MC organism in BV
Gardnerella vaginalis
discharge is watery gray filmy with fishy/musty odor
BV
(+) whiff test and presence of clue cells
BV
Treatment for bacterial vaginosis
Metronidazole (Flagyl) 500mg BID x7
flagellated protozoan T. vaginalis causes
Trichomonas
discharge is copious frothy green with a fishy odor and pruritus
Trich
PE finding indicative of Trichomonas
strawberry cervix
Wet mount showing a motile organism
Trichomonas
discharge is like “cottage cheese” white and clumpy with pruritus
Candidiasis
MCC Candida albicans
wet prep demonstrates pseydohyphae
Candidiasis
Hx of small painless genital ulcer that healed
Now Inguinal LAN with abscess formation
+/- proctitis
Lymphogranuloma Venereum (LGV)
rectal discharge, bleeding, and painful inflammation in MSM recent travel to South America
LGV
Treatment of LGV
Doxycycline 100mg BID x3weeks
Cause of syphilis
Treponema pallidum
corkscrew spaed spirochete
Primary stage of syphilis
painless ulcer at site of exposure
diffuse maculopapular rash with lesions involving palms and soles
secondary syphilis
condylomata lata
moist heads up lesions in intertriginous regions
Different classifications of tertiary syphilis
Neurosyphilis
Cardiovascular (now rare)
Gummatous/Late benign syphilis
Sxs of neurosyphilis-
P: personality- emotional lability A: affect- flat R: reflexes- hyperreflexia E: eye- Argyll-Robertson pupil S: sensorium- illusions, delusions, hallucinations I: intellect- memory & judgement impairment S: speech- slurring \+ tabes dorsalis \+ CN abnl, ocular, & otic manifestations
w/o for syphilis
VDRL or RPR for screening
FTA-ABS is confirmatory
Tx for primary, secondary, and early latent syphilis
Benxathine Penicillin G (Bicillin) 2.4mill units IM x1
Tx late latent syphilis
Bicillin weekly x3
Neurosyphilis tx options
Aqueous PCN G IV daily x2weeks
Procaine PCN IM daily + Probenecid QID x2wk
Ceftriaxone 2g IV daily x2wk
dysmenorrhea
painful menses
menorrhagia
prolonged menstrual bleed >7d
metorrhagia
bleeding between menstrual periods
menmetorrhagia
prolonged, excessive, irregular
MCC PID
Chlamydia & Gonorrhea
abd pain and cervical motion tenderness
PID
Outpt tx for PID
Ceftriaxone IM + Doxy BID 14d
MCC mastitis
if bilat suspect
Staph aureus
bilat- neonatal streptococcal infection
breast abscess tx
I&D
abx TOC- Cephalosporin or Methicillin Sodium
lumpy breast tissue that is transient
fibrocystic breast “disease”/changes
Fibrocystic breast changes d/t what hormone
estrogen
Tx for severe fibrocystic breast disease that have failed conservative tx and OCPs
Danazol
Breast mass that is round, firm, discrete, relatively moveable and NONtender
“rubbery”
Breast Fibroadenoma
RF for breast CA
BRCA endometrial CA prolif form of fibrocystic breast dis menses <12 nulliparous/late White more likely to get (AA higher mortality)
mammography screening should DEF start
50-65 q1 yr
estrogen receptor positive breast CA tx
Tamoxifen
Anastrozole (not in premenopausal)
Dx PCOS
Need 2/3:
1) oligomenorrhea/anovulation
2) hyperandrogenism- via PE or labs
3) US demonstrates ( “string of pearls”)
LH:FSH >3
PCOS
PMS is associated with which phase of cycle
luteal
PMDD core sxs
Depressed, Anxiety, Sad, Irritable/Anger
dx must have atleast 1 core sx, 5 sxs all together
best pharmacotherapy for PMS or PMDD
SSRI Fluoxetine
premenstrual pelvic pain
dysmenorrhea
w/o endometriosis
laparoscopy
ovarian CA MC what type
90% epithelial
adnexal mass
next step
US (pref transvag)
endometrial CA MC what type
adenocarcinoma
MC type 1 estrogen receptive
what lab value is indicative of menopause
FSH >30
dominant estrogen once a woman is in menopause
estrone
in a women with a uterus, what kind of HRT should be used
combined estrogen & progesterone
