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Dermatology > Sec 32 Sexually Transmitted Diseases > Flashcards

Sec 32 Sexually Transmitted Diseases Flashcards

1
Q

Etiologic agent: Syphilis

A

Treponema pallidum pallidum

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2
Q

Etiologic agent: Chancroid

A

Haemophilus ducreyi

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3
Q

Etiologic agent: Lymphogranuloma venereum

A

Chlamydia trachomatis

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4
Q

Etiologic agent: Granuloma inguinale

A

Klebsiella granulomatis

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5
Q

Etiologic agent: Gonorrhea

A

Neisseria gonorrheae

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6
Q

Etiologic agent: Chlamydia

A

Chlamydia trachomatis

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7
Q

Etiologic agent: Genital mycoplasma

A

Mycoplasma sp.

Ureaplasma sp.

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8
Q

Etiologic agent: Trichomoniasis

A

Trichomonas vaginalis

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9
Q

Etiologic agent: Bacterial vaginosis

A

Polymicrobial

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10
Q

Characterized by one or more chancres in presence of laboratory evidence

A

Primary syphilis

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11
Q

Starts as a dusky red macule that evolves into a papule then to a round-to-oval ulcer with sharply demarcated regular, raised borders that are indurated giving a cartilaginous feel

A

Chancre

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12
Q

Retraction of the foreskin when a chancre is present on the underside causes foreskin to flip suddenly

A

Dory flap

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13
Q

Unilateral labial swelling with rubbery consistency and intact surface indicative of deep-seated chancre

A

Edema induratum

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14
Q

Characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy in the presence of laboratory evidence from tissues or sera

A

Secondary syphilis

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15
Q

Lesions of secondary syphilis that erupts 3-12 weeks after the chancre erupts

A

Syphilids

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16
Q

Erythematous macules in secondary syphilis

A

Roseola syphilitica

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17
Q

A white scaly ring on the surface of papulosquamous lesions in secondary syphilis

A

Biette’s collarette

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18
Q

Seborrheic dermatitis-like lesions around the hairline in secondary syphilis

A

Crown of Venus

corona veneris

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19
Q

Plantar lesions mistaken for calluses in secondary syphilis

A

Clavi syphilitici

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20
Q

Confluence of mucous patches on the tongue in secondary syphilis

A

Plaques fauches en prairie

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21
Q

Rare manifestation that presents as crusted or scaly papules and plaques that can ulcerate or become necrotic with lesions described as rupioid

A

Malignant lues

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22
Q

Without treatment, the secondary stage recedes in

A

4-12 weeks

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23
Q

Hallmark of late benign syphilis

A

Gumma

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24
Q

Nontender pink to dusky red granulomatous nodular lesion with variable central necrosis which commonly affect skin or mucous membranes common in scalp, forehead, buttocks, presternal, supraclavicular or pretibial areas

A

Gumma

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25
Q

Two syndromes commonly associated with late neurosyphilis

A
  1. Dementia paralytica

2. Tabes dorsalis

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26
Q

Presents with sensory ataxia and bowel & bladder dysfunction resulting from damage to the posterior columns of the spinal cord which can be accompanied by an Argyll-Robertson pupil (accommodates but does not react to light)

A

Tabes dorsalis

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27
Q

Presents as a rapidly progressive dementia accompanied by personality changes in late tertiary syphilis

A

Dementia paralytica

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28
Q

Treatment: Primary or Secondary or Early latent syphilis

A

Benzathine penicillin G 2.4 M units IM single dose (both HIV-uninfected and -infected)
Alt - Doxycycline 100mg orally BID for 14 days

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29
Q

Etiologic agent: Pinta

A

Treponema carateum

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30
Q

Etiologic agent: Yaws

A

Treponema pallidum pertenue

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31
Q

Etiologic agent: Bejel or Endemic syphilis

A

Treponema pallidum endemicum

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32
Q

Treatment: Nonvenereal treponematoses

A

Benzathine penicillin G 1.2 M units IM single dose (>10 years old
Benzathine penicillin G 0.6 M units IM single dose(<10 years old)

