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VAGINITIS
Gardnerella vaginalis 90 %
Gram negative rods 50-70%
Peptostreptococcus 30-60%
Mycoplasma hominis 60-75%
Mobiluncus sp 50%
SCHEMATIC
REPRESEENTATION
OF MICROBIAL
SHIFTS IN BV
Normal vaginal
secretions
Bacterial vaginosis
pH 4.0-4.4
104 CFU/ml
Lactobacilli
predominate
pH 4.7
Up to 1011 CFU/ml
Few lactobacilli
Abundant anaerobs
G.Vaginalis and
genital mycoplasmas
Salpingitis
PID
Abortion
Prematurity
PROM
Chorioamnionitis
Postpartum and postoperative morbidity
Routine
treatment of
sex partners is not
recommended
Candida
Candida
Candida
Candida
Candida
albicans 85%
glabrata
tropicalis
parapsilosis
krusie
Pruritus
Erythema
Edema
Excoriation
Tenderness
Discharge is thick, white, curdy and attached
on the vaginal walls
Vaginal pH is acidic (<4.5)
Intravaginal agents:
Butoconazole 2% cr 5g for 3 days
Butoconazole 2% cr 5g (butoconazole1sustained release), single intravaginal
application
Clotrimazole 1% cr 5g for 7-14 days
Clotrimazole 2% cr 5g for 3 days
Oral agent:
Fluconazole 150mg oral tablet, one tablet in
single dose
Drugs with clinically important interactions
with oral fluconazole :
Astemizole, Ca channel antagonist, cisalpine,
warfarin, oral hypoglycemic agents,
phonation, protease inhibitors, tacrolimus,
terfenadine, theophylline, trimetrexate,
rifampicin
Only
topical azole
therapies, applied for
7 days
Recommended regimens
Metronidazole 2g orally in a single dose
Tinidazole 2g orally in a single dose
Alternative regimen
Metronidazole 500mg orally 2x/day for 7 days
MUCOPURULENT
CERVICITIS
Gram stain
Culture Thayer-martin medium (standard
means of diagnosis)
Nucleic acid hybridization test
Nucleic acid amplification test (NAAT)
Alternative regimen :
Spectinomycin 2g in a single dose IM
Cefpodoxime 400mg single dose
Cefuroxime axetil 1g single dose
PLUS
Treatment for chlamydia infection is not
ruled out
PHARYNGITIS
Recommended regimen :
Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycine 1g orally in single dose
Doxycycline 100mg orally 2x/day for 7 days
DGI
Recommended regimen :
Ceftriaxone 1g IM or IV every 24h
Alternative regimen :
Ceftriaxone 1g IM every 8h
Cefotaxime 1g every 8h
Treatment should be continued for 24-48h after
improvement begins, and therapy may be
switched to Cefixime 400mg orally 2x/day to
complete 1 week of therapy
Chlamydia trachomatis
Incubation periods are relatively long (1-3
weeks)
It is an obligatory intracellular organism,
exits in 2 forms :
1. elemantary body infectious particle
2. reticulate body metabolically active
and reproductive form
15 serotypes
Is a major cause of mucopurulent cervicitis
(MPC)
Cytology
Serology (anti-chlamydial antibody)
Culture
Antigen detection method (enzyme
immunoassay)
DNA probe (hybridization without
amplification)
Nucleic acid amplification tests (NAATs)
Hybridization with amplification of detection
signal
PID
Tubal factor infertility
Ectopic pregnancy
Chronic pelvic pain
Adverse pregnancy outcome
High risk for HIV infection
Neonatal infection
Recommended regimen :
Azithromycin 1g orally in SD
Doxycycline 100mg orally 2x/day for 7 days
Alternative regimen :
Erythromycin base 500mg orally 4x/day for 7
days
Erythromycin ethylsuccinate 800mg orally 4x/day
for 7 days
Ofloxacin 300mg orally 2x/day for 7 days
Levofloxacin 500mg orally once daily for 7 days
Recommended regimen :
Azithromycin 1g orally in SD
Amoxicillin 500mg orally 3x/day for 7 days
Alternatives regimen :
Erythromycin base 500mg orally 4x/day for 7
days
Erythromycin base 250mg orally 4x/day for 14
days
Erythromycin ethylsuccinate 800mg orally 4x/day
for 7 days
Erythromycin ethylsuccinate 400mg orally 4x/day
for 14 days
GENITAL ULCERS
Chronic
DIAGNOSIS
Serologic
Specific
TPI
nontreponemal test
PRIMARY SYPHILIS
SECONDARY SYPHILIS
Develops between 6 weeks after chancre
The cutaneous and mucousmembrane manisfestations :
macular, maculopapular, scaly lesions involving face,
torso&flexor aspect of extremities
Classic rash: red macules and papules over the palms of the
