Discharges and Infections in Gynecology ppt

Discharges and Infections in Gynecology

• Instructional objectives include differentiating, diagnosing, and treating various STIs, recognizing history and physical exam needs, and comparing diagnostic tests (pap smear, KOH prep, wet mount).
• Key conditions include Vaginitis, Cervicitis, Bartholin’s Cyst/Abscess, Endometritis, and Pelvic Inflammatory Disease.
• Infection pathways are particularly relevant in gynecology due to the short tract from external to internal sites.
• Assess cervical/vaginal discharge through external inspection, speculum examination, pH testing, wet prep, STD testing, and considering HPV testing.

Cervical Disease and STD Testing

• Nucleic Acid Amplification Test (NAAT) is crucial for identifying STDs.
• Endocervical swabs for GC/Chl and Trich should be performed before bimanual exams to avoid contamination.
• The cervix shows variations; Nabothian cysts and ectropion occur often due to hormonal changes.

Herpes Simplex Virus (HSV)

• HSV is transmitted through skin/mucous contact; genital HSV-1 is rising due to increased oral-genital contact.
• Symptoms include fever, chills, and painful vesicular lesions.
• Primary infections are most symptomatic; future episodes are usually less severe but can still result in shedding.
• Diagnosis often involves culture (PCR for specific types), and management includes oral antivirals like acyclovir.

Syphilis

• Syphilis is caused by Treponema pallidum, with increasing rates reported in the U.S.; primary lesions are typically painless ulcers.
• Diagnosis relies on serology or darkfield examination of chancres.
• Treatment is mainly via Benzathine Penicillin; partners should also be treated.

Bartholin’s Gland Cyst/Abscess

• The Bartholin's glands, located at the 4 and 8 o'clock positions of the vulva, secrete lubricating fluid and can develop cysts or abscesses.
• Cysts are often asymptomatic, while abscesses cause severe pain and require incision and drainage.
• Management includes monitoring asymptomatic cysts, draining symptomatic abscesses, and culture if necessary.

Vaginitis and Vulvovaginitis

• Vulvitis often accompanies vaginitis; both conditions can stem from similar irritants.
• Normal vaginal physiology involves a pH of 4.0-4.5, promoting beneficial flora and defensive against infections.
• Trauma, pH shifts, and decreased immunity can lead to infections like yeast or BV.

Vulvovaginal Candidiasis

• Often caused by Candida albicans; symptoms include pruritis and thick, white discharge.
• Diagnosis involves examination and wet prep showing hyphae.
• Treatments include OTC antifungals and prescription therapies like fluconazole.

Bacterial Vaginosis (BV)

• Represents a shift in normal flora with increased anaerobic bacterial growth; often asymptomatic but may produce a fishy odor.
• Diagnosed based on Amsel Criteria: thin discharge, high vaginal pH, and presence of clue cells.
• First-line treatment includes Metronidazole and Clindamycin.

Trichomonas Vaginalis

• A protozoal infection, presenting with yellow/green discharge and causing vulvar discomfort.
• Diagnosis via wet prep showing motile organisms; treatment involves Metronidazole for both patient and partner.

Cervicitis and PID

• Cervicitis can result from several infections, including Trichomonas and STIs leading to potential upper genital tract infections.
• Gonorrhea and Chlamydia are common causes; both can often present asymptomatically, especially in women.
• Diagnosis usually involves NAAT and clinical examination; high-risk populations should be screened regularly.

Pelvic Inflammatory Disease (PID)

• Diagnosed through specific criteria, including imaging and biopsy.
• Treat with broad-spectrum antibiotics to cover multiple pathogens.
• Hospitalization criteria include severe illness or non-responsiveness to treatment; follow-up is critical to ensure recovery.

This quiz assesses your understanding of the diagnosis, treatment, and laboratory tests related to sexually transmitted infections in gynecology. It covers the differentiation of various vaginal infections as well as the use of diagnostic methods such as pap smears and KOH prep. Test your knowledge on recognizing clinical signs and appropriate treatments.