GYN- Vaginal disease

Question 1

BV Amsel Crieteria

Answer 1

Need three of the four
1) vaginal pH > 4.5
2) Thin watery discharge
3) >20% clue cells on wet mount
4) positive whiff test (amine odor present with addition of KOH)

Question 2

Gold standard for BV diagnosis

Answer 2

Nugent score on gram stain

Question 3

Recurrent BV
Rate
Definition
mechanism
treatment

Answer 3

recurrence as high as 30% in 3 months, 60% in 12 months
3 or more episodes in a 12 month period
reinfection or incomplete restoration of normal vaginal flora
antibiotic resistance or development of biofilm (assemblage of microbes within surface associated extracellular matrix that acts to inhibit antibiotic penetration)
treatment: flagyl 500 mg qd x 7d then vaginal boric acid capsules 600 mg BID x21d (recurrence 30% by 6 mo) OR twice weekly metronidazole gel for 6mo after treatment of acute episode

Question 4

gold standard for diagnosis of trich
Follow up?

Answer 4

nucleic acid amplification (NAAT)
Have increased pH
can see trichomonads on wet prep
Retest for reinfection in 3 months after treatment

Question 5

diagnosis of candida

Answer 5

requires one of the following
1) visualization of spores, pseudohyphae or hyphae on wet mount
2) vagina fungal culture or commercial diagnostic test

Question 6

BV treatment

Answer 6

clindamycin 2% cream 5g x7d intravaginally or metronidazole 0.75%gel /5gm qd x5 days or Flagyl 500 mg PO BID x7d

Question 7

BV AND Trich can be associated with..

Answer 7

PTL/PROM, post hyst cuff cellulitis, PID, increased risk of getting STIs

Question 8

uncomplicated vs complicated candidiasis and the associated treatments

Answer 8

uncomplicated:
1) sporadic/infrequent episodes
2) mild to moderate symptoms or findings
3) albicans
4) non immunocompromised
-need all of the following

complicated: presence of any:
1) recurrent episodes (4 or more/year). Treat with fluconazole 150 mg q3d x 3 doses, then weekly x6 months OR topical clotrimazole 500 mg vaginally q week x 6 months
2) severe sx (need 10-14d of topical intravaginal azole or 2-3 doses of oral fluconazole 3 days apart)
3) non albicans, 5-10% (use boric acid 600 mg qd intravaginaly for 14d)
4) diabetes, immunocompromised, immunosuppresive therapy

Question 9

when should you give abx with bartholin

Answer 9

recurrent abscess
extensive surrounding cellulitis
pregnant
immunocompromised
risk of MRSA or culture + for MRSA
signs of infection
abx: bactrim 5-7 days