Gynecological disorders

How does an IUD work?

-A LARC that is safe, effective, long term. Placed by clinician. -Copper T380A increases uterine and tubal fluid that impair sperm function. Lasts ten years. Failure rate 0.8%. -LNG-IUS releases levonorgestrel which thickens cervical mucus, inhibits sperm, suppresses endometrium. Lasts 5 years. Typical use 0.8%. -Reduces risk of ectopic pregnancy -Decreases blood loss. -Fertility rebounds when discontinued -Does not protect against STIs.

How does nexplanon work?

-It is a LARC-etonogestral -One rod implanted in SQ tissue in upper inner arm along tricep -Effective for 3 years -Vaginal bleeding and spotting are not predictable -Does not protect against STIs -Radiopaque -Typical use failure of 0.05% most effective birth control method.

What are risks of using vaginal spermicides?

-It's not effective in preventing cervical gonorrhea, chlamydia, or HIV -Frequent use can disrupt genital epithelium and can be associated with risk of HIV -Increased risk for UTI in women using a diaphragm and spermicide -Should not be used as a lubricant or microbicide for anal intercourse d/t rectal cell damage.

How does depo-medroxyprogesterone acetate work?

-Long acting contraceptive that is injected. -Dose is 150 ng/ml IM every 3 months -Can be started without waiting for menses -Need a neg pregnancy test before starting and plan repeat pregnancy test 2 weeks after injection -Emergency contraceptive can be given if intercourse 5 days before. -Failure rate 6% in the first year related to returning late for injections

How do you treat the primary episode of genital infection with HSV?

1. Acyclovir > 12 yo: PO 5 xday for 7-10 days. < 12 yo: lower dosing for 3-4 days 2. Initiate treatment within 6 days of onset of lesions can reduce duration and severity of sx. 3. Valacyclovir: PO for 7-10 days. 4. Famiciclovir TID for 7-10 days.

What is used for suppressive therapy for HSV?

1. Acyclovir BID 2. Famiciclovir BID 3. Valacyclovir 500 mg daily or 1000 mg daily if more than 10 occurences a year 4. Discontinue after 1 year to reassess recurrences.

How do you treat recurrent episodes of HSV?

1. Acyclovir PO 5xday or BID for 2-5 days. 2. Famciclovir PO BID for 1 day or PO for 2 days with a different dose. 3. Valacyclovir PO BID for 3 days 4. Acyclovir less effective in the treatment of recurrent vs primary episodes.

What prophylaxis can be used for gonorrhea?

1. After sexual victimization: -Incidence of STI is low -Prepubertal girls are less likely to develop PID -Regular f/u care is usually ensures with parents. Antimicrobial prophylaxis is no longer recommended for this age group. 2. Postpubertal females often seen within 72 hours of sexual victimization. -Ceftriaxone IM single dose -Azithromycin PO single dose AND Metronidazole PO single dose.

What does prevention of secondary sex characteristics look like for transgender patients?

1. Allows time for the patient to decide if they want to move forward with the development of secondary sex characteristics of the desired gender 2. i.e. breast, deep voice 3. must meet criteria to start meds: pervasive and intense gender dysphoria, the dysphoria worsened with puberty, other coexisting comorbidities have been addressed, the adolescent and caretakers are informed and consenting. 4. Medication is managed by endocrine or transgender specialist. 5. Patients will need frequent lab evaluation and bone health assessment 6. Expected SE include mood changes, lack of accrual of bone mass, decreased fertility.

What screening tools are used in the 2nd trimester of pregnancy?

1. Alpha-fetoprotein -Screens for neural tube defects -Serum levels less accurate than amniotic fluid analysis but can be done earlier in pregnancy for initial screen. -High levels may be due to inaccurate pregnancy dates or multiple pregnancies. 2. Fetal anatomy screen, US at 20 weeks to evaluate for fetal anomalies.

What are common causes of GU trauma?

1. Athletic activities 2. MVAs 3. Falls 4. No specific incidence: commonly seen. Can be associated with trauma to intraperitoneal organs.

What education should you provide for BV?

1. Avoid douching 2. Common recurrence 3. Treatment of male partner not recommended. Does not decrease female recurrence 4. Increased risk for PID 5. Pregnancy risk for chorioamnionitis and premature delivery.

What are infectious causes of vulvovaginitis?

1. Bacterial -Group A beta-hemolytic streptococcus -Staph aureus -Haemophilus influenzae -Pneumococcus -Enterococcus -Shigella flexneri -Gardnerella vaginalis -Mycoplasma homis -N gonorrheae -Chlamydia trachomatis 2. Viral: -HSV -HPV 3. parasitic -Enterobius vermicularis -Trichomonas vaginalis 4. Mycotic/fungal: -Candidiasis

What are the risk and precautions of male condoms?

1. Breakage rate is 1-2% 2. Only water based lubricants should be used. Latex breaks down in contact with petroleum based products 3. Latex breaks down over time when exposed to heat.

What are physical exam findings of pregnancy in the first trimester?

1. Breast: fullness/tenderness, nipple tingling/discharge/darkening areola. 2. Abdomen: uterine fundus at symphisis pubis after 12 weeks 3. Pelvic exam: -Softening of uterine isthmus at 6-8 weeks -Bluish hue to cervix/vaginal epithelium at 6-8 weeks (chadwick sign) -Cervical softening (goodell sign) at 6-8 weeks -Increased leukorrhea 4. Weight gain: dependent on prepregnancy weight, approximately 5 lbs. 5. FHR by doppler at 10-12 weeks.

What is the differential diagnosis for gonorrhea?

1. C. trachomatis infection 2. Genital mycoplasma 3. BV 4. Trichomoniasis 5. Complications include PID, epididymitis, or disseminated infection.

What physical exam findings can be found with vulvovaginitis?

1. Can have none 2. Discharge: -White to yellow: chemical, mechanical, or C. trachomatis -Pale yellow to gray green-trichomoniasis -White, thick, cheezy-yeaset -Thin, white, frothy-bacterial vaginosis -Brown, bloody, foul odor-foreign body 3. Genital erythema 4. Lesions 5. Perianal soiling

What is physiological leukorrhea?

1. Can occur with pubertal changes 2. Some benefit form minipads in the underwear to absorb moisture/prevent wetness from staining clothes. 3. Avoid douches and creams.

What is on the differential diagnosis with trichomoniasis?

1. Candidiasis 2. Chemical vaginitis 3. Bacterial vaginosis 4. UTI 5. Poor hygiene 6. Gonorrhea

What are findings in women with gonorrhea?

