Gynecologic Infectious Disease and Family Planning
Domain 8 - Gynecologic Infectious Disease and Family Planning
This domain tests syndromic management of vaginal discharge and PID, plus WHO Medical Eligibility Criteria for contraception. The exam rewards exact regimens, partner treatment and correct MEC category.
Core rules
- Bacterial vaginosis (Amsel): three of four - homogeneous discharge, pH >4.5, positive whiff test, clue cells. Treat with metronidazole 500 mg twice daily for 7 days.
- Vulvovaginal candidiasis: fluconazole 150 mg single dose, or topical imidazole; not sexually transmitted.
- Trichomoniasis: metronidazole 2 g single dose, and treat the partner.
- PID minimum criteria: cervical motion, uterine or adnexal tenderness. Outpatient regimen: ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily plus metronidazole 500 mg twice daily for 14 days.
- WHO MEC categories: 1 no restriction, 2 benefits outweigh risks, 3 risks usually outweigh benefits, 4 unacceptable risk.
- Category 4 for combined pills: smoker ≥35 years with ≥15 cigarettes/day, migraine with aura, current breast cancer, VTE or ischaemic heart disease, major surgery with immobilisation.
- Emergency contraception: copper IUD up to 5 days (most effective), levonorgestrel 1.5 mg within 72 hours, ulipristal within 120 hours.
- GBS screening at 35–37 weeks; intrapartum penicillin prophylaxis.
Worked example
A 38-year-old who smokes 20 cigarettes daily and has migraine with aura requests combined oral contraceptives. Both smoking ≥15/day at ≥35 years and migraine with aura are category 4, so the pills are refused. Offer a progestin-only method, copper or levonorgestrel IUD, or condoms, and document the counselling.
Traps
Skipping partner treatment in trichomoniasis; diagnosing candidiasis from pH alone; prescribing combined pills in migraine with aura; giving antibiotics routinely before IUD insertion.