Vaginitis and STI presentation/dx

Question 1

What does the acronym HOME stand for?

Answer 1

Hue
Odor
Microscopy
Exam

Question 2

Normal vaginal presentation

HOME (Hue Odor Microscopy Exam)

Answer 2

Hue: clear or white
Odor: yes, but not foul
Microscopy: 
     * pH: 3.8 - 4.2
     * KOH whiff: negative
     * KOH wet mount: may see yeast
     * Saline wet mount: lactobacilli, healthy epithelial cells
E: No clinical findings

Question 3

Bacterial vaginosis presentation

HOME (Hue Odor Microscopy Exam)

Answer 3

Hue: Homogenous, adherent, thin, milky, grey, white, copious
Odor: fishy/foul
Microscopy:
* pH: > 4.5
* KOH whiff: POSITIVE
* KOH wet mount: negative
* Saline wet mount: Clue cells, no/few WBC’s, few lactobacilli
E: Burns, odor after sex, goes away with menses, often
recurrent

Question 4

Candidiasis presentation

HOME (Hue Odor Microscopy Exam)

Answer 4

Hue: White, thick/clumpy “cottage cheese”
Odor: None
Microscopy:
* pH: Usually < 4.5
* KOH whiff: negative
* KOH wet mount: Pseudohyphae or spores if non-
albicans species
* Saline wet mount: Few to many WBC’s
E: Inflammation, erythema, excoriation

Question 5

Trichimoniasis presentation

HOME (Hue Odor Microscopy Exam)

Answer 5

Hue: Frothy, gray/yellow-green (can be neon), can be
itchy, 70% asymptomatic
Odor: Malodorous
Microscopy:
* pH: > 4.5
* KOH whiff: Often positive, can be negative
* KOH wet mount: nothing
* Saline wet mount: Motile flagellated protozoa, many
WBC’s
E: Cervical petechia (strawberry cervix)

Question 6

Syphilis Lesions

• Number
• Pain
• Lymph Nodes
• Lesion/ulcer
• Dx

Answer 6

• Number: 1
• Pain: No
• Nodes: No
• Lesion/ulcer: Hard, no discharge
• Dx: RPR, VDRL, FTA, titers

must do test of cure

Question 7

HSV Lesions

• Number
• Pain
• Nodes
• Lesion/ulcer
• Dx

Answer 7

• Number: One or many
• Pain: Very painful
• Nodes: potentially swollen
• Lesion/ulcer: Vesicles, wet
• Dx: Culture of wet lesion

Question 8

Chancroid lesions

• Number
• Pain
• Nodes
• Lesion/ulcer
• Dx

Answer 8

• Number: Many, often “kissing”
• Pain: Can be painful, not always
• Nodes: +
• Lesion/ulcer: Soft with discharge
• Dx: of exclusion

Question 9

What can cause a false + on RPR or VDRL?

Answer 9

HIV infection
Malaria
Lyme's disease
Lupus
Normal pregnancy

Question 10

AMSEL Criteria for Bacterial Vaginosis

Answer 10

At least 3 of the following:

1) Thin, homogenous consistency
2) pH > 4.5
3) Clue cells
4) Positive whiff