1. Cervical erythema, friability, and exudate 2. Vaginal wall discharge/erythema 3. Cervical/adnexal tenderness

What is on the differential diagnosis with HSV?

1. Chancre of early syphilis 2. Chancroid 3. Lymphogranuloma venereum, granuloma inguinale 4. Behcet's lesion 5. Excoriation 6. Allergic reaction

What are noninfectious causes of vulvovaginitis?

1. Chemical irritation: bubble bath, powder, detergent, soap, OTC douches 2. Mechanical irritation: tight clothes and nylon underwear 3. Foreign body irritation: toilet tissue, retained tampon, small toys/batteries, hair elastics 4. Trauma/sexual abuse 5. Masturbation 6. Obesity

How do you treat complicated disseminated gonorrhea infection?

1. Children < 45 kg: -Ceftriaxone IV or IM 7 days -Erythromycin base or ethylsuccinate PO for 14 days. 2. Children > 45 kg: -Ceftriaxone IM or IV single dose for 7 days -Azithromycin 1 g orally in single dose. > 8 yo doxycycline for 7 days.

How do you manage uncomplicated gonorrhea infection?

1. Children < 45 kg: -Ceftriaxone sodium IM or IV -Erythromycin base or ethylsuccinate PO for 14 days. 2. Childen > 45 kg: -Ceftriaxone IM single dose -Azithromycin 1g orally. > 8 yo doxycycline for 7 days.

How do you treat neurosyphilis?

1. Children: aqueous crystalline penicllin G q4-6h for 10-14 days. 2. Adults: aqueous crystalline penicllin G IV q4h for 10-14 days or penicillin G procaine IM once daily + probenecid AID PO for 10-14 days.

How do you manage primary, secondary, and early latent syphilis?

1. Children: penicillin G benzathine IM 2. Adults: penicillin G benzathine IM -Those allergic to penicillin can get doxycylicline PO BID for 14 days or tetracycline QID for 14 days.

How do you manage late latent syphilis?

1. Children: penicillin G benzathine IM at 3 single doses administered at 1 week intervals. 2. Adults: penicillin G benzathine IM at 3 single doses at 1 week intervals. -Those allergic to penicillin can get doxycylicline (and not pregnant) PO BID for 4 weeks or tetracycline QID for 4 weeks.

What diagnostic tools are used for genetic abnormalities?

1. Chorionic villus sampling: tissue (villus) sample from fetal placenta at 9-11 weeks gestation. Chromosomal abnormality, usually reserved for women > 35 yo 2. Amniocentesis: collection of amniotic fluid, 15-16 weeks gestation. Karyotype/chromosomal analysis. Inborn errors of metabolism. Confirmatory test with abnormal serum feto protein. 3. Metabolic disease: hemoglobinopathies from DNA analysis.

Which contraceptive methods are less suitable for adolescents?

1. Coitus interruptus: failure 27% 2. Natural family planning: failure rate 12% 3. Cervical cap: difficulties with proper placement. Risk of infection 4. Progestin only mini pill: failure rate 13% among mature adults. Increased risk of ectopic pregnancy if it fails.

What are physical exam findings of pregnancy at the third trimester?

1. Colostrum from breast at 28-40 weeks. 2. Fundus between umbilicus and xiphoid. 28 weeks. 38 weeks. 3. Weight gain: dependent on prepregnancy weight, underweight and normal weight patients should gain 1 lb a week and overweight and obese should gain 0.5 lbs per week. 4. Blood show: impending labor 5. Ruptured membranes: clear or green fluid

What diagnostic tests should be done for syphilis?

1. Dark field microscopic tests or direct fluorescent antibody (DFA) tests. Look for present of spirochetes from scrapings or washings of the primary lesion. Definitive diagnosis. 2. Serologic tests: (presumptive diagnosis) -RPR, VDRL, TRUST, USR. Measures nonspecific antigens. Can do serial testing using the same test to monitor response to treatment. 3. Treponemal tests: FTA-ABS, TP-PA, MHA-TP, TP-EIA, CIA. -Detects specific treponemal antigens. Greater specificity. Usually reactive for life. Useful to distinguish positive from false positive. Used often for primary screening now. 4. There is a high probability of infection in sexually active persons with reactive nontreponemal and treponemal tests. 5. Syphilis screening in early pregnancy and delivery for all women to prevent transplacental transmission.

What are the health benefits of OCP's?

1. Decreased risk of endometrial and ovarian cancer 2. Improved androgen insensitivity 3. Decreased risk of hospitalization for GC-PID 4. Suppresses endometriosis 5. Decreases iron deficiency anemia 6. Improves dysmenorrhea.

What are diagnostic tests for HPV?

1. Diagnosis is usually based on clinical inspection. NO culture is available. 2. Colposcopy to detect cervical lesions. Application of 3-5% acetic acid causes lesions to blanch. Not definitive testing. Refer to gynecology if present. 3. Biopsy of lesions for histologic exam: maybe diagnostic. Rarely indicated 4. DNA probe: may detect asymptomatic HPV infection, not routinely performed.

How do you manage premenstrual syndrome?

1. Diet: -Frequent small meals -Increase intake of complex carbs, protein, fresh fruit, and vegetables. -Vitamin/mineral supplement: some evidence for vitex agnus castus -Limit intake of refined sugar, salt, red meat, alcohol, coffee, tea, and chocolate. 2. Lifestyle -Exercise -Stress management -Address psychosocial needs -Chart symptoms for 2-3 cycles to clarify and treat sx. -Avoid alcohol -Sleep 9 hours a day. 3. Pharmacologic treatment: OCPs.

What are elective abortion options in the 2nd trimester?

1. Dilation and evacuation currettageg (D&E): can do up to 20-24 weeks of pregnancy: -Cervical dilation prior to procedure with osmotic dilators . May add mifepristone or misoprostol to aid dilation. -Conceptus removed via curretage, aspiration, or ring forceps under general anesthesia. Risk of cervical trauma. -Abx recommended before the procedure: doxycycline. 2. Prostaglandin suppository technique: 16-24 weeks of pregnancy. Rarely used. -Cervical dilation with osmotic dilators followed by vaginal suppositories of prostoglandin E. Has largely replaced more controversial intra-amniotic instillation techniques. -20 mg prostoglandin suppositories used q3-4h induces labor and subsequent aboriton in 4-60 hours. -Complications: flu like sx, delivery of live fetus, vaginal bleeding, and retained placenta.

