Vaginal Infections and Bartholin's Glands Abnormalities
Hx: Sexually active female, menses, douching, use of lubricants such as petroleum jelly, ABx
Sx - Thin, gray discharge; prominent vaginal odor, minimal inflammation, NO PRURITUS.
Dx - pH > 4.5; Positive amine test; Positive saline microscopy (clue cells)
Tx - Oral metronidazole 500mg PO BID x 7days.
Hx - ABx, corticosteroid therapy, diabetes, oral contraceptive use, pregnancy, immunodeficiency, use of vaginal oils
Sx - Pruritus, Erythema, Edema, Satellite Pustules, White curd-like discharge
Dx - Normal pH (3.8-4.2), KOH prep (ID budding yeasts and hyphae), culture if on refractory treatment
Tx - Topical antifungal - Miconazole/clotrimazole/terconazole; Oral antifungal - fluconazole (diflucan 150mg); Preventive measures - avoid bubble bath, avoid douching, avoid vaginal oils, wear cotton undergarments, careful hygiene; Recurrent Tx: Use topical or oral agent monthly after menses, oral medication weekly x 12 weeks, or oral meds daily.
Hx - Sexually active, Highly contagious
Sx - Increased urine frequency, dysuria, dyspareunia, erythema, pruritus, yellow-green frothy discharge, punctate cervical hemorrhages
Dx - pH > 4.5; Pap smear; Saline prep (ID motile organisms); culture
Tx - Metronidazole (Flagyl) PO 2g x 1; must also treat sexual partner
Bartholin Gland Cyst
Sx - Pain, swelling, palpable mass
Dx - Clinical
Tx - Drainage, sitz bath, Surgx (marsupialization)
Bartholin Gland Abscess
Hx - exposure to Chalmydia, Gonorrhea, Coliform, anaerobic bacteria
Sx - Fever, pain, swelling, erythema, fluctuant mass, purulent discharge
Dx - Clinical
Tx - Drainage, Abx - Doxycycline 100mg BID plus metronidazole 500mg BID; Surgx if req'd (marsupialization)