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Treatment: Fluconazole Candida Cottage Cheese Discharge.

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Presentation on theme: "Treatment: Fluconazole Candida Cottage Cheese Discharge."— Presentation transcript:

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2 Treatment: Fluconazole Candida Cottage Cheese Discharge

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? 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???

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

8 Secondary Syphilis

9 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 1 st 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

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

17 Gonorrhea Bartholin Gland Abscess

18 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

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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:  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  1 st visit labs: syphillis, Chlamydia, GC, Hep B, Hep C, Pap

24 How about a few Pictures??

25 Imperferate Hymen

26 Mom complains of constant scratching of bottom!!! Scotch tape Test!!!

27 Urethral Prolapse Common Presentation: Vaginal bleeding

28 Genital Trauma

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

30 Lichen Sclerosis

31 Strep Vulvovaginitis Usually very painful!! Sharp demarcation


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