
    • M. hominis
81
Q

Name acute complications of PID (5)

A
  • Pelvic peritonitis
  • Endometritis
  • Salpingitis
  • Tubo-ovarian abscess
  • Sepsis
82
Q

Name chronic complications of PID (5)

A
  • Infertility
  • Chronic pelvic or abdo pain
  • Pelvic/Abdo adhesions
  • Fitz-Hugh-Curtis syndrome
  • EP
83
Q

Name PID Minimum Triad (3)

A

Lower abdo pain + oneofthe following:

  • Adnexal tenderness
  • Cervical motion tenderness
  • Uterine tenderness
84
Q

Describe: Fitz-Hugh-Curtis Syndrome (2)

A
  • Perihepatitis resulting in adhesions between the liver capsule and the abdo wall.
  • Perihepatitis resolves with Rx of PID.
85
Q

Describe: Inpatient Rx of PID (4)

A
  1. Cefotetan 2 g IV q12h + doxycycline 100 mg PO b.i.d. until clinical improvement > 24 h, then continue doxycycline PO only for a total of 14 d
  2. Cefoxitin 2 g IV q6h + doxycycline 100 mg PO b.i.d. until clinical improvement > 24 h, then continue doxycycline PO only for a total of 14 d
  3. Clindamycin 900 mg IV q8h + gentamicin 2 mg/kg IV load, then 1.5 mg/kg IV q8h until clinical improvement × 24 h, then doxycycline 100 mg PO b.i.d. or clindamycin 450 mg PO q6h for a total of 14 d
  4. Note: consider adding metronidazole 500 mg PO b.i.d. × 14 d to all the above regimens
86
Q

Describe: Outpatient Rx of PID (4)

A
  1. Ceftriaxone IM × 1 + either doxycycline 100 mg PO q12h × 14 d or azithromycin 1 g PO × 1 dose, then q weekly × 2 wk
  2. Cefixime 800 mg PO × 1 dose + either doxycycline 100 mg PO q12h× 14d or azithromycin 1g PO × 1dose, then q weekly × 2 wk
  3. Levofloxacin 500 mg PO b.i.d. × 14 d
  4. Note: consider adding metronidazole 500 mg PO b.i.d. × 14 d to all the above regimens
87
Q

Gold Standard Dx for PID (1)

A

Laparoscopy demonstrating abnormalities consistent with PID, including fallopian tube erythema and/or mucopurulent exudates

88
Q

What to do with IUD if PID? (2)

A
  • IUD: the device does not have to be removed during treatment of PID.
  • If the patient prefers removal, it should not be removed until at least 2 doses of antibiotic Rx have been administered.
89
Q

Name Criteria for Inpatient Rx in PID (10)

A
  • Pregnancy
  • Appendicitis/EP cannot be excluded
  • Adolescence/poor compliance
  • Inability to follow or tolerate an oral regimen
  • If pelvic or tubo-ovarian abscess is suspected
  • Patient previously failed to respond to outpatient Rx
  • Patient is immunocompromised
  • Dx is uncertain (i.e., need for laparoscopy)
  • The patient has severe illness (vomiting, fever, pain)
  • HIV-positive patient
90
Q

Describe: Management of tubo-ovarian abscesses (Figure)

A

Essentials - Gynecology (14 decks)

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