Vaginal Infections: Gardnerella, Trichomonas, Candida and Cervical Infections: Gonorrhea, Chlamydia

Question 1

Most common cause of vaginal discharge in women of childbearing age?

Answer 1

Bacterial Vaginosis (Gardnerella) - 40-50% of cases

Question 2

What is the cause of bacterial vaginosis development?

Answer 2

altered vaginal microbiota –> dec. amounts of Lactobacillus that normally creates hydrogen peroxide and lactic acid

Question 3

Gardnerella Vaginalis discharge

Color and smell

Answer 3

thing, grey-white homogenous

“fishy” smell

Question 4

What the the G in Gardnerella vaginalis mean?

Answer 4

GREY

Question 5

Whiff Test

What is it used for and what does a positive test look like?

Answer 5

Aids in the diagnosis of Gardnerella vaginalis

• add 10% KOH solution –> “fishy smell” = (+) test

Question 6

What is a “Clue Cell” and which STI is it commonly associated with?

Answer 6

vaginal epithelium covered in Gardnerella vaginalis

Question 7

What is the typical antibiotic used to treat Gardnerella vaginalis?

Answer 7

Metronidazole

Question 8

What are the 4 Amsel criteria used to aid in diagnosis of Bacterial Vaginosis? (must have 3 to make diagnosis)

Answer 8

1. thin, grey-white discharge that smoothly coats vaginal walls
2. pH > 4.5
3. (+) Whiff-amine tests
4. Clue Cells present on microscopy

Question 9

Metronidazole (Gardnerella vaginalis)

• Route (oral or IV)
• Dosing (2)

Answer 9

ORAL

< 45 kg = 15-25 mg/kg/day divided in doses TID (Max: 2250 mg/day)

> 45 kg/Adolescents = 500 mg BID x7 days

Question 10

Metronidazole (Trichomonas)

• Route (oral or IV)
• Dosing (2)
• Dosing for male sexual partners

Answer 10

ORAL

< 45 kg = 45 mg/kg/day divided TID x7 days (Max: 2000 mg/day)

> 45 kg/adolescents = 500 mg/day BID x7 days

MALES= 2000 mg single dose

Question 11

Is Bacterial Vaginosis considered a Sexually Transmitted Infection (STI)?

Answer 11

Technically no, but prepubescent female with BV should potentially be worked up for sexual abuse

Question 12

What is the most common nonviral STI worldwide?

Answer 12

Trichomonas vaginalis

Question 13

Trichomonas Vaginalis discharge

color and smell

Answer 13

copious, yellow-green, frothy

malodorous

Question 14

Trichomonas Vaginalis

What is seen on wet-mount?

Answer 14

moving, pear-shaped trophozoite

FLAGELLATED

Question 15

What is the normal pH of the vagina?

Answer 15

4.0-4.5 pH

Question 16

What is the typically vaginal pH seen in these infections:

1. Gardnerella vaginalis
2. Trichomonas vaginalis
3. Vulvovaginal Candidiasis

Answer 16

1. > 4.5 pH
2. 5.0-6.0 pH
3. 4.0-4.5 pH (NORMAL)

Question 17

Rapid Diagnosis (vaginal infection)

Answer 17

Trichomonas vaginalis

Question 18

What is the second most common cause of vaginitis, behind Bacterial Vaginosis?

Answer 18

Vaginal Candidiasis

Question 19

Rapid Diagnosis (vaginal infection)

Answer 19

Vaginal Candidiasis

Question 20

Vaginal Candidiasis discharge

color and smell

Answer 20

white, thick, adherent; “curd-like or cottage cheese-like”

no odor

Question 21

Vaginal Candidiasis

What does it look like on wet-mount?

Answer 21

budding yeast, hyphae, and pseudohyphae

Question 22

Rapid Diagnosis (vaginal infection)

Answer 22

Vaginal Candidiasis

Question 23

Rapid Diagnosis (vaginal infection)

Answer 23

Vaginal Candidiasis

• pseudohyphae

Question 24

Rapid Diagnosis (vaginal infection)

Answer 24

Vaginal Candidiasis

• hyphae

Question 25

Fluconazole (Vaginal Candidiasis)

• Route (oral or IV)
• Dosing (uncomplicated vs severe infection)

Answer 25

ORAL

Uncomplicated: 150 mg single dose

Severe (non-HIV): 150 mg q72hrs for 2-3 doses

Question 26

What is the most common sexually-transmitted bacterial infection in the United States?

Answer 26

Chlamydia

Question 27

Should partners of patients with diagnosed Chlamydia or Gonorrhea STIs be screened/treated too?

Answer 27

ABSO-FREAKING-LUTELY!

YES

Question 28

When should patients with documented Chlamydia infections who received treatment be retested for infection?

Answer 28

after 3 months

Question 29

Doxycycline (Uncomplicated Chlamydia infection)

• Route
• Dose (2)

Answer 29

ORAL

> 8 yo: 2.2 mg/kg/dose BID x7 days (Max: 100 mg/dose)

Adolescents: 100 mg BID x7 days

Question 30

Ceftriaxone (Uncomplicated Gonorrhea infection)

• Route
• Dose (2)

Answer 30

ORAL

< 150 kg: 500 mg IM once

> 150 kg: 1 gram IM once

Question 31

Patient tested (+) for Gonorrhea without definitive evidence of co-infection with Chlamydia. What should be done?

Answer 31

Empiric treatment for Chlamydia with oral Doxycycline 100mg BID x7 days

• repeat testing in 3 months due to high rate of reinfection

Question 32

What is the difference in discharge between Gonorrhea and Chlamydia?

Answer 32

Gonorrhea: purulent green/yellow/white

Chlamydia: watery white/yellow