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33
Q

Treatment: Chancroid

A

Azithromycin 1g orally single dose
Ceftriaxone 250mg IM single dose
Ciprofloxacin 500mg orally BID for 3 days
Erythromycin 500mg orally QID for 7 days

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34
Q

Treatment: Lymphogranuloma venereum

A

Doxycycline 100mg orally BID for 3 weeks (1st line)
Erythromycin 500mg orally QID for 3 weeks (2nd line)
Azithromycin 1g orally once weekly for 3 weeks (3rd line)

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35
Q

Treatment: Granuloma inguinale

A

Doxycycline 100 BID orally for 3 weeks or until lesions heal (CDC)
Azithromycin 1g on Day 1 then 500mg OD for 3 weeks or until lesions heal (WHO)

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36
Q

Treatment: Uncomplicated Gonococcal infection

A

Ceftriaxone 125mg IM single dose or

Cefixime 400mg PO single dose

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37
Q

Treatment: Disseminated Gonococcal infection

A

Ceftriaxone 1g IM or IV every 24 hours until improvement noted

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38
Q

Treatment: Gonococcal infection in Neonates

A

Ceftriaxone 25-50 mkday IV or IM OD for 7 days (10-14 days if with meningitis)

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39
Q

Treatment: Chlamydia

A

Azithromycin 1g PO single dose or

Doxycycline 100mg PO BID for 7 days

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40
Q

Treatment: Trichomoniasis

A

Metronidazole 2g PO single dose or

Tinidazole 2g PO single dose

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41
Q

Treatment: Bacterial vaginosis

A

Metronidazole 500mg PO BID for 7 days
or
Metronidazole gel 0.75% 5g intravaginal OD for 5 days
or
Clindamycin cream 5% 5g intravaginal OD for 7 days

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42
Q

Ranges in diameter from a few millimeters to 2 cm and is sharply demarcated with regular, raised borders that are indurated, giving the lesion a cartilaginous feel; base is usually clean, and is classically not painful

A

Hunterian chancre or “ulcus durum” (hard

ulcer)

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43
Q

Relapses of primary syphilis

A

Monorecidive syphilis or chancre redux

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44
Q

Present as moist, flat, well-demarcated papules or plaques with macerated or eroded surfaces in intertriginous areas, commonly in the labial folds in females or in the perianal region in all patients

A

Condyloma lata

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45
Q

Pigmentary changes in Syphilis from inhibition of melanogenesis

A

Leukoderma colli syphiliticum or, if on the neck, “necklace of Venus”

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46
Q

A type of mucous patch of secondary syphilis that can be present at the angle of the mouth, with a characteristic slit traversing its center

A

Split papule

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47
Q

An asymptomatic stage with no clinical findings, with seroreactivity by definition the only evidence of infection; which is a diagnosis of exclusion

A

Latent syphilis

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48
Q

Refers to a solitary gumma of the penis

A

Pseudochancre redux

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49
Q

Responsible for most deaths caused by syphilis

A

Cardiovascular manifestations:
Syphilitic aortitis leading to aortic regurgitation
Coronaryostial stenosis
Saccular aneurysm

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50
Q

Any stage of infection and a reactive CSF-VDRL

A

Confirmed Neurosyphilis

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51
Q

Any stage of infection, a nonreactive CSF-VDRL, elevated protein or white blood count without other known causes of those abnormalities, and clinical symptoms or signs of neurosyphilis without other known causes for those symptoms or signs

A

Probable Neurosyphilis

52
Q

Most common ophthalmic manifestation of early neurosyphilis, presenting as eye pain, redness, and photophobia

A

Uveitis

53
Q

Most common manifestation of otologic syphilis

A

Sensorineural hearing loss

54
Q

Refers to syphilis caused by infection in utero with T. pallidum

A

Congenital syphilis

55
Q

Signs of disease in an infant or child with specific laboratory evidence of infection with T. pallidum

A

Confirmed Congenital syphilis

56
Q

Condition affecting an infant whose mother had
untreated or inadequately treated syphilis at delivery,
regardless of signs in the infant, or an infant or child
who has a reactive treponemal test for syphilis and evidence of congenital syphilis on physical examination
or radiographs of long bones, a reactive CSF-VDRL,
an elevated CSF cell count or protein (without other
known cause), or a reactive FTA-ABS IgM antibody
test or IgM enzyme-linked immunosorbent assay