What antibiotics do you use for chlamydia in pregnant women?

1. Doxycycline is CI in pregnancy 2. Treatment with: -Azithromycin PO single dose -Erythromycin base QID for 7 days. -Amoxicillin TID for 7 days.

What are risks of OCPs?

1. Drug interactions: drugs that can reduce CHC effectiveness include abx, antifungals, anticonvulsives, antacids. 2. Drugs that enhance CHC effectiveness: ascorbic acid and co-trimoxazole 3. SE: thrombosis 4. Minor SE: vaginal spotting, nausea, blotting, irritability 5. Doesn't protect against STIs

What is the differential diagnosis for pregnancy?

1. Ectopic pregnancy 2. Incompelte spontaneous abortion 3. Molar pregnancy 4. UTI

What are the external genitalia findings of gonorrhea?

1. Erythema, edema 2. Thick, purulent, greenish yellow discharge (penile or vaginal)

How do you treat chlamydia in children < 45 kg?

1. Erythromycin QID for 7 days

How do you treat chlamydia in infants <6 months old?

1. Erythromycin base or ethylsuccinate QID for 14 days OR Azithromycin PO QD for 3 days 2. 2nd course may be required 3. Association between oral erythromycin and infantile hypertrophic pyloric stenosis has been reported in infants < 6 weeks old. Requires informing parents of potential risks and need for careful follow up.

What are the estrogen-progestin combinations you find in OCPs?

1. Estrogen: ethinyl estradiol and mestranol -Ethinyl estradiol: 1.2-1.4 x stronger than mestranol. z -Ethinyl estradiol is effective at doses as low as 10 ug -Usually select lowest effective estrogen dose 20-35 ug 2. Basic progestins: norethindrone, norethindrone acetate, norethynodrel, ethynodiol diacetate, norgestrel 3. Newer progestins: norgestimate, desogestrel, gestodene 4. Monophasic, biphasic or triphasic combinations: deliver constant or progressively increasing progestin during cycle. 5. Users must remember to take pill everyday

What are the signs and symptoms of trichomoniasis?

1. Females -Are asymptomatic in 25-50% of all cases -Vaginal discharge -Vulvovaginal irritation and hearing -Vaginal odor -Dysuria, urinary frequency, abdominal pain, dyspareunia -Risk of preterm birth and LBW infants 2. Male: -Usually asymptomatic -mild dysuria -itching

What are the signs of the secondary stage of syphilis?

1. Fever 2. Malaise 3. Sore throat 4. Skin rash 5. Hair loss 6. Up to 25% of untreated persons relapse with secondary symptoms in 1 year

What are the signs and symptoms of HPV?

1. Firm bumps in anogenital area 2. Occasional local symptoms: pain, burning, itching, and bleeding. 3. Often asymptomatic.

What are physical exam findings that can be found with HPV?

1. Firm, flesh colored anogenital lesions resembling cauliflower 2. Range in size from a few mm to cm 3. Males: warts on the shaft of the penis, meatus, scrotum, and perianal areas 4. Female: warts usually on the labia and perianal areas 5. Anal genital warts: primarily from anal-receptive intercourse but can be from proximity to genital region

How does monitoring of pap smears for cervical cancer work?

1. First pap smear at 21 yo. Do not get HPV testing until 30 yo. 2. Repeat every 3 years if normal 3. For atypical squamous cells of undetermined significance or low grade squamous intraepithelial lesions repeat in 12 months if age 21-24. 4. For ACUS, positive reflex HPV, age 25+ refer to gynecology for a colposcopy. 5. For ACUS, cannot r/o high grade squamous intraepithelial lesion (SIL) refer to gynecology for colpscopy. 6. For high grade SIL, cervical intraepithelial neoplasia 1, CIN-2-refer to gynecology for a colposcopy 7. Obtain pap smear for suspicious cervical exam.

What are signs and symptoms of pregnancy in adolescents?

1. First trimester: -irregular menses/amenorrhea -GI: N/V -Urinary frequency -Breast tenderness/tingling -Other: HA, vertigo, abdominal cramps 2. Second trimester: -Increased/darkening skin pigmentation -Fetal movement: quickening at 16-20 weeks. -Contractions: braxton hicks 16 weeks to full term 3. Third trimester: -Increased contractions.

What is the differential diagnosis for BV?

1. Foreign body 2. Gonorrhea/chlamydia/trichomoniasis 3. Vulvovaginitis: GAS, shigella organisms 4. Candidiasis 5. Physiologic leukorrhea

How do you manage vulvovaginitis?

1. Foundation of treating childhood vulvovaginitis is improvement of perineal hygiene 2. Nonspecific vaginitis often resolves without intervention 3. Discontinue genital irritants: bubble bath, harsh bath soaps, and laundry detergent. 4. Cotton or cotton lined underwear: avoid tight fitting clothing (tights, leggings, tight pants/jeans, undergarments) 5. Positive cultures suspicious for sexual abuse or sexual activity should be addressed.

What are signs and symptoms and PE findings of GU Trauma?

1. Frank urethral bleeding 2. Hematuria 3. Bluish red mass in perineal area. PE: 1. Hematomas: urethral/scrotal/perineal 2. Periurethral lacerations

What are signs and symptoms of labial adhesions?

1. Generally asymtpomatic 2. Parental concern regarding potential anatomic abnormality 3. Difficulty voiding, general discomfort, pulling sensation. 4. Enuresis: primarily diurnal -Pooling of urine behind adhesion after voiding can occur depending on degree of meatal obstruction. -Results in dribbling of urine throughout the day.

What is the differential diagnosis for primary syphilis?

1. Genital herpes 2. Chancroid, granuloma inguinale, lymphogranuloma venereum 3. Traumatic lesion, excoriation 4. Behcet's lesion

What are the signs and symptoms of chlamydia?

1. Genital tract infection that is often asymptomatic for months-years 2. Abdominal/pelvic pain 3. Dysuria/burning

What meds are used to suppress secondary sex characteristic development?

1. GnRH agonist: leuprolide acetate injection, histrelin acetate SQ implant 2. Progestin-medroxyprogesterone acetate pill or injection, norethindrone pill. 3. Androgen receptor inhibitors: spironolactone pill, cyproterone acetate pill or injection.

What is the differential diagnosis for chlamydia?

1. Gonorrhea 2. Genital mycoplasma 3. Trichomoniasis 4. BV 5. PID

What are the risks that occur with teenage pregnancy?

