Urogenital Tract Infections and Vulvovaginal Disorders
What you must know
Differentiate vaginitis by pattern: bacterial vaginosis (thin gray discharge, clue cells, pH >4.5, fishy amine odor), vulvovaginal candidiasis (thick white discharge, pruritus, pseudohyphae, normal pH), and trichomoniasis (frothy yellow-green discharge, motile trichomonads, pH >4.5). Understand recurrent BV and recurrent candidiasis management, and that vaginitis is not always infectious (atrophic vaginitis, desquamative inflammatory vaginitis).
Know urinary tract infection: uncomplicated cystitis (dysuria, frequency, no systemic signs) vs pyelonephritis (fever, flank pain) vs complicated UTI. Understand asymptomatic bacteriuria (treat in pregnancy and before urologic procedures, not routinely otherwise). Know common uropathogens (E. coli, Klebsiella, Proteus, Enterococcus) and antibiotic principles.
Vulvar disorders: lichen sclerosus (white plaques, pruritus, increased squamous cell carcinoma risk), lichen planus, contact dermatitis, and vulvar intraepithelial neoplasia. Understand sexually transmitted infections and partner management.
Traps
Treating asymptomatic bacteriuria in nonpregnant patients is a classic wrong answer. Confusing BV with candidiasis - BV is not treated with antifungals. Missing lichen sclerosus as a cause of chronic vulvar itch, or attributing all discharge to infection.
Rule of thumb
"pH and discharge pattern narrow the diagnosis; confirm before treating recurrent symptoms."
Worked example: A pregnant patient with a positive urine culture but no symptoms. Treat - pregnancy is the exception to the "don't treat asymptomatic bacteriuria" rule.