Gynecologic Infections and Preventive Care
What this domain tests
This domain tests syndromic diagnosis of vaginitis, empirical treatment of pelvic inflammatory disease, partner management, and preventive care including vaccination and cancer screening.
Core rules
- Bacterial vaginosis. Amsel criteria: three of four - homogeneous discharge, pH >4.5, clue cells, positive whiff test. Treat with metronidazole 500 mg twice daily for 7 days; partners are not treated.
- Candidiasis. Vulvar pruritus with thick discharge; azoles are effective. Recurrent disease needs 6 months of suppressive therapy and evaluation for diabetes.
- Trichomonas. Motile organisms on wet mount; metronidazole 2 g single dose; treat partners.
- PID. Minimum criteria: cervical motion tenderness, uterine tenderness, or adnexal tenderness. Treat empirically: ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily plus metronidazole 500 mg twice daily for 14 days. Remove an IUD only if there is no improvement.
- Chlamydia and gonorrhea. Nucleic acid amplification testing; azithromycin 1 g or doxycycline for 7 days for chlamydia; ceftriaxone for gonorrhea. Test partners and retest at 3 months.
- Syphilis. Benzathine penicillin G 2.4 million units IM; penicillin is also the only proven regimen for preventing congenital syphilis.
- Prevention. HPV vaccination before sexual debut; cervical screening, mammography, and blood pressure checks per national programs.
Worked example
A 22-year-old has 4 days of pelvic pain, discharge, and cervical motion tenderness. Treat for PID immediately with ceftriaxone, doxycycline, and metronidazole; test for chlamydia and gonorrhea; treat her partner; review in 72 hours and retest at 3 months.
Traps
Treating the partner of a woman with bacterial vaginosis; withholding PID treatment until culture results return; missing syphilis in pregnancy; advising metronidazole plus alcohol without explaining that the disulfiram reaction is rare.