Discharge

Question 1

Candida

Answer 1

• C.Albicans
• Acute but can be chronic
• High risks: pregnancy, DM, abx, steroid use, moist panties/swim suits, spermicides
• Signs: curdy discharge in vaginal walls, excoriation
• Symptoms: Dyspareunia, Itching, burning
  DIAGNOSTICS:
• pH: less than 4.5
• Negative whiff test- KOH negative
• Microscopy: negative in 50% cases
  -Lactobacillus on microscopy
  TREATMENT:
• Symptom relief in 48 hrs
• Flucanazole 150mg PO x1 or any azole in vagina x3-7 days
• For recurrent: more than 4/year: Fluc PO days 1,4,7 then every week for 6 months
  -Pregnant women: vaginal azole x7days
• PO meds slower than vaginal

Question 2

Bacterial Vaginosis (BV)

Answer 2

• Overgrowth of anaerobic flora (G. Vaginalis)
• Chronic
• High risks: genetic predisposition, increases risk for other STIs, pregnant women may have preterm labor. Worse symptoms with sex and during menses
• Signs: THIN white/grey dc, fishy smell
  DIAGNOSTICS:
• MUST have 3 of 4 in Amsel criteria:
  1. pH: more than 4.5 3. Clue cells (>20%)
  2. Positive whiff test 4. Thin, homogen dc coats vag
• Decreased lactobacillus
• KOH +
  TREATMENT:
  -Test for STIs
• Metroidazole (Flagyl) 500mg BID x7days or gel or Clinda crean qHS
• Pregnant women: NO gel
• Recurrent: Flagyl gel x5days then biweekly x6months
• Condom therapy to prevent alkalinization
• No alcohol x24hrs- Flagyl!
• Difficult to erradicate

Question 3

Trich

Answer 3

• Trichomonas: human parasite
• Acute
• High risks: STI, acquired from women, unprotected sex, HIV increase virus shedding, premature labor
• Symptoms: bad odor, dc is yellow, green, foul and frothy. Burning, post coital bleeding
• Signs: friable cervix
  DIAGNOSTICS:
• pH: 5-6
• Whiff test +/-
• KOH +
• Trich on microscopy
• PCR test- swabs and urine
  TREATMENT:
• Flagyl 2gm PO x1
• Treat partner
• No need for test of cure in asymptomatic individuals
• CDC” retest in 2 weeks

Question 4

Gonorrhea/Chlamydia

Answer 4

• GC/CT
• High risks: unprotected sex. Can lead to PID
• Symptoms: dysuria, frequency, normal or mucopurulent cervical dc
• Signs: friable cervix, vulvar irritation
  DIAGNOSTICS:
• pH: less than 4.5
• Whiff -
• More than 10 WBCs
• Diplococci in mircoscopy for GC
• CT/GC test and NAAT
  TREATMENT:
• CT: Azithromycin x1 or Doxy x7days
• GC: Ceftriaxone IM PLUS Azithro x1. Or Cefixime PLUS Azithro with TOC in 7days
• Partner tx
• Pregnancy: TOC
• RTC in 2 weeks

Question 5

Atrophic vaginitis

Answer 5

• Decrease of estrogen thins vaginal walls
• Symptoms: pruritus, dyspareunia, dysuria
• Signs: dry labia
  DX:
• pH: 5.5-7
  Tx:
• Estrogen