1. Greater risk of C-section delivery d/t immature pelvic skeletal development. 2. More likely to have a premature or LBW child. -Can prevent with good prenatal management. Encourage good nutrition, folic acid, iron, and calcium. 3. More likely to have threatened abortion, preeclampsia or preterm delivery. 4. Substance use in mother. 5. Domestic violence

How do you manage mild dysmenorrhea?

1. Head to abdomen 2. Exercise 3. Acetaminophen 4. Ibuprofen immediately with onset of pain. q6-8 h. Give with food to avoid GI distress. 5. Well balanced diet 6. Acknowledge symptoms

What is the differential diagnosis for a GU injury?

1. Hemorrhagic cystitis 2. Vaginitis 3. Sexual abuse

What are absolute contraindications for OCPs?

1. History of a clotting disorder 2. Impaired liver function 3. Abnormal vaginal bleeding 4. Pregnancy 5. Estrogen dependent carcinoma Relative CI: 1. Severe HTN 2. Migraine with aura 3. Chronic diseases (i.e. diabetes, heart disease, sickle cell) 4. rheumatologic disorders 5. Smoking cigarettes over 35 yo

Why is screening done at prenatal exams?

1. Identifies potential inherited or acquired defects. 2.There are causes like genetic, enviornmental, and unaccountable. 3. Occurs in 3-5% of infants in the US 4. Risk factors for defect: -Disease: diabetes, thyroid, immuen deficiency or compromise -Age: young, especially younger than 16 yo and older than 25 yo -Previous child with down syndrome, ancephaly, or meningomyelocele

How does the timing for the HPV vaccine work?

1. If it is given at 9-14 yo then you give 2 doses with 6-12 mo apart 2. If it is given at 15-45 yo then you give 3 doses at 0, 2, and 6 months.

What are some risks of depo provera

1. If more than 13 weeks between injections, pregnancy test should be done as a precaution 2. CI: active thrombophlebitis undiagnosed vaginal bleeding, breast malignancy and significant liver disease 3. SE: spotting, weight gain, bloating, HA, mood changes. 4. Risk of decreased bone density. Reversible with cessation. 5. Assess for adequate calcium and vitamin D intake 6. Manufacturer recommends not to be used long term > 2 years unless other measures are inadequate.

What diagnostic tests should be run with dysmenorrhea?

1. If there is suspicion of PID, then a STI screen should be done. 2. Pelvic US for palpable masses or concern for GU abnormality 3. Urine pregnancy: may need to consider ectopic pregnancy or miscarriage if positive.

What is the cause of primary dysmenorrhea?

1. Increased production of uterine prostoglandins, uterine contractions, or ischemia. 2. Ovulation is required for development of primary dysmenorrhea. 3. most common gynecological complaint. 4. 20-90% of adolescent women report dysmenorrhea.

What is the differential diagnosis for labial adhesions?

1. Intersex anomalies 2. Imperforate hymen 3. Genital scarring.

What should we know about emergency contraceptives?

1. It's the use of oral contraceptives within 72 hours of unprotected intercourse 2. Evaluate for pregnancy risk 3. EC will not terminate existing pregnancy 4. Plan B one step is progesterone only. Available OTC 5. Ulipristal cetate, available by Rx only. Taken in one dose. Highly effective and low side effects. 6. The copper IUD can be placed up to 5 days after unprotected sex to prevent pregnancy 7. Schedule of doses form 20 OCPs brands given in 2 doses 12 hours apart can do it. May cause nausea nad vomiting. 8. provide counseling for unintended pregnancy 9. Perform pregnancy test if no menses after 3 weeks 10. Failure of UPA and LNG: 1.8-2.6%. Failure rate of copper IUD is 0.1%.

How do you treat severe dysmenorrhea that is not responsive to NSAIDS alone?

1. Low dose combination of OCPs. 2. Minimum 3-4 cycles before symptom improvement. 3. If symptoms persist after 4 months, then OCPs can be used with NSAIDS. should consider gynecological referral.

How do elective abortions occur in the 1st trimester?

1. Manual vacuum aspiration (MVA): can do up to 10 weeks of pregnancy. -Cannula positioned into uterus with aspiration or suction of conceptus -Low risk of genital injury or complications -Can be done in the office setting -Oral doxycycline should be given 1 hour prior to aspiration -Risks are pain, bleeding, perforation of uterus, and infection. 2. Suction curretage/ vacuum aspiration: can do up to 12-14 weeks of pregnancy: -Cervical dilation 12-24 hours prior to procedure using Laminaria or synthetic osmotic dilators. -Cannula positioned into uterus with suction followed by curretage -Typically anesthesia is used in a surgical suite -Prophylactic abx are indicated: doxycycline 1 hour prior to procedure -Risks: pain, bleeding, perforation of uterus and infection. 3. Medical abortion: up to 10 weeks. -Mifepristone acts as progesterone antagonist -Initial dose in the clinic of mifepristone followed by misoprostol, vaginally or buccaly. 24-48 hours later outside of the clinic. -Risks: pain and excess bleeding.

What physical exam findings can be seen with chlamydia?

1. May be normal 2. Vaginal/penile discharge: yellow/watery 3. Tenderness on bimanual exam.

What are physical findings of dysmenorrhea?

1. Maybe none. Defer pelvic exam in adolescent that is not sexually active with mild dysmenorrhea. 2. Benign abdominal exam when pt is not on menses. On menses, there can be generalized tenderness to the lower abdomen. 3. Bimanual and rectovaginal exams indicated for moderate to severe cases for sexually active patients. 4. Cervical motion tenderness with PID

What does promotion of secondary sex characteristics look like for transgender patients?

1. Meds are used when patient is ready to move forward with secondary sex characteristics of desired gender. 2. Testosterone enanthate injection 3. Testosterone cypionate injection 4. Other testosterone: transdermal gel or patch 5. 17beta-estradiol pill, transdermal patch, injection, Sublingual. 6. Risks: CV concerns, HTN, elevated lipids, decreased insulin sensitivity, decreased bone density, and decreased fertility.

How do you treat BV?

1. Metronidazole PO BID for 7 days. 2g PO single within 48 hours. 2. Alternative treatment: -Clindamycin cream 2% one full applicator intravaginally QD for 7 days -Metronidazole gel one full applicator intravaginally BID for 5 days -Tinidazole 2 g PO QD for 2 days -Tinidazole 1g PO QD for 5 days -Clindamycin PO BID for 7 days

What is the treatment for bacterial vaginosis?

