And all

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Cottage
Cheese
Discharge
Candida
Treatment: Fluconazole
Candida Vulvovaginitis



Antibiotic use
Think DIABETES in older children w/o risk factors
Symptoms:
Dysuria, dyspareunia, pruritis
 Thick cheesy vaginal discharge


Diagnosis:
KOH budding yeast and pseudohyphea
 Low vaginal pH


Treatment:

Fluconazole
What is the bug?
HPV
Condylomata
acuminata
Human Papillomavirus

Most common STD in females
HPV 6 and 11 – warts
HPV 16, 18, 31, 33, 35 – cervical cancer

Treatment


 Podofilox,
Imiquimod cream
 Cryotherapy
 Surgical removal
Syphilis
Does this
hurt???
Syphilis


Treponema Pallidum
Primary
 Painless

chancre
Know testing
 1st:
nontreponemal test
 VDRL
 RPR
 2nd: treponemal
test
 FTA-ABS
 TP-PA

These may be + for life regardless of treatment
Secondary Syphilis
Syphilis

Secondary

Palmar rash
 Mucocutaneous lesions
 Lyphadenopathy
 PALMS and SOLES –
nickel and dime


Tertiary
Cardia
 Opthalmic and auditory
 Gummatous lesions

Latent

+ test with no clinical
symptoms
Early – within past year
 Late – after 1st year of
infection


Treatment

PCN G IM x 1
Neurosyphilis



Adolescent with hearing loss
Cognitive dysfunction, motor or sensory deficits
CSF VDRL is diagnostic
 Very

specific
Usually diagnose based on:
 Clinical
suspecion
 Elevate WBC, protein

Treatment
 Peniciliin
G IV for 2 weeks
Genital Herpes
Wright-Giemsa stain –
multi nucleated giant
cells
Genital Herpes – usually Type 2



Clusters of vesicular ulcers, erythematous base
Tender Inguinal Adenopathy, fever, myalgia
Diagnosis:
 Physical
exam
 Wright-Giemsa stain

Treatment:
 Acyclovir
7 days (oral)
Trichomonas infection
Strawberry cervix
Trichomonas Vaginalis


“Strawberry Cervix”
Symptoms:
 Assymptomatic
in males
 Burning, itching, abnormal odor
 “frothy yellow discharge”

Tests:
 Flagellated

organisms wet prep
Treatment:
 Metronidazole
 Treat
partners
– 2 gm
Bacterial Vaginosis
CLUE CELLS
Gardnerella Vaginalis - BV


Caused by disruption of vaginal flora
Test:
 Whiff
test – fishy amine odor
 Clue cells

Treatment
 Metronidazole
Gonorrhea
Bartholin Gland
Abscess
Gonorrhea


Commonly assymptomatic
Males
 Dysuria
and discharge
 Can progress to epididymitis (unilateral pain and
swelling of scrotum)

Females
 Urethritis
and cerivicitis
 Dysuria and malodorous discharge
 Fitz-Hugh-Curtis – perihepatitis
 *normal
LFTs
 RUQ pain
GC Con’t


THINK GC for any arthritis in adolescents
GC pharyngitis
 Patchy,
erythematous, pustular lesions on palate
*DON’T
FORGET,
 Diagnosis
– throat
cultureTREAT ALL GC CASES

FOR CHLAMYDIA
Disseminated
GC
 Usually
don’t have local symptoms anymore
 Most common arthritis and rash
 Can develop meningitis and endocarditis
 Diagnosis: culture – GRAM - DIPLOCOCCI
Chlamydia


Most common treatable STD
Symptoms:
Men – urethritis
 Women - cervicitis


Diagnosis:


Nucleic acid amplification test
Treatment:
Azithromycin 1 gm x 1
 Doxycyclin 100 mg BID x 7 days
 or Erythromycin 500mg BID x 7 days

Don’t forget –
You need a
TOC in
pregnancy
PID


Complication of lower genital tract infection
Risk Factors:


Symptoms:



Culture, U/S (fluid in cul-de-sac)
Treatment:




Ill apperaing fever, shaking chills, lower abdominal pain
Cervical motion tenderness
Diagnosis:


Adolescent, multiple sexual partners, previous PID
Can try outpt but need to reexamine within 24 hours
Hospitalization
Ceftriaxone and Doxycycline
Complications:

Ectopic pregnancy
Pregnancy

½ of all pregnancies occur with 6 mos of first
intercourse
 1/5

in first month
Testing
 All
pregnant women have to be tested for HIV
 1st visit labs: syphillis, Chlamydia, GC, Hep B, Hep C,
Pap
How about a few Pictures??
Imperferate Hymen
Mom complains of constant scratching
of bottom!!!
Scotch tape Test!!!
Urethral Prolapse
Common
Presentation:
Vaginal
bleeding
Genital Trauma
Irriatant Vulvovaginitis
**Think if they mention
“bubble baths”
Lichen Sclerosis
Strep Vulvovaginitis
Usually very painful!!
Sharp demarcation
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