gyn
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| KOH preparation | Add one drop of KOH to slide. Perform whiff test. All cell materials will be destroyed but candida
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| 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
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| Trichomonas | thin, light green,frothy discharge mild itch, dysuria
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| wet mount documentation | # cells per hpf (wbc's)
presence or absence of clue cells,rbc's, spores, hyphae and bacteria
motility
koh used
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| BV contributes | BID, preterm labor, PROM, chorioamnionitis, postpartum endometritis
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| 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
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| 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
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| Trichomonas treatment | Flagyl 2g po single dose or tinidazole 2g po single dose (avoid etoh 4 24 hours /p flagyl and 72h /p tinidazole)
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| Gonorrhea | (can co-infect /c chlamydia-treat both)
pyogenic,purulent discharge, green, dysuria, can be asymptomatic
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| 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
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| chlamydia | if not treated can cause infertility
can be asymptomatic
sx can resemble vaginitis or uti
copious clear discharge
can affect any organ
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| 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
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| PID | upper reproductive tract inflammation (uterus, fallopian tubes, ovaries)can cause tubal scarring which can lead to infertility and ectopic pregnancy
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| PID (presenting history) | tender cervix, abd pain, fever (predisposed 16-24 yo unmarried, nulliparous, multiple partners and previous hx)
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| 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
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| 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
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| molluscum contagiosum | viral, multiple dome-like papules,central material
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| LGV | chlamydia trachomatis small, painless papules/ vesicles, generalized illness, lymph buboes
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| chancroid | ulcerative, profuse discharge, painful, lymphadoenapthy
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| molluscum | benign poxivirus-spread through autoinoculation- no tx necessary; however, genital lesions are tx to prevent spread-->curettage, cautery, cryotherapy with liquid nitrogen
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| LGV (lymphogranuloma venerum) | tender inguinal &/or femoral lymphadenopathy-typically unilateral-self limited genital ulcer or papule at site of inoculation may be present
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| LGV tx | doxycycline 100mg po bidx 21d
alt-->erythromycin base 5000mg po qid x21d
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| 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 -
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| chancroid tx | zithromax 1g po x1; rocephin 250mg IM x1; cipro 500mg po bid x3d; erythromycin base 500mg po tid x7d
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| granuloma inguinale | painless, progressive ulcerative lesions /s regional lymphadenopathy, highly vascular(beefy red appearance)bleed easily on contact
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| GI tx | doxycycline 100mg po bid x3 week (until all lesions have healed)
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| 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
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| 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
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| neurosyphilis dx | various combinations of reactive serologic testing,CSF cell count or protein, CSF reactive VDRL with or without clinical manifestations
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| 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
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| 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)
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| 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
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| severe hsv | iv dosing acyclovir 5-10mg/kg iv q8h for 2-7d followed by oral therapy x10d
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