1. Metronidazole for 7 days PO or gel intravaginally for 5 days (adolescents). 2. Clindamycin cream 2% intravaginally for 7 days. 3. Alternative treatments are less effective 4. Pregnant women should be treated for bacterial vaginitis, metrogel or flagyl PO preferred.

How do you manage trichomoniasis?

1. Metronidazole: -Prepubertal TID for 7 days. or higher dose in a single dose PO. -Adolescent: 2g PO single dose or BID for 7 days. -Avoid alcohol during drug treatment and for 24 hours after treatment -During pregnancy: 2g single dose or 7 day treatment. 2. Alternative for adolescents: tinidazole 2 g PO in a single dose. No alcohol 72 hours after. 3. NO sexual activity during treatment 4. Partners should receive concurrent therapy 5. Evaluate for presence of STIs: treat accordingly 6. HIV infected women may need the 7 day course of metronidazole 7. Encourage condom use

Describe spontaneous termination of pregnancy.

1. Miscarriages/spontaneous abortion occurs before 20 weeks of gestation 2. May be complete or incomplete 3. Occurs in 20% of all pregnancies including adolescents. 4. Often associated with genetic abnormality in the fetus.

What is on the differential for HPV?

1. Molloscum contagiosum 2. Chancre of syphilis

What does congenital syphilis look like?

1. Most infectious when untreated mother has primary or secondary syphilis. 2. Stillbirth 3. Neurologic impairment 4. Bone deformity

How do you manage labial adhesions?

1. Mostly reassurance and observation for resolution especially if it is asymptomatic and there's only a partial adhesion. 2. Mechanical lysis not recommended bc high rates or refusion 3. Observation for UTIs 4. If symptomatic or recurrent UTIs or pain is present, can use topical estrogen sparingly twice a day for 2-3 weeks. -Overuse=precocious puberty -Transient hyperpigmentation of labia -Following separation: good hygiene and daily bathing. Topical application of bland creams or petroleum jelly -Inspect vulva on routine WCC to monitor anatomy, hygiene, and sexual development.

What diagnostic tests should be done with gonorrhea?

1. NAAT: Best sensitivity and specificity of any other test. Preferred site is vaginal swab or first void for men. culture is needed with child abuse. Culture is also needed for treatment failure. 2. Screening recommendations: annual for sexually active persons. More frequent for pregnant women and those at risk d/t new, anonymous, or multiple partners and those in communities with high burden of disease. 3. No useful serologic test available to distinguish current from past infection 4. Evaluate for possible concurrent syphilis, hep B, and chlamydia.

What diagnostic testing should be done for chlamydia?

1. NAAT: most sensitive test to screen for this. Specimen from vaginal or urine for asymptomatic women. Urine for males. Cervical for symptomatic women. -Rectal and pharyngeal sites should be done with culture 2. Tissue culture: culture specimen must have epithelial cells to be accurate. -Necessary for suspected child abuse. Culture sent for boys and for extragenital infections in girls. processing takes 2-3 days.

How do you manage moderate-severe dysmenorrhea?

1. NSAID therapy: to inhibit prostogladin synthesis. Naproxen or mefenamic acid. Assess efficacy after 3-4 cycles.

How do you manage HPV?

1. No definitive treatment yet to eradicate it. Palliative treatment is done by removing lesions, symptom relief, and close f/u for recurrences. Unclear if treatment decreased infectivity. 2. Spontaneous resolution in 3 months in 25% of cases. Treatment is optional 3. External visible lesions treatment: for patients that have symptoms, are distressed, or desire treatment. -There are self applying options and physician applying options. 4. Gynecologic referral necessary for cervical warts. 5. Educate regarding safe sex practices.

What are the latent stage signs of syphilis?

1. No lesions 2. Can occur between different stages. 3. Early latent: less than 1 year 4. Late latent more than 1 year

What are screening tools used in the first trimester of pregnancy?

1. Nuchal translucency US and serum hormone evaluation (beta-hCG, PAPP-A) will screen for down syndrome, trisomy 18 and 13 2. Cell free DNA (cfDNA) test; not designed for teens. Better for women > 35 yo. Can screen for down syndrome, trisomy 18 and 13, sex chromosome abnormalities, and microdeletions in the fetus' genetic code. Usually covered by insurance for women under the age of 35.

What are the signs of the primary stage of syphilis?

1. One or more painless lesions 2. Usually on genitalia but can be on the lips, tongue or extremities 3. Chancres are very infectious and resolve in 1-6 weeks. 4. Painless regional lymphadenopathy

What are the signs and symptoms of premenstrual syndrome?

1. Onset of symptoms usually begin within 1 week of menses. 2. Breast tenderness 3. Headaches, muscle aches 4. Weight gain, bloating 5. Mood swings, lethargy, anxiety, irritability, depression 6. Fatigue 7. Appetite changes 8. Lower back pain 9. Loss of concentration 10. Acne 11. Constipation 12. Hot flashes, chills

How do you treat vaginal candidiasis?

1. Oral agent fluconazole. 2. Various topical agents include clotrimazole, miconazole, butoconazole nitrate, terconazole. More effective than nystatin.

What are signs and symptoms of dysmenorrhea?

1. Pain usually starts with flow or several hours later or may precede flow by several hours to 2 days 2. Crampy/spasmodic pain, primarily in the lower abdominal area. May radiate to the inner thighs or lower back. 3. Systemic symptoms: -Nausea/vomiting/diarrhea -Lightheadedness/dizziness -Fatigue or general malaise

What is primary dysmenorrhea?

1. Pain with the menstrual cycle with no pelvic abnormality. 2. Common in adolescents 3. Usually develops 6-12 months after menarche 4. Ovulation is necessary.

What is secondary dysmenorrhea?

1. Pain with the menstrual cycle with underlying pelvic abnormality. 2. Congenital anomalies (septate uterus) 3. Cervical stenosis or strictures 4. Cysts, tumors, or ovary or uterus 5. Endometriosis, adenomyosis 6. PID

What are the signs and symptoms of HSV?

1. Painful genital lesions 2. Burning with urination 3. Tender, swollen lymph nodes 4. Fever, malaise

How do you do a GU exam on a prepubertal female?

1. Pelvic exam is usually deferred. Visual inspection only 2. Exploratory procedure under anesthesia may be needed for vaginal bleeding and should be referred.

What is the differential diagnosis for vulvovaginitis?

1. Physiologic leukorrhea: thin, clear, or white discharge 2. UTI 3. Dermatologic disorders: psoriasis, seborrheic dermatitis, or atopic dermatitis.

