Gynecology [GYN INFECTIONS]

Vaginal Infections Discharge Micro Notes Abx

Patients with a vaginal infection come down to three diseases: Candida Thick, white, Hyphae DM, Anti-Fungals
adherent to wall (KOH prep) Abx OTC: Topical
Candida, Gardnerella (BV), and Trichomonas. The patient Rx: Fluconazole
presentation is very nonspecific but involves pruritis, odor, and BV Grey-white, Clue Cells KOH Metronidazole
discharge. Nothing is very sensitive or specific from patient fishy odor, (saline prep) fishy
history so always do a pelvic exam and run some tests before most common smell
Trich Yellow-Green Motile Ping- Metronidazole
treating. Though it’s the best test, a culture often isn’t necessary.
and Frothy, Flagellated Pong Both partners!
However do these in order: speculum exam, microscopic exam, Strawberry (saline prep)
and then antibiotics. The microscopic exam should be of the Cervix
cervical mucous. There should be two samples on one slide - one
with normal saline the other with KOH.
Test Cla Gc
Cervicitis Gram Polys, but no Gram negative
Cervicitis is inflammation of the cervix caused by the same bugs Stain organisms diplococci
as vaginal infections plus gonorrhea and chlamydia. There will be Culture Gold standard, not Chocolate agar
yellow-green mucopurulent discharge and cervical motion needed required
tenderness but there will be the absence of other PID symptoms. PCR Preferred, 48 hrs Preferred, 48 hrs
To figure out the cause do a wet mount, KOH prep, and Urine Rapid Rapid
Gc/Chla PCR and treat accordingly. Abx Doxy or Azithro Ceftriaxone IM
(no orals)
Pelvic Inflammatory Disease
This is actually a clinical spectrum of disorders of the upper
genital tract including endometritis, salpingitis, tubo-ovarian
abscess, and florid pelvic peritonitis. It comes from either Tubo ovarian abscess
Gonorrhea (1/3), Chlamydia (1/3), and organisms of the
vaginal flora. The idea is that it is possible for an infection of the
cervix to progress into an ascending infection into the sterile
uterus. But it’s also possible that the protective barrier gets Salpingitis
compromised and normal vaginal flora can ascend into the uterus
and fallopian tubes. The person is usually quite ill. Pelvic pain
and mucopurulent cervical discharge is almost always present.
There will be cervical motion tenderness (“chandelier sign”),
uterine tenderness, or adnexal tenderness. Only 1 of 3 is Cervicitis (Gc / Chla)
necessary. Often there’s high fever and the patient is quite toxic. = Ceftriaxone IM x 1
Imaging is not necessary, but a transvaginal ultrasound may = Azithro or Doxy
reveal free fluid or tubo-ovarian abscess.

Admission is required for severe disease – high fever,

nausea/vomiting, or TOA. Antibiotic coverage must include
gonorrhea, chlamydia, and the gram negatives / anaerobes of the Normal Vaginal Flora
vaginal fauna.

Inpatient regimens are either: CDC 1) Pelvic pain or Abdominal Pain

1) Cefoxitin + Doxycycline Diagnosis: 2) No other cause except PID
2) Clindamycin + Gentamycin 3) One of the following
- Cervical motion tenderness
Outpatient Regimens include: - Adnexal tenderness
1) Ceftriaxone IM x 1 + Doxycycline + Metronidazole - Uterine tenderness
2) Cefoxitin + Probenecid + Doxycycline + Metronidazole Additional 1) Fever
Criteria: 2) Mucopurulent discharge
Surgery is required for abscess drainage or frank peritonitis. 3) WBC on wet mount
Pitfalls: Absence of leukocytosis is irrelevant
Leave in IUD
Outpatient therapy attempted first unless
severe or pregnant

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