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Gyn Infections


On microscopic exam, these suggest presence of bacterial vaginosis Clue cells (epithelial cells with irregular borders in clusters, very shiny)
Bacterial vaginosis requires 3 of 4 criteria. What are the 4 criteria? Gray-white discharge, alkaline pH(>4.5) 2/2 suppression of lactobacilli, positive “whiff” test (fishy odor 2/2 anaerobes), clue cells on wet prep
Bacterial vaginosis is not considered an: STD
Treatment for bacterial vaginosis Metronidazole (500mg PO BID or 750 QD x7d) or clindamycin (300mg PO BID); or topical
Should you treat male partners of women with bacterial vaginosis? No
Signs and Symptoms of Trichomonas vaginitis Severe pruritus, musky greenish-yellow/frothy discharge, dysuria, dyspareunia, petechiae / strawberry cervix
Treatment for trichomonas vaginitis Metronidazole 2gm PO x1 or 500mg BID x7d. Nonoxynol-9 helps prevent. Treat partners, look for other STDs
Treatment for yeast vaginitis OTC imidazoles, oral fluconazole 150mg
Atrophic vaginitis often masquerades as what Infection
Signs and symptoms of atrophic vaginitis Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation; women w/o menses (decreased estrogen)
Bilateral Bartholin abscess said to be associated with what Gonorrhea. Strep, E. coli, Chlamydia, anaerobes
Treatments for Bartholin gland abscess if not pointing Antibiotic treatment may be successful
Treatment for Bartholin gland abscess I&D and placement of Word catheter (left in for 1-2 weeks), marsupialization, needs to remain open to avoid recurrence
What organism is associated with toxic shock syndrome S. aureus/endotoxins
CDC case definition of toxic shock syndrome Fever >39C, hypotension (may ->shock in <48h), diffuse erythroderma, desquamation, involvement of at least 3 organ systems.
Treatment for toxic shock syndrome Supportive, look for foreign body in vagina and remove, clindamycin and oxacillin/nafcillin, MRSA: clindamycin and vancomycin/linezolid
Pruritus, burning; cottage cheese discharge; dyspareunia Yeast vaginitis
Chronic Bartholin cyst may be mistaken for: acute abscess, esp perirectal abscess (more posterior)
DDx for vaginal discharge and pH: Candida, BV, trich: itching & discharge. BV / trich: pH >4.5, Candida lower pH
Vaginitis DDx candida (azoles), trich/BV (pH >4.5; flagyl); genital warts (podophyllum/ trichloroacetic acid)
Vaginitis sxs vaginal discharge; Dyspaurenia; Dysuria; Urinary Frequency
Toxic shock syndrome: Skin Erythroderma of skin / mucous membrane; diffuse, red, sunburn-like rash. Involves palms and soles. Conjunctival-scleral hemorrhage; later, pruritic maculopapular rash, desquamation
6cm unilateral, mobile, tender adnexal mass Tubo-ovarian abscess
If Candida is suspected clinically, but KOH is negative, suspect: Candida glabrata
Cytolytic vaginitis is distinguished from BV by: lower pH (3.5-4.5, 2/2 lactobacillus overgrowth)
Toxic shock syndrome recurrence 30% of women with TSS have recurrence. Greatest risk in 1st 3 menstrual cycles after original episode
TSS mortality 3-6%. Most common COD: ARDS, DIC, hotn/shock
Created by: Adam Barnard Adam Barnard