How is parasitic vaginitis treated?

1. Pinworms are treated with mebendazole, pyrantel pamoate or albendazole in a singe dose which is repeated in 2 weeks. Treat household members and wash linens and trim fingernails. 2. Trichomonas vaginalis are treated with metronidazole for 7 days. Partner must be treated.

What is the differential diagnosis for secondary syphilis?

1. Pityriasis rosea 2. Psoriasis 3. Condylomata acuminata 4. Drug sensitivity reactions 5. Infectious mononucleoisis 6. lupus erythematous

What are clinician applied options for treating HPV?

1. Podophyllin 10-25% in compound tincture of benzoin (CI in pregnancy) -Weekly treatment up to a total of 6 applications. Must be washed off in 1-4 hours. Recurrence is common. 2. Trichloroacetic acid 80-90%: not for children. -Apply topically followed by careful drying and application or talc or baking soda. Weekly treatments for up to 6 applications. Causes local discomfort 3. Liquid nitrogen or cryotherapy 4. Laser surgery, cryosurgery, excision, electrodessication: reserved for extensive, severe and or resistant cases.

What are self treatment options for HPV?

1. Podophyllum resin solution or gel 0.5% (CI in pregnancy and not tested on children) -Apply topically BID for 3 days. First application needs to be done in the office to make sure it's done right. Treatment can be repeated up to 4 cycles with 4 day rest periods between. 2. Imiquimod 5% cream: -Wash 3 times per week for 6-10 hours, then wash off. Max 16 weeks.

What is the differential diagnosis for premenstrual syndrome?

1. Pregnancy 2. Dysmenorrhea 3. Premenstrual dysphoric disorder.

How do you treat vaginitis caused by foreign body?

1. Prepubertal: attempt irrigation. Warm saline via small feeding tube. 2. Postpubertal: -Pelvic exam to locate object -Moisten cotton tip applicator or forceps for removal. -Unsuccessful irrigation or anxious child should be referred for exam under general anesthesia.

What are the physical findings of syphillis?

1. Primary: chancres. 2. Secondary: -Generalized polymorphic maculopapular rash: classic if palms and soles are included. -Round to oval, reddish brown, copper colored lesions -Lymphadenopathy, arthralgia, fever, malaise, sore throat, HA, splenomegaly -Hypertrophic popular lesion of vulva/anus-condylomata lata 3. Latency: no lesions 4. Tertiary: 15 or more years after chancre. Can see aortitis, gummous changes of bone, skin or viscera. 5. Neurosyphilis

What are the signs and symptoms and PE findings of BV?

1. Profuse vaginal discharge with fishy odor 2. May be asymptomatic 3. Vaginal/cervical discharge: thin, white-gray, malodorous, coats the vaginal wall. 4. Itching, swelling, redness of external genitalia.

What diagnostic tests should be made with GU injuries?

1. Referral necessary if extensive injury is suspected. 2. Imaging of urinary tract.

What is the differential diagnosis for dysmenorrhea?

1. Reproductive system malformations 2. Endometriosis 3. PID 4. Psychogenic problems: abuse, depression. 5. Ovarian cyst 6. Ectopic pregnancy

What are the risks of a diaphragm?

1. Requires technical skill/comfort with body for correct placement 2. Must be kept in place for 6 hours postintercourse 3. Spermicidal agent must be used for subsequent intercourse 4. SE: UTI and vaginitis

How do you prevent gonorrhea?

1. Risk reduction education 2. Condom use 3. Routine screening for sexually active adolescents. 4. Test for reinfection at 3 months after treatment for adolescents.

How do you prevent syphilis?

1. Screen partners of positive patients. 2. Patient education/discussion of sexuality, contraception, and STIs as part of adolescent WCC 3. Counsel regarding safe sex practices including abstinence and proper use of condoms 4. Treatment of sexual contacts 5. Report each case to the local health authorities for contact investigation. 6. all women should be screened early in pregnancy and at delivery 7. F/u treated cases: -primary and secondary 6-12 mo. -Latent: 6, 12, 24 months, -coinfections with HIV, primary and secondary: 3, 6, 9, 12, and 24 months. -coinfections with HIV, latent: 6, 12, 18, 24 months -Jarisch-Herxheimer reaction is a sepsis like reaction to an abx when endotoxins are released from the death of harmful organisms. This requires immediate medical evaluation.

How do you treat secondary dysmenorrhea?

1. Should begin PID treatment immediately if indicated. 2. Gynecological referral if persistent dysmenorrhea after PID treatment or if pelvic pathology persists.

What are the physical exam findings of labor?

1. Stage 1: effacement and dilatation of cervix to fully dilated 2. Stage 2: pushing and delivery of the fetus 3. Stage 3: separation and delivery of the placenta.

What are physical exam findings of pregnancy at the second trimester?

1. Stretch marks on abdomen and breast possible 2. Fundus midway between pubic symphisis and umbilicus by 14-16 weeks at umbilicus at 20-22 weeks 3. Fetal heart ones by fetoscope at 20 weeks 4. Weight gain: dependent on prepregnancy weight. Underweight and normal weight patients should gain 1 lb per week and overweight and obese should gain 0.5 lbs per week.

What are the signs of tertiary stage syphilis?

1. Symptoms can recur years after initial untreated infections. Rarely seen among adolescents. 2. Cardiac or gummatous lesions can appear 3. Neurosyphilis: can be asymptomatic and can occur at any stage. Shows up as fever, HA, photophobia, meningismus, CN palsies, and less frequently confusion, delirium and seizures.

What are the failure rates of male condoms?

1. Theoretical 3% 2. Actual 18% due to nonuse or misuse 3. Combined with spermicide: no more effective than lubricated condoms in protecting against STIs and HIV. Higher cost, shorter shelf life.

What are findings in men with gonorrhea?

1. Thick, creamy penile discharge 2. Enlarged, tender prostate 3. Tender swelling above the testis.

What are the physical exam findings that can be seen with labial adhesions?

1. Thin, flat membrane of variable length found midline extending from clitoris to posterior fourchette when labia major are generally separated. 2. Complete fusion: entire vestibule covered. may see pinpoint opening 3. Partial fusion: much of genital structure visible.

What diagnostic tests should be run for herpes?

