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Gyn Infections (Cervicitis (Vulvovaginitis
most benign (All present w/…
Gyn Infections
Cervicitis
- All present w/ vaginal itching
- recognize the bug, based on presentation
- everyone gets speculum exam & wet prep
- Wet prep: Saline & KOH
- :warning:no culture needed, just look and treat (unless can't ID the bug)
Candida
DM :candy:, steroids, recent Abx
- vaginal discharge & pruritus
- Thick white discharge thats sticky to vaginal wall
- no odor :forbidden::hotsprings:
- hyphae :sunflower:
- hyphae (KOH)
Antifungals:
- OTC topical
- Rx fluconazole PO 1x
BV
#1 common infx
Itchy discharge
- Thin, gray-white discharge
- fishy odor :fish::hotsprings:
- Clue cells :mag:(saline)
- Whiff test :hotsprings::dog2: (KOH)
:bullettrain_side: Metronidazole
Trichomonas
Ping-ponging :table_tennis_paddle_and_ball:
- untreated :man_dancing::skin-tone-4: reinfects the :dancer::skin-tone-2:
- Repeat infections
- Speculum :
- yellow green frothy discharge
- Cervical Erythema (strawberry :strawberry::tophat: Cervix)
:bullettrain_side: Metronidazole
- PO for both partners :couple_with_heart:
- Vaginal discharge :sweat_drops:
- Wet prep :umbrella_with_rain_drops:
Path: Inflammation of the cervix
Pt:
- Cervical motion tenderness
- mucopurulent discharge
- :forbidden:No PID s/s
- ie :female_sign: may not know she has cervicitis until PEx
- coital/penetration pain
Dx: PEx w/ tender inflamed cervix (speculum)
- GC/Chla NAAT
- Wet prep
- :warning:
Gram stain: low yield
-
Cx: useless w/ a concurrent NAAT
shelf Test may give gram stain: use that
- Gonnorrhea: Gram - diplococci
- Chlam: many WBC and no bacteria
Tx: Empirically since we are waiting for NAAT.
- Find one, treat the other too
- Gonorrhea : Ceftriaxone 1x IM
- Chlamydia: Doxycycline :bicyclist::skin-tone-2: = Azithromycin
:warning:Watch out for pregnancy :pregnant_woman:(doxy), or cardiotoxicity :broken_heart: (Azithromycin)
Wet prep shows different bug?
- Treat for the Vulvovaginitis bug
- spectrum of diseases that starts at the vulva and gets worse the higher you go.
Cervicitis
- Gonnorh/Chlam
- & all the same vulvovaginitis bugs
- infx can ascend into uterus, breaking down the uterine lining and ascending farther
Vulvovaginitis (bottom)
- Trichomomas
- BV (bacterial vaginosis = gardnerella)
- Candida
:pencil2:Vulvuvaginitis can't get past the cervix
-
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PID
- serious. No time to wait for tests
Path: Any bug in previous milder diseases
- ascending infx
- Gonorrhea (33%)
- Chlamydia (33%)
- Vaginal flora (33%)
Dx: Criteria
- Pelvic or Abn px
- No other cause for sx
- Any 1 of the following must be positive
- cervical motion tenderness
- adnexal tenderness
- Uterine tenderness
Pt: More ill
- fever :fire:
- many WBC on wet prep
- ( :warning:absence of leukocytosis, fever ≠ absence of disease)
- Mucopurulent discharge
Dx: Clinical
- transvaginal US to see tuboovarian abscess :volcano: or free fluid :ocean:
:pencil2:but you can treat empirically w/ abx
Tx: don't wait
Abx inpatient: (severely toxic, can't tolerate PO/pregnant :pregnant_woman:):
- Cefoxitin :fox_face: & Doxy :bicyclist: IV
- Backup: Clinda & Gentamycin
- allergies or pregnancy :pregnant_woman:
Outpatient: Ceftriaxone IM 1x & Doxycycline :bicyclist: & Metro :bullettrain_side:
- can replace ceftriaxone w/ Cefoxitin :fox_face: & Probenecid 1x
- 1 more item...
:pencil2:See that Ceftriaxone covers Gonorrhea. Doxy = chlamydia. Metronidazole = anaerobes
- Coverage of G/C & mycoplasma
- some gram - coverage
- 1 more item...
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Higher up the infection, the more severe the patient presentation
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