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GYNECOLOGICAL INFECTIONS . . . CONT.

diagnosis • KOH wet mount reveals hyphae and spores • pH < 5 treatment • advise regarding good hygiene (e.g. cotton underwear) • clotrimazole, butoconazole, miconazole, ticonazole or terconazole suppositories and/or creams for 1-day, 3-day or 7-day treatments • oral fluconazole or ketoconazole • symptomatic relief with douching, yogurt, acidophilus • treat partners only if symptomatic • treatment in pregnancy is nystatin (Mycostatin)

B a c t e r i a l V a g i n o s i s G a r d n e r e l l a v a g i n a l i s o v e r g r o w t h i n p r e s e n c e o f v a g i n a l a n a e r o b e s a n d s c a n t l a c t o b a c i l l i ( B a c t e r o i d e s , M o b i l u n c u s ) e s p e c i a l l y s u s c e p t i b l e w h e n p o s t - m e n s t r u a l o r p o s t - c o i t a l , w i t h I U D s y m p t o m s f i s h y o d o u r e s p e c i a l l y a f t e r c o i t u s p r o f u s e , t h i n g r e y i s h d i s c h a r g e v u l v a r a r e l y i t c h y o r i n f l a m e d n o t n e c e s s a r i l y s e x u a l l y t r a n s m i t t e d , a l t h o u g h c a n s e e p i n g - p o n g t r a n s m i s s i o n d i a g n o s i s s a l i n e w e t m o u n t > 2 0 % c l u e c e l l s = s q u a m o u s e p i t h e l i a l c e l l s d o t t e d w i t h c o c c o b a c i l l i ( G a r d n e r e l l a b a c i l l i ) p a u c i t y o f W B C p a u c i t y o f l a c t o b a c i l l i a m i n e w h i f f t e s t = r o t t e n , f i s h y o d o u r w i t h a d d i t i o n o f K O H t o s l i d e p H 5 - 5 . 5 t r e a t m e n t n o t r e a t m e n t r e q u i r e d i n n o n - p r e g n a n t , a s y m p t o m a t i c w o m e n u n l e s s s c h e d u l e d f o r p e l v i c s u r g e r y o r p r o c e d u r e m u s t t r e a t a l l a s y m p t o m a t i c c a s e s i n p r e g n a n c y ; h i g h e r i n c i d e n c e o f P T L , P P R O M a n d m i s c a r r i a g e i f l e f t u n t r e a t e d o r a l m e t r o n i d a z o l e 5 0 0 m g b i d f o r 7 d a y s o r 2 g o n c e c l i n d a m y c i n 3 0 0 m g b i d f o r 7 d a y s t o p i c a l c l i n d a m y c i n 2 % v a g i n a l c r e a m q h s x 7 d a y s f l a g y s t a t i n v a g i n a l s u p p o s i t o r y ( a l s o c o v e r s y e a s t ) a m p i c i l l i n o r a m o x i c i l l i n i f p r e g n a n t f o r r e p e a t e d i n f e c t i o n o n e c a p s u l e o r t a b l e t o f l a c t o b a c i l l u s a c i d o p h i l u s d a i l y i n v a g i n a c o n t r o v e r s y e x i s t s r e g a r d i n g t r e a t m e n t o f p a r t n e r

T r i c h o m o n a s V a g i n a l i s a f l a g e l l a t e d p r o t o z o a n , a n a e r o b i c o f t e n c o - e x i s t s w i t h b a c t e r i a l f o r m s s e x u a l l y t r a n s m i t t e d ( m e n a s y m p t o m a t i c ) m o r e f r e q u e n t w i t h m u l t i p l e s e x u a l p a r t n e r s p o s s i b l y v i a h o t t u b s , w h i r l p o o l s , s a u n a s s y m p t o m s p r o f u s e , t h i n , f r o t h y y e l l o w - g r e e n d i s c h a r g e m a y b e f o u l - s m e l l i n g d i s c h a r g e o f t e n s e e n p o s t - m e n s t r u a l o c c a s i o n a l l y i r r i t a t e d , t e n d e r v u l v a d y s u r i a p e t e c h i a e o n v a g i n a a n d c e r v i x ( 1 0 % ) a s y m p t o m a t i c ( 2 5 % ) d i a g n o s i s s a l i n e w e t m o u n t m a n y W B C m o t i l e f l a g e l l a t e d o r g a n i s m s i n f l a m m a t o r y c e l l s p H 5 - 6 . 5 t r e a t m e n t m e t r o n i d a z o l e 5 0 0 m g b i d f o r 7 d a y s o r 2 g o n c e t r e a t p a r t n e r ( s ) a l s o t o p i c a l c l i n d a m y c i n o r m e t r o n i d a z o l e

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 25

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