Approach To STIs In females

Question 1

What are the “5 P’s” of female reproductive history’s

Answer 1

Partners

Practices

Prevention of STDs

Past history of STDs

Prevention of pregnancy

Question 2

Examples of inclusive language

Answer 2

This is bad**

1) Are you married?; instead use “do you have a spouse or domestic partner?”
2) do you have a boyfriend/girlfriend?; instead use “do you have a partner?”
3) are you the mother or father?; instead use “are you the parent or guardian?”
4) who is the real father/mother?; instead use “who is the biological father/mother?”

Question 3

What are the tests used in females to determine STDs

Answer 3

NAAT = chlymida and gonorrhea

Wet mount = take sample of vaginal discharge and place on glass slide. Mix with a salt solution and look at slide under microscope for bacteria, yeast, trichmoniasis or “clue cells” (significant for bacterial vaginosis)

KOH slide = take ample of discharge and place on slide with KOH (potassium hydroxide)

• if yeast is the causative agent = very easy to see under microscope
• **yeast will NOT show fishy odor

Vaginal pH test

• normal pH = 3.8-4.5
• if >4.5 = bacterial vaginosis, trichomoniasis or atrophy vaginitis

Whiff test = add several drops of KOH to sample of discharge. Strong fishy odor = bacterial vaginosis

Question 4

What STDs need to be screen in pregnant women

Answer 4

Syphills, HBV and HIV infections

Also screen chlymida and gonorrhea but you will do this for any women under the age of 24 or any older women that has increased risk factors

also kinda should HIV for anyone between the ages of 15-65 but especially do this in pregnancy

Question 5

Are vaginosis and candida technically STIs?

Answer 5

NOOO

Question 6

Treatment for bacterial vaginosis

Answer 6

1st line = metronidazole 500 mg PO 2x daily for 7 days
can also do 0.75% metronidzole gel or 2% clindamycin cream applied intravaginally 1x daily for 5 days/7days respectively

2nd line = tinidazole 2g orally for 2 days

Question 7

Treatment of vulvovaginal candidiasis

Answer 7

Topical azole therapy’s are okay
- if going this route requires application intravaginally for 7 days

1st line = fluconazole 150 mg SPO 1x period

Question 8

Trichomoniasis treatment

Answer 8

1st line = metronidazole 2g PO 1 period OR tinidaziole 2g PO 1 time period

Could do metronidazole 500mg PO 2x daily for 7 days also if you worry that 2g dose is too much at one time

Question 9

Prevention and screening in bisexual/gay women

Answer 9

Avoid contact of menstrual blood and any visible genital lesions

Cover sex toys that penetrate more than one persons vagina or anus with a new condom

Use a barrier when performing oral sex

Us latex or vinyl gloves and lubricant for any sex that might cause bleeding

Question 10

Treatment options for genital warts

Answer 10

Imiquimod 5% topical cream

• apply every other night (no more 3 times a week) for 16 weeks
• make sure to only apply on for 6-8hrs at a time (wipe if off afterwards)

Podofilox 0.5% topical solution

• apply 2x daily for 3 consecutive days a week Only (give 4 days break)
• repeat the above for 4 weeks

Surgery also options

• cryotherapy
• electrosurgery (best rates)

Question 11

What are male prophylaxis against HPV?

Answer 11

Male circumcision and vaccination