1. Tissue culture: sensitivity varies with stage of disease. Highest with vesicular lesions. Lowest with recurrent infections and crusted lesions. Results are available in 1-5 days. 2. PCR-DNA probe test of choice for lesions and CSF specimen. Good sensitivity and specificity and available in 1-3 days. 3. Direct fluoresent ab/enzyme immunoassay: more rapid than culture but less sensitive 4. PCR: very sensitive. Useful to detect shedding in clinical trials. 5. Serologic testing: Show rise in ab within a few weeks of infection and persists indefinitely. Can be useful to confirm diagnosis. Can let us know past infection, atypical infection, or previous negative culture. Can also be used if a partner has HSV and it determines the person's susceptibility to infection.

What education should you provide for HSV management?

1. Topical acyclovir is no longer recommended bc of limited benefit. 2. Sitz bath may provide relief 3. Education: recurrences, viral shedding, abstinence when lesions are present, use of condoms during sexual activity

how do you manage chlamydia?

1. Treat with abx based on age 2. Identify, examine, test, and treat any sexual contacts 3. Evaluate for other STIs: gonorrhea, syphilis etc. 4. Retest for infection in 3 months after treatment for adolescents 5. Partners must be treated to avoid reinfection.

What causes syphillis?

1. Treponema pallidum-thin motile spirochete. 2. Transmitted: sexual contact, transplacental, direct contact with infected tissue. 3. At risk are MSM

What should we know about disseminated gonococcal infection (DGI)?

1. Typically present with one or both of two syndromes. Polyarthralgias, tenosynovitis, dermatitis triad, and purulent arthritis. 2. Acute stage of tenosynovitis illness includes fever, chills, and general malaise. Diminishes as illness progresses. Those with purulent arthritis present without systemic symptoms. 3. Diagnosis based on history, phsyical, and labs 4. Risk factors: recent menstruation, pregnancy, or immediate postpartum. Congenital or acquired complement deficiencies, or SLE. 5. Treat with IV abx. Purulent arthritis requires drainage 6. NAAT testing for genital sites, pharynx, rectal, synovial fluid and skin lesions.

What diagnostic testing should be done for vulvovaginitis?

1. UA for presence of WBCs 2. Tape test for pinworms 3. Saline prep for wet mount -Clue cells: BV -Presence of WBC: vaginitis or cervicitis -Trichomonads -Candidiasis: budding yeast, hyphae 4. KOH prep -Hyphae or budding yeast-candidiasis -whiff test-fishy odor of BV 5. pH testing of vaginal secretions. -pH< 4.5 is normal or candidiasis -pH> 4.5 is BV or trichomonas

What should we know about the vaginal contraceptive ring?

1. Uses ethinylestradiol/etonogestrel (monthly) and ethinyl estradiol/segesterone (yearly) 2. Inserted ring must remain in place for 3 weeks, then removed for 1 week. The monthly ring is replaced with a new ring, but the yearly ring can be inserted for up to 13 cycles. 3. User must learn how to place and check for ring 4. May cause increase in normal leukorrhea 5. Failure rate: 0.5% theoretical. 9% with typical use.

what should we know about the transdermal contraceptive patch?

1. Uses ethinylestradiol/norelegestromin 2. Wear one patch for 1 week. Repeat with new patch weekly for 2 more weeks. 3. Patch must be correctly applied to dry skin and site rotated 4. Failure rate may be higher in women who weigh > 198 lbs 5. May cause rash d/t adhesive tape.

What are the signs and symptoms of vulvovaginitis?

1. Vaginal discharge 2. Genital discomfort/itching 3. Dysuria/burning 4. Erythema/edema of vulva or vagina 5. Vaginal odor

What are the physical exam findings of trichomoniasis?

1. Vaginal discharge: frothy, light yellow to gray-green, musty odor with a pH> 4.5 2. Pelvic exam: evidence of vaginitis, cervicitis, punctate hemorrhage known as "strawberry cervix". Erythema, edema, and pruritis of external genitalia may be present. 3. Males generally asymptomatic.

What diagnostic tests can be used with suspicion of BV?

1. Vaginal secretions: -pH> 4.5 -KOH 10% mixed with vaginal discharge: release amine "fishy odor" whiff test. -Saline wet mount: clue cells, epithelial cells covered in bacteria, obliterating the nucleus -Culture available: sometimes helpful with frequent recurrent often expensive.

What are the signs and symptoms of gonorrhea?

1. Varies by site and gender. Asymptomatic in 10-40% of males and 50-80% of females. 2. Vaginal or penile creamy discharge 3. Perineal discomfort 4. Menstrual irregularity 5. Frequent, urgent, painful urination 6. Rectal pain/itching 7. Sore throat 8. FEver, malaise, chills.

What are the physical findings of HSV?

1. Vesicular/ulcerated lesions on the genital tract, perineum, mouth, lips, and pharynx 2. Genital, perianal erythema and/or edema 3. Cervical friability, discharge. 4. Lymphadenopathy 5. Primary HSV rare complications include aseptic meningitis, encephalitis, proctitis in patients having anal sex and extragenital lesions.

How do you do a GU exam on a pubescent female?

1. Visual inspection of external genitalia, pelvic exam if symptoms of abdominal pain 2. Vaginal swab for GC and CT 3. Wet mount and KOH testing with vaginal pool secretion.

What are possible causes of premenstrual syndrome?

1. Vitamin deficiency (inconsistent evidence) 2. Fluid retention 3. Steroid hormone fluctuation 4. Alteration in serotinergic neuronal mechanisms 5. Inappropriate prostaglandin activity.

What diagnostic testing is indicated with trichomoniasis?

1. Wet mount of vaginal secretions or spun urine sediment: presence of motile trichomoniasis 2. NAAT, DNA hybrid probes, positive rapid antigen test, PCR analysis 3. Trichomonads may also be seen on pap smears and UA 4. Culture (less accurate)

How are female condoms used?

1. Worn by the woman 2. Available OTC 3. Packaged with a lubricant 4. Can be inserted up to 8 hours before intercourse 5. Failure rates: typical use is 21%.

What are the risk factors for domestic violence?

1. Young or immature adolescent parents 2. Minimal education 3. Financial stress 4. Lack of social support 5. Unplanned or unwanted pregnancy 6. Unrealistic expectations of parenting. Kids are more at risk of abuse when: 1. premature 2. Perception as "different/bad". Has a difficult temperament 3. Congenital defect or malformation.

What causes HPV?

1. a small DNA virus with more than 100 subtypes. -Type 6 and 11 usually causes genital warts. -16 and 18 are the most oncogenic 2. Primary mode of transmission is skin to skin contact, sexual abuse should be considered in pubertal child. It is also passed through bathing and diaper changing. 3. Genital HPV can be as high as 40% among sexually active female adolescents. 4. Most infections are transient and clear spontaneously within a few years.