A

Probable Congenital syphilis

57
Q

Probability of transmission of Syphilis infection

A

70-100% in primary syphilis
40% for early latent syphilis
10% for late latent syphilis

58
Q

Syphilis in a child aged <2 years

A

Early congenital syphilis

59
Q

Early congenital syphilis

A 
Persistent rhinitis (“snuffles”)
Hydrops fetalis (edema)
Lymphadenopathy
Neurosyphilis,
Leukocytosis, thrombocytopenia
Periostitis and osteochondritis, with the pain
associated with osteochondritic lesions causing the infantto refuse to move the affected anatomic area (“pseudoparalysis of Parrot”)
Bullous rash (“syphilitic pemphigus”)
60
Q

Child with Syphilis at least 2 years old that typically

manifests over the first two decades of life

A

Late congenital syphilis

61
Q

Late congenital syphilis

A

Scars (“rhagades”) resulting from cutaneous fissures
Saddle-nose deformity, resulting from destruction of nasal cartilage from snuffles
Frontal bossing (Olympian brow)
Thickening of the sternoclavicular portion of the clavicle (Higoumenakis sign)
Anterior bowing of the midtibia (saber shins),
Scaphoid scapula
Peg-shaped notched central incisors (Hutchinson teeth) Mulberry molars

62
Q

Hutchinson triad

A

Hutchinson teeth
Interstitial keratitis
Eighth nerve deafness

63
Q

Diagnostic test of choice in chancres, moist lesions of secondary syphilis (condylomata lata and mucous patches), and the discharge from rhinitis in congenital syphilis

A

Darkfield microscopy

64
Q

Histopathology: granulomas with central zones of acellular necrosis; endarteritis obliterans
and angiocentric plasma cell infiltrates of dermal
blood vessels can also be present

A

Tertiary syphilis

65
Q

Nontreponemal tests

A

Venereal Disease Research Laboratory (VDRL)

Rapid plasma reagin (RPR)

66
Q

In a small percent of secondary syphilis cases, very high antibody titers inhibit test reactivity, producing a false-negative result called

A

Prozone phenomenon

67
Q

Treponemal tests

A

T. pallidum particle agglutination (TPPA) test
Microhemagglutination assay for T. pallidum (MHA-TP)
Fluorescent treponemal antibody absorption assay
(FTA-ABS)
T. pallidum haemagglutination test (TPHA)
Treponemal enzyme immunoassays (EIAs)
Immunochemiluminescence assays

68
Q

Treatment: Penicillin-allergic persons with syphilis who are not pregnant and do not have neurosyphilis

A

Doxycyline

69
Q

Treatment success in Syphilis is generally defined as

A

A fourfold decline in serologic nontreponemal titer (or reversion to nonreactive result) following appropriate treatment

70
Q

A fourfold titer increase following appropriate treatment

indicates

A

Reinfection or treatment failure

71
Q

Self-limited clinical syndrome consisting of fever, headache, flare of mucocutaneous lesions, tender lymphadenopathy, pharyngitis, malaise, myalgias, and leukocytosis which occurs within 12 hours of initiating therapy and resolves within 24–36 hours

A

Jarisch–Herxheimer reaction

72
Q

Most benign of the endemic treponematoses with the skin being the only organ of involvement

A

Pinta

73
Q

Most prevalent nonvenereal treponematosis and the most destructive and disfiguring skeletal involvement

A

Yaws

74
Q

Second line treatment for Nonvenereal treponematoses

A

Erythromycin
Doxycyline
Tetracycline

75
Q

Incubation period of chancroid

A

3-7 days no more than 10 days

76
Q

Usually tender and or painful not indurated (soft chancre) with diameter varying from 1 mm to 2 cm
and most are found on the external or internal
surface of the prepuce, on the frenulum, or on the glans

A

Chancroid

77
Q

Painful inguinal adenitis occurs in up to 50% of patients within a few days to 2 weeks after onset of the primary lesion usually unilateral with erythema
of the overlying skin

A

Buboes

78
Q

The three classic etiologic agents for genital ulceratio

A
  1. H. ducreyi
  2. Treponema pallidum
  3. Herpes simplex
79
Q

Single lesion extends peripherically and shows extensive ulceration

A

Giant chancroid

80
Q

Lesion that becomes confluent, spreading

by extension and autoinoculation. The groin or thigh may be involved.

