Genital Infections

Question 1

Painless ulcer, well demarcated borders, painless inguinal adenopathy Dx Tx

Answer 1

Primary syphillis

Benza penicillin G (intramuscular)
Doxycycline oral if you cant^

Question 2

Painful ulcer, irregular borders, painful adenopathy, Dx Tx

Answer 2

Chancroid H. Ducreyi

Tx: azithromycin / Erythromycin oral
Or
IM ceftriaxone

Question 3

Painful small shallow ulcers, fever, inguinal adenopathy Dx, Tx

Answer 3

HSV 1/2

Oral acyclovir until symptoms subside
Or
Severe disseminated disease IV acyclovir

Question 4

16 yo girl with multiple sexual partners presents with green yellow malodorous vaginal discharge. She has pain during intercourse. Examination shows itching red vulva and friable red cervix. Workup and diagnosis?

Answer 4

Dx is vaginosis with T. Vaginalis
Workup should include
- PCR
- wet mount microscopy (show motile flagellated organisms)

Question 5

Tx for vaginitis by T. Vaginalis

Answer 5

Metronidazole/ tinidazole for herself and PARTNERS

Question 6

17 yo girl presents with thin, white vaginal discharge, that smells like fish. There is minimal redness and itching of the vulva. Workup and Dx

Answer 6

Dx= vaginosis due to G. Vaginalis or ureaplasma etc
Mild infection
Tests:
Whiff test (increased fishy odour)
Wet mount microscopy: CLUE CELLS (epithelial cells surr by bacteria)

Question 7

Tx for bacterial vaginosis

Answer 7

Metronidazole oral

Topical clindamycin otherwise

Question 8

17 yo girl presents with thick white vaginal discharge and a red inflamed vulva that is intensely itchy. Workup and Dx?

Answer 8

Wet mount microscopy shows pseudohypae.

PH <4.5

Question 9

Tx for candidal vaginitis

Answer 9

Fluconazole

Question 10

18 yo sexually active male, painful, swollen scrotum with dysuria?

Answer 10

Epidydimitis: c. Trachomatis and n gonorrhoea
Dx: wbc in urine and NAAT etc
Tx: azithro and doxy for trachomatis,
Im ceftriaxone for gonorrhoea