Sexually Transmitted Diseases in Female
Sexually transmitted diseases affects most ages but it tends to occur in young adults, and most infections are asymptomatic (do not exhibit frank infections symptoms).
Risk factors for STDs include: new partner, more than one current partner, a partner with STD, or a partner who has concurrent partners
- STDs in females is major risk factor for infertility (due to scarring of tubes)
- Any patient diagnosed with an STD should be screened for all other STDs including HIV
Genital Infections are classified into 3 categories:
- Vaginitis (infection of vagina)
- Cervicitis (cervix infection)
- Pelvic Inflammatory Disease (uterus and tubes infection)
Vaginitis
Candidiasis:
- Caused by overgrowth of vaginal fungi
- Risk factors include oral antibiotics, contraceptives and Diabetes
- Causes itchy red external genitalia with thick whitish discharge
- May cause male partner infection (Balanitis) in 10% of cases
- Test: wet mount or culture
- Treatment: 1 dose Diflucan 150mg or vaginal anti fungal cream
Bacterial Vaginosis
- Non STD infection,usually caused by Gardnerella Vaginalis & anaerobes
- Causes vaginal odor, mild grayish thin discharge with small bubbles
- Test: Positive whiff tests and clue cells
- Treatment: Flagyl 500 mg twice daily for 1 week or vaginal metronidazole
Trichomonas Vaginalis
This is STD infection
- Causes discharge, soreness and irritation
- Can cause burning on urination
- Can cause pain with intercourse
Discharge :
- Copious loose or
- Yellow green or
- Bubbly
Treatment: Flagyl 2 gram single dose
Cervicitis
Infection of the cervix or Cervicitis can cause abnormal vaginal discharge, intermenstrual bleed or can be asymptomatic
The diagnosis is confirmed by finding:
- Pus draining from cervix
- Eliciting bleeding when passing a swab into the cervix.
Cervicitis causes are:
A-Chlamydia Trachomatis:
- The most common STD in the USA
- Can be present at with Gonorrhea
- It can cause Urethritis, Cervicitis or PID
- It causes urethral discharge, vaginal discharge & burning on urination
- Diagnosis is made by urine test or pelvic exam and cervix swab
Treatment: Zithromax 1 gram orally
B-Neisseria Gonorrhoeae
- Second most common cause
- It can be asymptomatic
- It causes copious purulent discharge (cervicitis)
- It can cause severe burning on urination with urethral discharge (Urethritis)
- It can cause pharyngitis and rectal infection
- It can cause disseminated infection affecting skin and joints
Diagnosis is made with urine test or cervix swab
Treatment: Rocephin 250 mg single IM injection
Pelvic Inflammatory Disease (PID)
Infection of the lining of the uterus and or the tubes
- It is a major cause of infertility
- Symptoms include lower abdominal or pelvic pain and abnormal vaginal discharge.
- Fever is possible
- Patient may be quite ill
- Multiple bacteria are usually involved with Chlamydia and Gonorrhea being the most common
Diagnosis is made by pelvic exam:
1-The cervix , uterus or tubes are tender
2-Purulent cervix discharge
Treatment:
If very ill with fever —> admit for IV antibiotics
If not ill or in distress:
- Rocephin 250 mg IM+
- Doxycycline orally for 14 days+
- Flagyl orally for 14 days
Indications for hospitalization:
- Pregnancy
- Turbo-ovarian abscess
- High fever/severe illness
- Nausea and vomiting
- Failure of original outpatient treatment
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