hands and soles of the feet
Systemic manifestations include generalized
lymphadenopathy, hepatitis, nephrosis, optic neuritis, uveitis,
meningitis, alopecia, periostitis
Genital lesions are called mucous patches and condyloma
latum, both of witch are moist and highly infectious and
easily diagnosed by darkfield exam
Serologic test positive
Heal spontaneously within 2-6weeks
LATENT
After
SYPHILIS
2-3weeks
Diagnosis is made only by a reactive serologic
test
Early and late latent syphilis (WHO early lesst
than 2yr)
Late latent stage, patient has agreater risk
progressing to tertiary or neurosyphilis
This stage is not infectious by sexual
transmission, however the spirochetes may still
be transplacentally transmitted to the fetus at
any AOG
NEUROSYPHILIS
No
TREATMENT
Primary,
Recurrent
and incurable
Transmission during asymptomatic shedding (2-3
weeks after vulvar lesions appear)
HSV-1
infect the epithelium above the waist
May cause lower genital tract infections
HSV
Occur
waist
Symptoms:
paresthesia
DIAGNOSIS
By
clinical inspection
Herpesvirus cultures ( 80% sensitivity; less useful
in recurrent episodes)
PCR (most accurate and sensitive technique)
Western blot assay (most specific method for
diagnosing recurrent herpes
TREATMENT
Primary episodes:
Duration
Episodic episodes:
Shorten
Daily suppression:
Recommended
VALACYCLOVIR
ACYCLOVIR
FAMCICLOVIR
Primary episodes
200mg 5x day or
400 mg TID for 710 days
Recurrent
episodes
1000mg OD or
500mg BID for 5
days or 3 days
Daily suppressive
therapy
500mg OD (8
recurrences/yr)
or 1000mg OD or
250 BID (9
recurrences/yr)
400mg BID
250mg BID
Recurrence:
Less
Chronic
DIAGNOSIS:
Donovan
TREATMENT
Doxycycline
weeks
Alternative: Azithromycin 1g PO per week for 3
weeks, Ciprofloxacin 750mg BID PO for a
minimum of 3 weeks
Or Erythromycin 500mg or TMP-SMZ one double
strenght tablet BID PO for a minimum of 3 weeks
Sexual partners should be examined if they had
sexual contact during the 60 days preceding the
onset of symptoms
Highly
Incubation: 3 to 6 days
Small papule pustules (48 to 72 hours) ulcerates
Ulcers have dirty, gray necrotic, foul-smelling
exudate with no induration at the base
Bubo may develop
DIAGNOSIS:
Gram
stain
Culture of purulent material or by aspiration of
tender lymph nodes
TREATMENT
Azithromycin
1gm PO
OR Ceftriaxone 250mg IM
OR Ciprofloxacin 500mg BID for 3 days
Chlamydia trachomatis
Ratio to males to female (5:1)
Vulva is the most common site but the
cervix, urethra , rectum may also be
involved
Incubation: 3 to 30 days
PHASES
Primary
DIAGNOSIS:
Culture
node
TREATMENT:
Doxycycline
VIRAL INFECTION
Clinical presentation:
Small
Treatment:
Self-limiting
infection
Treatment will decrease transmission and
autoinoculation of the virus
Caseous material is evacuated and nodule
excised with a sharp dermal curet
Base of the papule is subsequently chemically
treated with either ferric subsulfate (Monsels
solution) or 85% trichloroacetic acid OR
treated cryosurgery or electrocautery
Clinical presentation:
Occur
on moist skin
Pedunculated warts are friable and tend to
bleed following minor trauma
Initial lesions are pedunculated, soft papules
approx 2-3mm in diameter and 10-20mm long
May occur as a single papule or in clusters
Progresses by autoinoculation
Lesions vary from pinhead-sized papules to
large cauliflower-like masses
Clinical presentation:
Condylomata
Clinical presentation:
Subclinical HPV
infection: discovered
by routine cytology
Predisposition:
immunosuppression,
pregnancy, DM and local
trauma; vulvovaginitis
Management:
Topical
Podofilox
Management:
5-fluorouracil
Cryotherapy, electrocautery
ECTOPARASITIC
INFECTIONS
Diagnosis:
Demonstration of eggs and adults lice in hair
shaft- pepper grain feces
Microscopy- miniature crab with 6 legs that
have claws
Treatment:
Permethrin cream 1%
Lindane
Diagnosis:
Visual inspection- papule, burrow in the
skin
Microscopy- mites lack legs but have 2
anterior triangular hairy buds
Treatment:
Permethrin cream 5%
Lindane 1%
antihistamines
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