Vagina/Cervix

Vaginitis

Vagina is typically acidic pH < 4.5

Bacterial vaginosis - pH > 4.5

• • Gardnerella vaginalis ➔ clue cells (vaginal epithelium covered with bx)

  • Positive whiff test (10% KOH ➔ amine odor)

  • TX with metronidazole

Trichomoniasis - pH > 4.5

• • Trichomonas vaginalis (flagellated protozoan) ➔ frothy, purulent/foul odor

  • Cervicitis ➔ strawberry cervix

  • TX with metronidazole

Vaginal yeast infection - pH 4-4.5

• • Candida albicans ➔ cottage cheese discharge

  • Pseudohyphae on KOH

  • TX with topical azole/nystatin/PO fluconazole

    • Pregnant: topical imidazole clotrimazole or miconazole

Chlamydia

• Chlamydia trachomatis ➔ purulent, bloody, odorless

• CAN'T BE SEEN ON LIGHT MICROSCOPY/GRAM STAIN

  • Gram-negative intracellular with cytopasmic inclusion bodies on Giemsa stain

  • Can infect eyes, GU, lungs

    • LGV (Lymphogranuloma venereum) - painless genital ulcers and b/l inguinal LN swelling

• NAAT is test of choice

  • TX with PO azithro (if pregnant) or doxycycline

    • TX partner too

Gonorrhea

• Neisseria gonorrhoeae ➔ purulent discharge

• Gram-negative, intracellular, diplococci

• Can disseminate ➔ polyarthralgias, tenosynovitis, gonococcal arthritis

• NAAT is test of choice

• Tx with Ceftriaxone 500mg IM and doxycycline 100mg PO BID x7d (azithro if pregnant)

  • Gentamicin 240mg IM and azithromycin 2g PO if allergic to cephalosporin

  • TX partner too

Syphilis

• Treponema pallidum ➔ painless ulcer

• Spirhochete

• Weeks later ➔ diffuse maculopapular rash on trunk, palms and soles

• Darkfield microscopy or PCR or direct fluorescent antibody (DFA) of lesions

• Nontreponemal tests (RPR, VDRL) followed by treponemal tests enzyme immunoassay (EIA) or FTA-ABS

• TX with Penicillin G benzathine IM

  • Penicillin G IV for neurosyphilis