A

Large Serpiginous Ulcer

Ulcus molle serpiginosum

81
Q

Variant caused by superinfection with
fusospirochetes. Rapid and profound
destruction of tissue can occur.

A

Phagedaenic Chancroid

Ulcus molle gangraenosum

82
Q

Small ulcer that resolves spontaneously in a few days may be followed 2–3 weeks later by acute regional lymphadenitis.

A

Transient Chancroid

Chancre mou volant

83
Q

Multiple small ulcers in a follicular distribution.

A

Follicular Chancroid

84
Q

Granulomatous ulcerated papule may

resemble donovanosis or condylomata lata.

A

Papular Chancroid

Ulcus molle elevatum

85
Q

Most frequent complaint in Chancroid

A

Local pain

86
Q

Complications of Chancroid

A

Painful inguinal adenitis (up to 50%)
Spontaneous ruptures of inguinal buboes with occurrence of large abscesses and fistula formation
Spreading of Haemophilus ducreyi to distant sites
(kissing ulcers and/or extragenital lesions due to autoinoculation)
Esophageal lesions in HIV patients
Acute conjunctivitis
Bacterial superinfection (including anaerobs) leading
to extensive destruction
Scarring leading to phimosis
Erythema nudism
Enhanced HIV transmission

87
Q

DOC for pregnant patients with Chancroid

A

Ceftriaxone

88
Q

A sexually transmitted disease due to specific Chlamydia variants contracted by direct contact with infectious secretions

A

Lymphogranuloma venereum (LGV)

89
Q

Two distinct morphologic forms of Chlamydiae

A
  1. the small metabolically inactive and infectious elementary body
  2. the larger metabolically active and noninfectious
    reticulate body
90
Q

5-to-8-mm painless erythematous papule(s) or small

herpetiform ulcers appear at the site of inoculation; heals within a few days, and may go unnoticed

A

Primary stage of LGV

91
Q

Marked LN involvement and hematogenous dissemination

A

Secondary stage of LGV

92
Q

Characterized by inguinal and/or femoral LN involvement and is the major presentation in
men

A

Acute genital syndrome (GS) or inguinal syndrome

93
Q

Pathognomonic of LGV

A

Nodal enlargement on either side of the inguinal ligament, the “groove sign,”

94
Q

Characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms

A

Acute anorectal syndrome

95
Q

In women with untreated ArS, and includes rectal
strictures (most common) and abscesses, perineal
sinuses, rectovaginal fistulae (leading to “watering
can perineum”), and “lymphorrhoids” (perianal
outgrowths of lymphatic tissue)

A

Tertiary stage of LGV

96
Q

Diagnostic of LGV

A

Positive on lymph node aspirate

97
Q

Most commonly used test with titers greater than 1:256 are highly suggestive of LGV and titers below 1:32 exclude the diagnosis

A

Complement fixation test

98
Q

The earliest diagnostic modality to identify LGV which consists of an intradermal skin test assessing delayed hypersensitivity to chlamydial antigens but no longer used because of its low sensitivity and limited specificity due to cross reaction with C. trachomatis D-K

A

Frei test

99
Q

In Donovanosis, single or multiple papules or

nodules later develop and grow into a painless ulcer that may extend to the adjacent tissues and moist folds, forming

A

Kissing lesions

100
Q

Commonly presents as beefy red, easily bleeding, foul-smelling ulcer, which may have hypertrophic or verrucous borders, with granulation tissue; may also present as soft, red nodules that eventually ulcerate

A

Granuoma inguinale

101
Q

The infectious form in Chlamydiawhich enters host cells through endocytosis

A

Eelementary body

102
Q

Most common manifestation of Chlamydia which is
characterized by a watery or mucoid discharge
from the urethra that may be accompanied by variably
severe dysuria in both men and women

A

Urethritis

103
Q

Gonorrhea can also be transmitted vertically from
mother to child during normal vaginal birth, characteristically causing an inflammatory eye infection characterized by profuse, purulent ocular discharge

