GYN Flashcards
Microbial Changes
*Clear vaginal discharge and malodor (fishy)
Caused by sexual activity (especially new partners, changing practices) and douching
Some women do not seek tx because they are asymptomatic
Bacterial Vaginosis
gold standard dx for Bacterial Vaginosis?
gram stain
How to dx Bacterial Vaginosis?
Gram Stain = gold standard
Homogeneous, thin, white discharge that coats vaginal walls
Clue cells on microscopic examination
pH of vaginal fluid >4.5
Fishy odor, positive whiff test (before or after addition of 10% KOH)
Culture not recommended = not specific
How to tx BV?
(oral med can make people nauseous and CANT have alcohol while on flagyl)
Metronidazole 500 mg orally twice a day for 7 days
Metronidazole gel 0.75%, one full applicator (5g) intravaginally, one a day for 5 days
Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days
(Can weaken latex condoms up to 5 days after use )
Evidenced based does not support use of lactobacillus
how to tx BV that has failed tx?
Metronidazole gel 0.75%, twice weekly for 4–6 months
Metronidazole 500 mg twice daily for 7 days followed by intravaginal boric acid 600 mg daily for 21 days, then suppressive metronidazole gel twice weekly for 4–6 months
Monthly oral metronidazole 2 g with fluconazole 150 mg
pregnancy and BV?
Association with symptomatic BV and negative pregnancy outcomes Treat all symptomatic pregnant women Oral or topical therapy Metronidazole 250mg or 500mg—twice daily Clindamycin Metronidazole—secreted in breast milk
Asymptomatic Nontender Unilateral Palpable near vaginal orifice Vulvar asymmetry
Bartholin cysts
Severe vulvar pain \+/- fever Tender Erythematous \+/- vaginal discharge STIs may coexist
Bartholin Abscess
how to tx Bartholin cysts/ abscesses?
Conservative Tx= Warm moist compresses
Antibiotics = Bactrim
(Will also cover MRSA)
Augmentin + Clindamycin
Surgery
Do biopsy in women > 40 with Bartholin cyst to rule out vulvar cancer
Most seen in pediatrics, especially neonates
Once puberty starts and estrogen increases the adhesions resolve
S/S= asymptomatic, urinary dribbling, skin irritation, UTIs
Dx= physical exam
Tx= conservative, estrogen cream, surgery
Labial Adhesions
Haemophilus ducreyi
Prevalence declining
Incubation: 4-7 days
CM: deep, raw, painful genital ulcerations (one or a few). Painful inguinal adenopathy (50% of time), often unilateral, 1-2 weeks after primary lesion
Diag: clinical: combination of ulcer and tender inguinal adenopathy. Confirm with culture.
Chancroid
Incubation period 1-2 weeks
CM: most asymptomatic. Abnormal vaginal discharge, burning with urination, penile discharge, and discomfort and edema in testicles. Rectal: pain, discharge, bleeding
Diag: NAAT
Screen: all sexually active women under 26 and all pregnant women; MSM
Chlamydia trachomatis
Incubation period: 2-12 days (avg 4). Remains latent on nerve fibers for life subject to reactivation
Spread through direct contact with lesions, mucosal membranes, or genital or oral secretions. Transmission higher from men to women
Genital Herpes
HSV-1 and HSV-2
visible painful genital or anal lesions thin-walled vesicle on erythematous base → charachteristic lesion. Vesicles erode and leave painful ulcerations that heal in 2-4 weeks. First outbreak lasts longer and is most severe
Serologic test (ELISA) will be positive lifelong Screening not recommended; refer if eye involvement
Genital Herpes
Incubation period 1-14 days
Transmitted by sexual contact, autoinoculation to eyes, or to neonate during childbirth
Untreated can spread to fallopian tubes (menstruation increases risk)/ prostate and epididymis
CM: often asymptomatic
Women: thin, purulent and mildly odorous leukorrhea; dysuria; intermenstrual bleeding; dyspareunia or mild lower abd pain; pharyngitis. May progress to PID
Men: urethritis, burning with urination, serous penile discharge which progresses to copious, purulent, and blood-tinged discharge
Gonorrhea
N. gonorrhoeae
