Gyn Infection Notes

I.

II.

III.

Vulvitis
A. Ulcerative
1.
Painful
a. HSV
b. Haeomophilus Ducreyi
i. Chancroid
2.
Painless
a. Treponema Pallidum
i. Syphilis
1.
Chancre
2.
Condyloma lata
3.
Aortic Dissection
4.
Neurosyphilis
b. Chlamydiae Trachomatis L Type
i. LymphoGranuloma Venereum
c. Calymmobacterium Granulomatis (Donovani)
i. Granuloma Inguinale
B. Non-ulcerative
1.
HPV (Condyloma Accuminatum)
2.
Bartholins Gland Abscess
Vaginitis
A. Highest pH
1.
Trichimonas
B. High pH
1.
BV
C. Normalish pH
1.
Candida
Cervicitis
A. Gonorrhea
B. Chlamydia
C. HPV

I.A.1.b .i - Chancroid
Painful ulcerative lesion on the vulva
Caused by Haemophilus Ducreyi
Dx: Cx
Tx: Azithromax or Ceftriaxone
I.A.2.a.i - Syphilis
Chancre
o Dx: dark field microscopy RPR has low sensitivity early on
Latent or 2ndary syphilis rash on palms & soles
o Dx: RPR or VDRL & FTA-Abs

RPR can be used to diagnose repeat infection or relapse

FTA-Abs remains positive life-long
Neuro: Argyl-Robertson pupil, Tabes Dorsalis
Also check HIV
Tx: Penicillin
o Jarisch- Herxheimer Rxn rash from penicillin & syphilis, harmless, Tx through the
rash

I.A.2.b.i - LGV
Painless ulcerative lesion on the vulva
o Evolves into suppurative nodes & fistulas, strictures, & buboes
Caused by L type Chlamydiae Trachomatis
o More common in tropical regions
Dx: Cx
Tx: I&D & Doxycycline x3 weeks
I.A.2.c.i Granuloma Inguinale
Painless papular lesion that ulcerates on the vulva with beefy red base
o Evolves into non-suppurative granuloma and lymph nodes
Dx: Donovan bodies on giemsa stain
Tx: Bactrim or Doxy x3 weeks
I.B.1.a Condyloma Accuminatum
Warty lesion on the vulva
Caused by HPV, usually types 6 & 11, low risk for cancer
Tx
o Pt applied
Podofilix
Imiquimod (Lowest relapse, very expensive)
o Physician applied
Podophyllin
Trichloroactic Acid
Cryotherapy
o Surgery
Laser ablation
excision

Vaginal discharge is most common cause for office visit, Q-tip in posterior fornix of the
vagina
II.A.1 - Trichomonas
STI
Highest pH: 6-7
Classic discharge: frothy, yellow, green, or grey

Strawberry Cervix (it looks inflamed): punctuate epithelial papillae

Saline: moving flagellated protozoa
Dx: Cx has highest sensitivity, Q tip in posterior fornix
Tx
o Metronidazole 2G PO once
o Clotrimazole cream x7 days

II.B.1 Bacterial Vaginosis

Most common cause of Vaginitis
High pH: 5-7
KOH: whiff test = fishy, Q tip in posterior fornix
Saline: clue cells
Organism: Gardnerella Vaginalis
Complications: preterm birth during pregnancy
Tx
o Metrodinazole 500 or 375 MG BID x7 days
o Clindamycin 300 MG TID x7 days
II.C.1 - Candida
Normalish pH: 4-5
Classic Discharge: Cottage cheese like, thick, curdy
Risk factors: DM, AIDS, Abx
KOH: pseudohyphae
Gram stain: near 100% sensitive
Cx on Sabouraud agar: gold standard, Q tip in posterior fornix
Tx
o OTC: Monistat-7 or Tetrazole
o Nystatin
o Boric Acid 600 MG Q1D x2 weeks
o Fluconazole (Diflucan) 150 MG PO once
III.A Neisseria Gonorrhea
STI
Mucopurulent discharge from the cervical os
Intracellular gram-negative diplococcic bacteria
Dx: Cx highest sensitivity, DNA probe 90%, Q tip in cervical OS
Tx check HCG first
o Ceftriaxone 250 MG IM once
Ofloxacin PO for pregnant woman
o Also treat Chalmydia
Complication
o Salpingiitis => PID => Tubo-ovarian abscess

 Fitz-Hugh-Curtis Syndrome
Often polymicrobial including anaerobes
o Septic arthritis
o tenosynovitis
III.B Chlamydia Trachomatis
STI
Mucopurulent discharge from the cervical os
Intracellular Atypical bacteria
o Lacks cell wall
L type cause LymphoGranuloma Venereum (LGV)
Dx: PCR most sensitive, followed by DNA probe, Q tip in cervical OS
Tx check HCG
o Doxycycline 100 MG PO BID x7 days
o Azithromycin 1G once
o Pregnant woman Erythromycin PO or Amoxicillin PO
o Also treat Neisseria Gonorrhea
Complication
o Salpingiitis => PID => Tubo-ovarian abscess
Fitz-Hugh-Curtis Syndrome
Often polymicrobial including anaerobes
o Reactive Arthritis / Reiters Syndrome

Beta-strep = strep agalactiae: test mother

o Q-tip in Posterior forchette (meeting of inferior vulva/vestibule) of the perineum