STIs

Question 1

S/S of vulvovaginal candidiasis

Answer 1

vulvar & vaginal pruritus
vulvar erythema
painful urination (usually from urine flowing over excoriations)
discharge is thick, white, lumpy, cottage cheese

Question 2

If pH is greater than __ suspect trichomoniasis or BV

Answer 2

4.5

Question 3

Treatment for yeast infection (VV candidiasis)

What is the preferred treatment in pregnancy?

Answer 3

oral antifungals (Diflucan)
topically/vaginally with cream (Miconazole)

Miconazole - 7 day topical/vaginal cream

Question 4

What is the most prevalent cause of vaginal discharge or malodor?

Answer 4

Bacterial vaginosis

Question 5

What vaginal infections and STIs may be asymptomatic?

Answer 5

Bacterial vaginosis
Chlamydia
Gonorrhea

Question 6

S/S of bacterial vaginosis

Answer 6

fishy odor

discharge is profuse, thin, white or grey, milky

Question 7

clinical criteria for diagnosis of BV

Answer 7

require 3 of 4 S/S
1) homogeneous, white, non-inflammatory discharge coating the vaginal walls

2) clue cells on microscopic examination
3) pH of vaginal fluid >4.5
4) fishy odor of vaginal discharge before/after addition of KOH

Question 8

Treatment of BV

Answer 8

Metronidazole 500 mg PO BID for 7 days - most desirable in pregnancy

Metronidazole 250 mg PO TID for 7 days

avoid alcohol with med and for 24 hours after

withhold breastfeeding 24 hours after single dose

Question 9

Vaginal health teaching

Answer 9

avoid douching, feminine hygiene sprays

avoid perfumed soaps and cleansers

wear cotton underwear

avoid nylon panties/stockings

avoid scented/lubricated condoms

lubricate for sex with intended products

keep perineal area clean and dry

avoid excess tampon use

Question 10

S/S of UTI

Answer 10

dysuria
urgency
increased frequency of voids

Question 11

Treatment of UTI

Which is preferred treatment and why?

Answer 11

kefelex 250 mg Q6H for 7 days

Nitrofurantoin (Macrobid) 100 mg PO BID for 7 days

Nitrofurantoin because it is only 2x a day so there will be better comliance

Don’t use Bactrim after 36 weeks
Don’t use nitrofurantoin after 38 weeks, don’t give it to breastfeeding mothers of babies <1 month

Question 12

What 2 STIs usually happen together?

Answer 12

Gonorrhea and Chlamydia

Question 13

S/S of gonorrhea

Answer 13

purulent endocervical discharge
menstrual irregularities
lower abd pain
dysuria
urethritis
inflammation of labia
history of vaginal discharge, metrorrhagia, menorrhagia