What surgical interventions are available for male-> female?

1. breast augmentation 2. Penectomy 3. Orchiectomy 4. Vaginoplasty 5. Facial feminization 6. Voice surgery 7. Thyroid cartilage reduction 8. hair reconstruction 9. Laser hair removal

What diagnostic tests should be done with pregnancy?

1. hCG 7-10 days after conception 2. Blood test for pregnancy: more expensive, takes longer to get results. Positive 7-10 days after conception. hCG can be quantified and used for tracking miscarriage or ectopic pregnancy. 3. Cervical culture: GC and CT screen 4. Serology: syphilis, hep B, blood type/Rh factor, CBC, rubella, HIV, glucose screen in 3rd trimestser 5. BP check 6. UA and culture 7. Pelvic ultrasound

How do you manage GU trauma?

1. urethral/vulvar trauma: -mild bruising, superficial laceration: treat with ice pack, sitz bath, and analgesics. -blunt or penetrating trauma: surgical intervention 2. testicular trauma: surgical referral 3. Suspected renal injury: referral 4. Penetrating injury: immediate surgical exploration

How is a diaphragm used?

A diaphragm is a female barrier contraceptive method. -It is a thin latex dome with flexible ring with spermicide applied for vaginal insertion prior to intercourse. It's positioned iwth posterior rim on the posterior fornix and anterior rim behind pubic bone. A cervical cap is a smaller, thimble size cup that is fitted to cover the cervix. -Requires pelvic exam for proper fitting of appropriate size. -Failure rate among adolescents is 10-25%

What antibiotics do you use for uncomplicated chlamydia?

Antibiotic treatment for uncomplicated genital tract infection: 1. Adoelscents: azithromycin PO in single dose or doxycycline PO BID 7 days 2. Alternative therapy: -erythromcyin PO QID for 7 days -erythromycin ethylsuccinate QID for 7 days -levofloxacin for 7 days -ofloxacin BID 7 days

What diagnosis is indicated with a clinical syndrome characterized by vaginal symptoms, primarily in sexually active adolescents/adults. Often sexually transmitted but can occur outside of sexual activity. Results from replacement of normal vaginal flora with high concentrations of anaerobes--G vaginalis and M. hominis. Transmission is often sexual but recurrences can be nonsexual. Incidence is unknown.

Bacterial vaginosis

Which is the most common STI in the US with primary sites of infection being the genital tract, cornea, and respiratory system. It is an obligate intracellular bacteria. Prevalence is mostly among adolescent females.Complications include conjunctivitis, endometriosis, salpingitis, perihepatitis, acute/chronic PID, epididymitis, reactive arthritis triad for males. It can be spread mother to fetus and present as conjunctivitis or pneumonia. Screening is recommended for all women younger than 25 yo, pregnant women, MSM with rectal intercourse, and young men in prevalent areas.

Chlamydia trachomatis.

What diagnosis is indicated with an acute infectious process primarily involving the genital tract, anorectum, throat, and ophthalmic epithelium. N. gonorrhea is a gram negative diplococci that cause this. Women < 25 yo are at the highest risk. Other risk factors include previous infection, other STIs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use. It is associated with sexual abuse. People at high risk should be screened.

Gonorrhea

Which diagnosis is indicated with the most common symptomatic viral reproductive tract infection in the US. Characterized by epithelial warts/tumors of the mucous membrane and skin?

HPV

What is the difference between HSV 1 and 2?

HSV1: less common source of genital herpes, usually. Not always. Site includes face and skin above the waist. HSV2: primary source of genital herpes affecting skin below the waist.

What diagnosis is common in adolescents and includes clusters of painful lesions of the genital tract, perineum, mouth, lips or pharynx. It is a large DNA virus. Primary transmission is through sexual contact and direct contact with open lesions. Transplacental transmission can occur. It is rare in prepubertal children unless there is child abuse. Symptoms can be severe and persist in immunosuppressed individuals.

Herpes simplex virus.

What diagnosis is indicated with a generally benign fusion of labial minor. Can be a result from tissue irritation and hypoestrogenization of the labia minora. Sources of irritation include trauma, superficial infection, poor hygiene (damp skin), sexual abuse, and female genital cutting. It is rarely present at birth and occurs around 2 months old. Can occur any time up until menarche. Most common between 3 months-6 years.

Labial adhesions.

How does combined hormonal contraceptives work?

OCPs, transdermal contraceptive patch, and vaginal contraceptive ring works by -preventing ovulation -increasing viscosity of cervical mucus, inhibiting sperm penetration -Alters endometrium to resist implantation

What diagnosis is indicated with a cluster of symptoms, physical, cognitive, and behavioral, that occur in the 2nd half of the menstrual cycle (last week of luteal phase). Usually resolves with onset of menses. Symptoms exist over several cycles and disrupt activities.

Premenstrual syndrome.

Which diagnosis is indicated with a contagious systemic infectious disease characterized by 3 progressive stages. 1. Primary stage: painless chancres on skin or mucous membranes at the site of exposure 2. Secondary stage: between 1-2 months after inoculation. Characterized by skin rash, cutaneous lesions, lymphadenopathy, fever, HA, malaise, anorexia, sore throat, muscle pain, and weight loss. 3. latent stage: no lesions. Early latent is less than 1 year and late latent is over 1 year. 4. Tertiary stage: multisystem involvement that may occur years after primary infection including aoritis or gummatous changes of the skin, bone or viscera. -Neurosyphillis can occur at any time during infection especially in those who are HIV positive. -Congenital syphillis is transplacental transmission from infected mother to fetus

Syphillis

How are vaginal spermicides used?

They are topical creams, jellies, foams, suppositories, and films used to prevent pregnancy. Used alone or in combination with condoms. -Made of active spermicidal agent: nonoxynol-9 or octoxynol-9 -Failure rate is 6% -Need to wait 10 min after using products to have sex.

Which diagnosis is indicated by a common STI of the genital tract that is caused by T. vaginalis, a flagellated protozoan. It is transmitted primarily through sexual contact. Presence in prepubertal children should alert practitioner to sexual abuse. Often associated with other STIs like gonorrhea or chlamydia. Increases susceptibility to other STis.

Trichomoniasis

What diagnosis is indicated with perineal inflammation or infection of the vulva or vagina often associated with vaginal discharge, odor, itching, and irritation. Can be noninfectious or infectious.

Vulvovaginitis