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symptoms • papule/vesicle —> painless ulcer —> discharging buboe • rectal ulceration or stricture • inguinal lymphadenopathy diagnosis • serology • immunofluorescent test treatment • doxycycline 100 mg BID for 21 days

Less Common STDs Sarcoples scabie - genital scabies Phthirus pubis - pediculosis pubis Mycoplasma - non-specific urethritis


infection of an obstructed Bartholin gland 5 and 7 o’clock positions at vaginal introitus usually sterile but causative organisms may include • S. aureus, S. fecalis, E. coli, N. gonorrhea, C. trachomatis treatment • sitz baths • antibiotics and heat (rarely help) • incision and drainage with placement of Word catheter for 2-3 weeks • marsupialization for recurrent abscesses


Definition an infection of the upper genital tract or salpingitis also includes endometritis, tubo-ovarian abscess, pelvic peritonitis acute febrile illness usually bilateral

Causative Organisms (in order of frequency) C. trachomatis N. gonorrhea GC and Chlamydia often co-exist endogenous flora • anaerobic organisms (e.g. Bacteroides sp.) • a cause of recurrent PID • associated with instrumentation actinomyces • in 1-4 % of PID associated with IUDs others (TB, gram-negatives, etc...)

Risk Factors risk factors as for Chlamydia and GC history of salpingitis vaginal douching IUD (unilateral disease) infertility (instrumentation)

Clinical Presentation s y m p t o m s l o w a b d o m i n a l o r p e l v i c p a i n m e t r o r r h a g i a i n t e r m e n s t r u a l a n d / o r p o s t - c o i t a l b l e e d i n g v a g i n a l d i s c h a r g e d e e p d y s p a r e u n i a e x a c e r b a t e d b y m e n s e s a n d c o i t u s s i g n s f e v e r • abdominal tenderness s i g n s o f p e r i t o n e a l i r r i t a t i o n e n d o c e r v i c a l d i s c h a r g e c e r v i c a l m o t i o n t e n d e r n e s s • adnexal tenderness • adnexal mass

MCCQE 2000 Review Notes and Lecture Series


Gynecology 29

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