vulvar and vaginal disease and lower tract STI Flashcards

1
Q

HPV strains + diseases

A

6+11 = genital warts

16, 18, 45, 31 = neoplasia

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2
Q

genital warts dx + tx

A
  • visual dx, can biopsy
  • imiquimod 5% 3 days/wk x 16 wks
  • podofilox 5% for 3 days/wk in a row x 4 weeks

in office:

  • podophyllin - not if preg
  • trichloroacetic acid
  • cryotherapy
  • surgical removal (excise, laser)
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3
Q

HSV testing + treatment

A
  • test: HSV PCR or viral culture (not sensitive when heals)

first time:
- acyclovir, famciclovir, or valacyclovir for 5-10 days

recurrent:
- same for 5 days per episode

6+ recurrences per year or very bothersome:

  • acyclovir or famciclovir or valacyclovir daily
  • prevents outbreaks + shedding

to prevent transmission to partner
- valacyclovir daily

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4
Q

syphilis testing

A
  • darkfield examination of lesion fluid, +ve = spirochetes
  • VDRL: antigens, non specific, titre corresponds to disease activity, usually becomes nonreactive after tx
  • specific anti-treponemal antibody tests: confirmatory, reactive for life, can do 1st and then VDRL for active/vs old
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5
Q

syphillis treatment

A

primary, secondary, latent < 1 year
- benzathine penicillin G 2.4 million U IM in 1 dose
(or doxycycline x14 days if allergy)

latent >1 year or tertiary
- same but weekly for 3 weeks

neurosyphilis:
- aqueous crystalline pen G by IV q4h for 10-14 days

pregnant
- if allergic to penicillin, desensitize + then treat

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6
Q

lichen sclerosus presentation, dx, treatment,

A
  • intense itching + burning
  • white figure-8, purpura, hemorrhage, ulceration
  • dx = visual, can bx
  • tx: clobetasole, long term
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7
Q

lichen simplex chronicus

A
  • itching, burning, chronic irritation
  • leathery skin, esp lab majora
  • dx = visual, can bx
  • 2-3wks high or med potency steroid cream
  • antihistamines
  • break scratch cycle
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8
Q

lichen planus

A
  • plaques on skin, erosion of vestibule + vagina
  • loss of structure and erosion of vaginal wall
  • oral lesions: lacy, white
  • dx is visual, can biopsy
  • tx: steroid creams or foams internally, cyclosporine
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9
Q

bartholin’s gland disease

A
  • cyst in posterior vestibule, can become infected
  • centre at labia minora
  • dx - visual
  • tx: incise and drain, insert word catheter or surgical marsupialization
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10
Q

vulvodynia

A
  • pain without lesion/cause
  • dx of exclusion
  • tx: support, local moisturizers/creams, cold compress, xylocaine
  • amitriptyline or neurontin
  • biofeedback, pelvic floor physio
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11
Q

non infectious causes of vag discharge

A
  • physiologic
  • hypersensitivity
  • dermatologic condition
  • hormone related (OCP, HRT, preg)
  • genital atrophy
  • foreign body
  • trauma
  • lack of lubrication in intercourse
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12
Q

history for vag discharge

A
  • colour, amount, texture
  • smell
  • pruritis, burning, pain
  • dysuria
  • dysparunia
  • skin changes
  • associations: menstruation, sex
  • product use
  • sexual hx, symptoms in partners
  • hx of sti, treatments
  • current meds
  • medhx etc
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13
Q

physical exam + lab tests for vag discharge

A
  • external genitalia (lesions, colour, excoriations)
  • vagina + cervix: dicharge, edema, lesions, color
  • collect swabs
  • bimanual exam: CMT, uterine size, etc, adnexal mass

secretions tests:

  • pH
  • wet mount /w saline + KOH
  • KOH whiff test
  • gram stain
  • culture (Trichomonas and yeast, species of yeast, for BV use wet mount)
  • cervical swabs for C + G
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14
Q

BV signs + lab tests

A
  • discharge + odour
  • thin, grey/white, adherent discharge
  • +ve whiff
  • pH >4.5
  • wet mount: clue cells /w coccoids, decreased lactobacilli, no WBCs
  • gram stain: change in flora
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15
Q

yeast signs + labs

A
  • pruritis, burn, discharge
  • white, curdy
  • -ve whiff
  • pH <4.5 (normal)
  • on KOH slide: budding, hyphae
  • culture can grow yeast
  • gram stain: hyphae
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16
Q

trichomonas signs + labs

A
  • odour, itching, dysuria, prurutis
  • yellow/green, frothy, lots
  • +/- whiff
  • pH >4.5
  • wet mount: trichomonads, WBCs >10 hpf
  • gram stain:
  • culture
  • NAAT
17
Q

BV treatment

A

metronidazole 500 mg PO bid x 7 days

no tx for partner

18
Q

trichomonas tx

A

metronidazole 2g PO 1x

partner should be treated

19
Q

yeast

A

topical azoles (1-7 days) preferred over nystatin

or oral fluconazole

no tx for partner unless symtomatic

20
Q

atrophic vaginitis

A
  • visual dx: thinning, erythema, petechiae, bleeding, dry
  • tx: vag estrogen cream (premarin), or vag tablets or ring
  • water based lubricants + moisturizers
21
Q

pre-pubertal vulvovaginitis

A
  • infection, foreign body, trauma
  • avoid speculum unless bleeding
  • exclude foreign body
  • obtain vag (not cervical) swabs for gram stain, cultures, wet mount + treat appropriately
22
Q

signs of cervicitis + causes

A
  • mucopurulent discharge
  • friable
  • erythema
  • edema
  • most common = G or C, maybe genital mycoplasms
  • sometimes cannot isolate organism
23
Q

diagnosis approach of cervicitis

A
  • endocervical swabs for G + C
  • gonorrhea: gram stain, culture, or PCR
  • chlamydia trachomatis: culture or NAAT (most sensitive + specific)
  • can also use first void urine to avoid pelvic exam
24
Q

treatment of gonorrhea

A

ceftriaxone 250 mg IM

+ chlamydia tx unless ruled out

report

test sexual partners

no test of cure but follow-up in 6mo to re-screen (reinfection)

25
Q

chlamydia treatment

A

azithromycin 1g PO 1x
OR
doxycycline 100mg PO BID x7d (unless preg)

report, test partners

test of cure only if preg (3 weeks)

rescreen in 6 mo