vaginal discharge Flashcards by Rebecca Lea

fever

N/V

bleeding

dyspareunia

purulent endocervical discharge

cervical motion/ uterine/ adnexal tenderness

low abdominal pain after menses

PID

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gonorrhea treatment

azithromycin 1 gm PO x 1

plus

ceftriaxone 250 mg IM

plus

no sex for 7 days after meds are finished

test for other STIs

repeat testing in 3 months

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dysuria

urinary frequency

urethritis

seen in chlamydia and gonorrhea

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what will make candidiasis “complicated”

severe or recurrent sxs

non-albicans species

pregnancy

poorly controlled diabetes

immunocompromised

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clue cells

bacterial vaginosis

seen with saline microscopy

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which vaginitis?

risk factors:

sex/ STIs/ not using condoms

black/ Mexican

smoking

douching

bacterial vaginosis

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complications of gonorrhea

disseminated gonococcal infection (DGI)

chorioamnionitis

PID, ectopic preg, infertility, preterm, transmittable to neonate

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which HSV is genital

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how do you diagnose bacterial vaginosis

Amsel’s Criteria

presence of at least 3/4:

thin, white, homogenous discharge
clue cells on saline mount
vaginal pH > 4.5
positive whiff test

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how do you diagnose trichomoniasis

Nucleic Acid Amplification Test (NAAT) is gold standard

vaginal/ endocervical/ urine specimens

also you will see motile trichomonads on saline microscopy

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if you see cervicitis and urethritis, what do you do next?

Nucleic Acid Amplification Test

of vaginal swab/ endocervical swab/ urine

maybe also do a culture if you suspect gonorrhea (abx resistance)

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+/- asxs

malodorous, frothy yellow-green discharge

postcoital bleeding

punctuate hemorrhages on vagina/ cervix

trichomoniasis

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motile protozoa

trichomoniasis

seen with saline microscopy

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strawberry cervix

punctuate hemorrhages on vagina/cervix

seen in trichomoniasis

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pruritis

external dysuria

white, thick, curd-like discharge that adheres to vag walls

vulvovaginal candidiasis

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x 2-4 weeks:

painful genital ulcers

tender inguinal LAD

dysuria

fever

+/- asxs

primary infection of HSV

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HPV diagnosis

visualization

maybe biopsy

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HSV diagnosis

best= PCR

next best= viral cx

not recommended= serology

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how do you determine whether to hospitalize someone w/ PID

if they are:

pregnant

high fever

N/V

severe pain

pelvic abscesses

can’t tolerate or be relied on to take meds

HSV incubation

2-12 days post transmission

(avg 4)

transmitted via mucosal surfaces, genital/oral secretions

complications of PID

infertility

ectopic pregnancy

peri-hepatitis (Fitz Curtis Syndrome)

cervicitis + urethritis =

chlamydia OR gonorrhea

who are you screening for chlamydia and gonorrhea

women under 25

women over 25 w/ bad sex habits/ prior STIs/ prostitutes

which vaginitis?

risk factors:

abx use

estrogen

immunocompromised

vulvovaginal candidiasis

how do you treat bacterial vaginosis

**only if symptomatic!!** options: * metro 500 mg PO BID x 7 days * metro gel intravag daily x 5 days * clindamycin intravag Q HS x 7 days * secnidazole 2 gm PO x 1

**prodome** (ex tingling) **followed by** mild ulcers, inguinal LAD, HA, dysuria, fever

recurrent infections of HSV

+/- asxs fishy smell thin, white/gray dishcarge

bacterial vaginosis

how do you treat **un**complicated candidiasis

clotrimazole topical x 1-3 days or 150 mg fluconazole PO

complications of chlamydia

PROM PID, ectopic preg, infertility, preterm, transmittable to neonate

which vaginitis? risk factors: HIV/ other STIs risky sex behavior prisons

trichomoniasis

chlamydia treatment

azithromycin 1 gm PO x 1 **or** doxycycline 100 mg PO BID x 7 days **\*\*\* do not give doxy to a preggo \*\*\*** **plus** no sex for 7 days after meds are finished test for other STIs repeat testing in 3 months

how do you treat trichomoniasis

**treat symptomatic + asymptomatic + sexual partners (EPT)** metronidazole 2 gm x 1 repeat testing in 3 months

which vaginitis(s) are STI's? which are not?

* are STI's * **trichomoniasis** * NOT STI's * **vulvovaginal candidiasis** * **bacterial vaginosis**

how do you diagnose candidiasis

wetmount KOH see budding yeast/ hyphae/ pseudohyphae

perihepatitis

PID complication

what might you see on a NAAT for suspected PID

* most common * c. trachomatis * n. gonorrhea * emerging * mycoplasma genitalium

RUQ pain and adhesions

Fitz Hugh Curtis Syndrome aka peri-hepatitis (complication of PID)

HSV tx

val/fam/acyclovir: * 1st episode = 7-10 days * recurrent episodes = 1-5 days * suppression = daily BID

HPV tx

* cyclodestructive * podofilox * trichloracetic acid * bichloracetic acid * immune mediated * imiquimod * sinecatechins * surgery * cryo * laser * electrocautery * excision

chandelier sign

cervical motion tenderness seen in PID

budding yeast hyphae pseudohyphae

**vulvovaginal candidiasis** seen on wet mount KOH

PID tx

ceftriaxone 250 mg IM x 1 + doxy 100 mg BID x 14 days +/- metro 500 mg PO BID x 14 day **+** **F/U in 48-72 hours**

which vaginitis(s) have an elevated pH? which have a normal pH?

pH \> 4.5 * bacterial vaginosis * trichomoniasis normal pH (4 - 4.5) * vulvovaginal candidiasis

treatment of **complicated** candidiasis

clotrimazole topical x 1-2 weeks or 150 mg fluconazole PO q 72 hours x 2-3 doses

PID dx

(difficult) based on sxs and history of gonorrhea/ chlamydia

change in vaginal discharge intramenstrual/ post-coital bleeding friable/ edematous/ erythematous cervix endocervical discharge

cervicitis seen in chlamydia **and** gonorrhea

amsels criteria

diagnostic determination of bacterial vaginosis presence of at least 3/4: 1. thin, white, homogenous discharge 2. clue cells on saline mount 3. vaginal pH \> 4.5 4. positive whiff test