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advanced gynecology


KOH preparation Add one drop of KOH to slide. Perform whiff test. All cell materials will be destroyed but candida
Bacterial vaginosis One clue cell--resembles a pancake that has fallen into a bowl of poppy seeds. Clue cell appears smudged, with fuzzy contents and poorly defined borders. malodorous >pH of vagina <lactobacilli multiple sex partners, new sex partner,douching
Trichomonas thin, light green,frothy discharge mild itch, dysuria
wet mount documentation # cells per hpf (wbc's) presence or absence of clue cells,rbc's, spores, hyphae and bacteria motility koh used
BV contributes BID, preterm labor, PROM, chorioamnionitis, postpartum endometritis
BV presenting history thin, gray, malodorous discharge, painful sex, burning sensation when having sex DX-> clue cells, pH 4.5 and fishy odor before or after koh
BV treatment Flagyl 500mg bid x7 days or flagyl gel 0.75% one full applicator intravaginally x5days or clindamycin cream intravaginally x7days hs if pregnant-->flagyl 500mg bid x7d or flagyl 250mg tidx7days or clindamycin 300mg bidx7 days
Trichomonas treatment Flagyl 2g po single dose or tinidazole 2g po single dose (avoid etoh 4 24 hours /p flagyl and 72h /p tinidazole)
Gonorrhea (can co-infect /c chlamydia-treat both) pyogenic,purulent discharge, green, dysuria, can be asymptomatic
Gonorrhea treatment rocephin 125mg IM x1 cefixime 400mg po x1 cipro 500mg po x1 ofloxacin 400mg pox1 levofloxacin 250mg po plus tx for chlamydia if not ruled out
chlamydia if not treated can cause infertility can be asymptomatic sx can resemble vaginitis or uti copious clear discharge can affect any organ
chlamydia treatment zithromax 1g po x1 or doxycyline 100mg po bid x7d alternative regimens-->erythromycin base 500mg po qid x7d or levofloxacin 500mg po x7d neonatal-->erythromycin base 50mg/kg/d po 4 divided doses d x14 d
PID upper reproductive tract inflammation (uterus, fallopian tubes, ovaries)can cause tubal scarring which can lead to infertility and ectopic pregnancy
PID (presenting history) tender cervix, abd pain, fever (predisposed 16-24 yo unmarried, nulliparous, multiple partners and previous hx)
PID (hospitalization criteria) r/o surgical emergencies--pregnant,does not respond to oral antimicrobial therapy, unable to follow or tolerate outpatient regimen, severe illness,tubo-ovarian abscess
PID (tx) levofloxacin 500mg qd x14d ofloxacin 400mg po bid x 14d &/or flagyl 500mg po bid x14d reg b-->rocephin 250mg IM plus doxycycline 100mg po bid &/or flagyl bid x14d IV-->cefotetan 2g iv q 12h or cefoxitin 2g iv q6 h plus doxycycline 100mg po or iv q 12 h
molluscum contagiosum viral, multiple dome-like papules,central material
LGV chlamydia trachomatis small, painless papules/ vesicles, generalized illness, lymph buboes
chancroid ulcerative, profuse discharge, painful, lymphadoenapthy
molluscum benign poxivirus-spread through autoinoculation- no tx necessary; however, genital lesions are tx to prevent spread-->curettage, cautery, cryotherapy with liquid nitrogen
LGV (lymphogranuloma venerum) tender inguinal &/or femoral lymphadenopathy-typically unilateral-self limited genital ulcer or papule at site of inoculation may be present
LGV tx doxycycline 100mg po bidx 21d alt-->erythromycin base 5000mg po qid x21d
chancroid painful genital ulcer, tender suppurative inguinal adenopathy probable if all criteria met--> one or more painful genital ulcers, no evidence of t. pallidum infection or syphilis;typical presentation-genital ulcer and regional lymphadoneptahy; hsv -
chancroid tx zithromax 1g po x1; rocephin 250mg IM x1; cipro 500mg po bid x3d; erythromycin base 500mg po tid x7d
granuloma inguinale painless, progressive ulcerative lesions /s regional lymphadenopathy, highly vascular(beefy red appearance)bleed easily on contact
GI tx doxycycline 100mg po bid x3 week (until all lesions have healed)
Syphilis primary-clean, painless ulcer (3-12w contagious) secondary-copper penny rash, fever, malaise, alopecia, condyloma lata- highly contagious tertiary-organs, heart, CNA-noncontagious- serious complications
diagnostic tests for syphilis darkfield exam and direct flourescent antibody tests (DFA) tests of lesion exudate or tissue presumptive dx requires 2 serological tests--vdrl/rpr & treponemal tests
neurosyphilis dx various combinations of reactive serologic testing,CSF cell count or protein, CSF reactive VDRL with or without clinical manifestations
syphilis tx benzathine penicillin 2.4 million IM x1 (adults) benzathine penicillin G 50,000u/kg IM all patients who have syphilis should be tested for hiv
Herpes simplex--genital painful--transmitted sexually or maternal-fetus--neurotropic virus-grows in latency (dormant in dorsal root ganglia) --contagious the 1st 48hrs (before know it is there)
HSV tx 1st episode acyclovir 400mg po tid 7-10d famciclovir 250mg po tid 7-10d valacyclovir 1g po bid 7-10d recurrent--acyclovir 800mg po bid x5d famciclovir 125mg po bid x5d valacyclovir 1g po d x5d suppressive acyclovir 400mg po bid valacyclovir 1g po
severe hsv iv dosing acyclovir 5-10mg/kg iv q8h for 2-7d followed by oral therapy x10d
Created by: 100000682847149