A

Ophthalmia neonatorum

104
Q

The most common manifestation of gonococcal infection in men, characterized by a spontaneous, often
profuse, cloudy or purulent discharge from the penile
meatus

A

Urethritis

105
Q

In some cases, there is so much soft tissue
inflammation that the entire distal penis becomes
swollen, so-called

A

Bull head clap

106
Q

A manifestation of gonococcal infection
manifesting in those who practice unprotected
anoreceptive intercourse; symptoms may include a rectal mucopurulent discharge, pain on defecation, constipation, and tenesmus

A

Proctitis

107
Q

Occurs in about 10-40% of uncomplicated
gonorrheal infections in women and is characterized
by fever, lower abdominal pain, back pain, vomiting,
vaginal bleeding, dyspareunia, and adnexal or cervical
tenderness during movement associated with a pelvic
examination

A

Pevic inflammatory disease

108
Q

This involves inflammation of the liver capsule associated with genitourinary tract infection and may be present in up to one-fourth of women with PID caused by either N. gonorrhoeae or C. trachomatis. Presenting symptoms include right upper quadrant pain and tenderness with abnormal liver function tests.

A

Fitz-Hugh-Curtis syndrome

109
Q

Spread of infection from the primary site of inoculation to other parts of the body through the bloodstream leads to this which occurs in 0.5-3% of cases and is associated with a classic triad of dermatitis,
migratory polyarthritis, and tenosynovitis.

A

Disseminated gonococcal infection (DGI), also known as gonococcemia

110
Q

The cutaneous lesions of DGI with concurrence of some degree of hemorrhage and necrosis

A

Gun metal gray

111
Q

Considered diagnostic for infection with N. gonorrhoeae in symptomatic men

A

Gram stain of a urethral specimen that demonstrates
polymorphonuclear leukocytes with intracellular
Gram-negative diplococci

112
Q

Gold standard diagnostic test for years for N. gonorrhoeae

A

Bacterial culture

113
Q

Media for bacterial culture of N. gonorrhoeae

A

Modified Thayer-Martin medium

114
Q

Permanent sequelae of gonococcal infection in women

A

Infertility

115
Q

The area most commonly affected in men and women with Chlamydia

A

Urogenital tract infection

116
Q

Can occur up to 1 month after symptoms of nongonococcal urethritis (NGU) with classic triad associated with this syndrome is NGU, arthritis, and conjunctivitis.

A

Reactive arthritis

117
Q

Individuals with the haplotype are at increased risk of developing the reactive arthritis syndrome.

A

HLA-B27

118
Q

Smallest, free-living, self-replicating bacteria, developed
by degenerative evolution from lactobacilli, and lack
a cell wall

A

Mycoplasma

119
Q

STD caused by parasitic protozoan that infects mucosal epithelium, causing microulceration

A

Trichomoniasis

120
Q

Specific sign of trichomoniasis with punctate hemorrhages may be seen on the vaginal wall and cervix

A

Colpitis macularis or “strawberry cervix”

121
Q

Most common diagnostic test in Trichomoniasis

A

Saline wet mount

122
Q

Drug-drug interaction with Imidazoles

A

Cimetidine
Warfarin
Phenytoin
Lithium

123
Q

Most common vaginal infection in women of

childbearing age

A

Bacterial vaginosis

124
Q

Apolymicrobial syndrome that occurs when
there is an imbalance of the bacterial flora normally
present in the vagina. The shift occurs from hydrogen
peroxide-producing lactobacilli to a greater concentration of bacterial organisms.

A

Bacterial vaginosis

125
Q

Presents with fishy odor and thin, white or gray vaginal discharge; on physical examination, a milky, homogenous vaginal coating may be seen adherent to the vaginal wall

A

Bacterial vaginosis

126
Q

Amstel criteria for diagnosing Bacterial vaginosis (3 of 4)

A
  1. thin, homogenous vaginal discharge
  2. a positive whiff test, which involves the production of a fishy odor when mixing vaginal fluid with 10% potassium hydroxide
  3. vaginal fluid pH greater than 4.5
  4. the presence of clue cells (epithelial cells covered with bacteria) on microscopic examination

Dermatology (26 decks)

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