2. Treatment: Fluconazole
Cottage Cheese Discharge
Candida
Candida
Treatment: Fluconazole

3. 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

4. What is the bug?
Condylomata acuminata
HPV
Condylomata acuminata

5. 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

6. Syphilis
Does this hurt???
Chancre - syphilis

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

8. Secondary Syphilis

9. Syphilis Secondary Tertiary Latent Treatment 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

10. 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

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

12. 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)

13. Trichomonas infection
Strawberry cervix

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

15. Bacterial Vaginosis
CLUE CELLS BV

16. Gardnerella Vaginalis - BV
Caused by disruption of vaginal flora
Test:
Whiff test – fishy amine odor
Clue cells
Treatment
Metronidazole

17. Gonorrhea GC
Bartholin Gland Abscess

18. Gonorrhea Commonly assymptomatic Males Females 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

19. Dis GC

20. 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

21. Chlamydia Most common treatable STD Symptoms: Diagnosis: Treatment:
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

22. 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

23. 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

24. How about a few Pictures??

25. Imperferate Hymen
Imperferate hymen

26. Mom complains of constant scratching of bottom!!!
Pin worms
Scotch tape Test!!!

27. Urethral Prolapse Common Presentation: Vaginal bleeding

28. Genital Trauma
Genital Trauma

29. Irriatant Vulvovaginitis
**Think if they mention “bubble baths”
Irriatant vulvovaginitis

30. Lichen Sclerosis
Lichen sclerosis

31. Strep Vulvovaginitis Usually very painful!! Sharp demarcation