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Candida

Cottage Cheese Discharge. Candida . Treatment: Fluconazole. Candida Vulvovaginitis. Antibiotic use Think DIABETES in older children w/o risk factors Symptoms: Dysuria , dyspareunia , pruritis Thick cheesy vaginal discharge Diagnosis: KOH budding yeast and pseudohyphea

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Candida

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  1. Cottage Cheese Discharge Candida Treatment: Fluconazole

  2. Candida Vulvovaginitis • Antibiotic use • Think DIABETES in older children w/o risk factors • Symptoms: • Dysuria, dyspareunia, pruritis • Thick cheesy vaginal discharge • Diagnosis: • KOH budding yeast and pseudohyphea • Low vaginal pH • Treatment: • Fluconazole

  3. What is the bug? HPV Condylomataacuminata

  4. Human Papillomavirus • Most common STD in females • HPV 6 and 11 – warts • HPV 16, 18, 31, 33, 35 – cervical cancer • Treatment • Podofilox, Imiquimod cream • Cryotherapy • Surgical removal

  5. Syphilis Does this hurt???

  6. Syphilis • TreponemaPallidum • Primary • Painless chancre • Know testing • 1st: nontreponemal test • VDRL • RPR • 2nd: treponemal test • FTA-ABS • TP-PA • These may be + for life regardless of treatment

  7. Secondary Syphilis

  8. Syphilis • Secondary • Palmar rash • Mucocutaneous lesions • Lyphadenopathy • PALMS and SOLES – nickel and dime • Tertiary • Cardia • Opthalmic and auditory • Gummatous lesions • Latent • + test with no clinical symptoms • Early – within past year • Late – after 1st year of infection • Treatment • PCN G IM x 1

  9. Neurosyphilis • Adolescent with hearing loss • Cognitive dysfunction, motor or sensory deficits • CSF VDRL is diagnostic • Very specific • Usually diagnose based on: • Clinical suspecion • Elevate WBC, protein • Treatment • Peniciliin G IV for 2 weeks

  10. Genital Herpes Wright-Giemsa stain – multi nucleated giant cells

  11. Genital Herpes – usually Type 2 • Clusters of vesicular ulcers, erythematous base • Tender Inguinal Adenopathy, fever, myalgia • Diagnosis: • Physical exam • Wright-Giemsa stain • Treatment: • Acyclovir 7 days (oral)

  12. Trichomonas infection Strawberry cervix

  13. TrichomonasVaginalis • “Strawberry Cervix” • Symptoms: • Assymptomatic in males • Burning, itching, abnormal odor • “frothy yellow discharge” • Tests: • Flagellated organisms wet prep • Treatment: • Metronidazole – 2 gm • Treat partners

  14. Bacterial Vaginosis CLUE CELLS

  15. GardnerellaVaginalis - BV • Caused by disruption of vaginal flora • Test: • Whiff test – fishy amine odor • Clue cells • Treatment • Metronidazole

  16. Gonorrhea Bartholin Gland Abscess

  17. Gonorrhea • Commonly assymptomatic • Males • Dysuria and discharge • Can progress to epididymitis (unilateral pain and swelling of scrotum) • Females • Urethritis and cerivicitis • Dysuria and malodorous discharge • Fitz-Hugh-Curtis – perihepatitis • *normal LFTs • RUQ pain

  18. GC Con’t • THINK GC for any arthritis in adolescents • GC pharyngitis • Patchy, erythematous, pustular lesions on palate • Diagnosis – throat culture • Disseminated GC • Usually don’t have local symptoms anymore • Most common arthritis and rash • Can develop meningitis and endocarditis • Diagnosis: culture – GRAM - DIPLOCOCCI *DON’T FORGET, TREAT ALL GC CASES FOR CHLAMYDIA

  19. Chlamydia • Most common treatable STD • Symptoms: • Men – urethritis • Women - cervicitis • Diagnosis: • Nucleic acid amplification test • Treatment: • Azithromycin 1 gm x 1 • Doxycyclin 100 mg BID x 7 days • or Erythromycin 500mg BID x 7 days Don’t forget – You need a TOC in pregnancy

  20. PID • Complication of lower genital tract infection • Risk Factors: • Adolescent, multiple sexual partners, previous PID • Symptoms: • Ill apperaing fever, shaking chills, lower abdominal pain • Cervical motion tenderness • Diagnosis: • Culture, U/S (fluid in cul-de-sac) • Treatment: • Can try outpt but need to reexamine within 24 hours • Hospitalization • Ceftriaxone and Doxycycline • Complications: • Ectopic pregnancy

  21. Pregnancy • ½ of all pregnancies occur with 6 mos of first intercourse • 1/5 in first month • Testing • All pregnant women have to be tested for HIV • 1st visit labs: syphillis, Chlamydia, GC, Hep B, Hep C, Pap

  22. How about a few Pictures??

  23. Imperferate Hymen

  24. Mom complains of constant scratching of bottom!!! Scotch tape Test!!!

  25. Urethral Prolapse Common Presentation: Vaginal bleeding

  26. Genital Trauma

  27. IrriatantVulvovaginitis **Think if they mention “bubble baths”

  28. Lichen Sclerosis

  29. Strep Vulvovaginitis Usually very painful!! Sharp demarcation

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