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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

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candida

Cottage Cheese Discharge

Candida

Treatment: Fluconazole

candida vulvovaginitis
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
What is the bug?

HPV

Condylomataacuminata

human papillomavirus
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
Syphilis

Does this hurt???

syphilis7
Syphilis
  • TreponemaPallidum
  • 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
syphilis9
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
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
Genital Herpes

Wright-Giemsa stain – multi nucleated giant cells

genital herpes usually type 2
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
Trichomonas infection

Strawberry cervix

trichomonas vaginalis
TrichomonasVaginalis
  • “Strawberry Cervix”
  • Symptoms:
    • Assymptomatic in males
    • Burning, itching, abnormal odor
    • “frothy yellow discharge”
  • Tests:
    • Flagellated organisms wet prep
  • Treatment:
    • Metronidazole – 2 gm
    • Treat partners
gardnerella vaginalis bv
GardnerellaVaginalis - BV
  • Caused by disruption of vaginal flora
  • Test:
    • Whiff test – fishy amine odor
    • Clue cells
  • Treatment
    • Metronidazole
gonorrhea
Gonorrhea

Bartholin Gland Abscess

gonorrhea18
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
GC Con’t
  • THINK GC for any arthritis in adolescents
  • GC pharyngitis
    • Patchy, erythematous, pustular lesions on palate
    • Diagnosis – throat culture
  • Disseminated GC
    • Usually don’t have local symptoms anymore
    • Most common arthritis and rash
    • Can develop meningitis and endocarditis
    • Diagnosis: culture – GRAM - DIPLOCOCCI

*DON’T FORGET, TREAT ALL GC CASES FOR CHLAMYDIA

chlamydia
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

slide22
PID
  • Complication of lower genital tract infection
  • Risk Factors:
    • Adolescent, multiple sexual partners, previous PID
  • Symptoms:
    • Ill apperaing fever, shaking chills, lower abdominal pain
    • Cervical motion tenderness
  • Diagnosis:
    • Culture, U/S (fluid in cul-de-sac)
  • Treatment:
    • Can try outpt but need to reexamine within 24 hours
    • Hospitalization
    • Ceftriaxone and Doxycycline
  • Complications:
    • Ectopic pregnancy
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
urethral prolapse
Urethral Prolapse

Common Presentation: Vaginal bleeding

irriatant vulvovaginitis
IrriatantVulvovaginitis

**Think if they mention “bubble baths”

strep vulvovaginitis
Strep Vulvovaginitis

Usually very painful!!

Sharp demarcation