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Vaginitis

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s/s trich
pruritis, dysuria, frothy d/c, strawberry cervix, erythematous vulva, 50% asymptomatic
s/s candida
pruritis, thick curdy d/c, vulva erythematous c possible lesions fissures, no odor
s/s BV
fishy odor (esp after sex); irritation; 50% asymptomatic; frothy homogenous d/c,
trich microscope
trichomonads, WBC loaded, pH >4.5
candida microscope
pH<4.5, hyphae, mycelia
BV microscope
clue cells, dec'd or absent lactobacili, no inc WBC, small G+ cocci on stain
Dx BV
3/4: whiff test, homogenous d/c, clue cells, pH>4.5
Dx Trich
wet mount (50% sensitive): WBC loaded, lactobacilus present, pH > 4.5
Culture is more sensitive
Dx candida
symptoms (itching, burning, d/c) PLUS wet mount: hyphae, buds, poss inc'd wbcs, normal pH
candida--what would you prescribe in pregnancy?
miconazole, cream or suppository PV
BV tx in preg
metronidazole, gel or PO
trich tx in preg
metronidazole, PO
Flagyl (aka metronidazole)
cheap, treats BV & trich in pregnancy, avoid in 1st tri unless benefits outweigh risks, AVOID ETOH, may cause candida infection

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